title: Motor evoked potentials from masseter muscle induced by transcranial magnetic stimulation of the pyramidal tract: the importance of coil orientation.
abstract: BACKGROUND
  Reliable recording of motor evoked potentials (MEPs) of the masseter muscle by transcranial magnetic stimulation (TMS) has proved more difficult than from facial or intrinsic hand muscles. Up to now it was unclear whether this difficulty was due to methodological and/or anatomical reasons.
  
  
  METHODS
  The mechanism of pyramidal cell activation in masseter MEPs was investigated by using magnetic and electric transcranial stimulation. Analysing the effect of magnetic coil positioning and orientation over the scalp, and scrutinizing the masseter recording technique to avoid compound motor action potential (CMAP) contamination from facial muscles, an optimized method of masseter MEPs was developed.
  
  
  RESULTS
  In particular, an antero-lateral inducing current orientation in the stimulating coil, approximately paralleling the central sulcus, proved clearly more effective for the masseter muscles than the postero-lateral orientation (P=0.005) found optimal for intrinsic hand muscles. The thus evoked masseter MEPs by transcranial magnetic stimulation (TMS) were found to be identical in shape, amplitude and latency as those evoked by transcranial electric stimulation (TES), evidencing a direct rather than trans-synaptic activation of the pyramidal cells.
  
  
  CONCLUSIONS
  We conclude that in TMS evoked MEPs of masseter muscles, the direct stimulation of the pyramidal tract is more easily achieved than the trans-synaptic activation, which is in contrast to the intrinsic hand muscles. We hypothesize that the presynaptic projections to pyramidal cells of the masticatory muscles are less abundant than in hand muscles, and are therefore less accessible to trans-synaptic stimulation.
authors.affiliation: Department of Neurology, University Hospital, Inselspital, 3010, Bern, Switzerland.
authors.forename: A G
authors.initials: AG
authors.lastname: Guggisberg
authors.forename: P
authors.initials: P
authors.lastname: Dubach
authors.forename: C W
authors.initials: CW
authors.lastname: Hess
authors.forename: C
authors.initials: C
authors.lastname: Wüthrich
authors.forename: J
authors.initials: J
authors.lastname: Mathis
mesh_terms: D000200:Action Potentials / Q000502:physiology; D000328:Adult; D001921:Brain / Q000502:physiology; D004558:Electric Stimulation / Q000379:methods; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008406:Masseter Muscle / Q000502:physiology*; D009431:Neural Conduction; D011712:Pyramidal Tracts / Q000502:physiology*; D011930:Reaction Time / Q000502:physiology; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation; D014276:Trigeminal Nerve / Q000502:physiology