title: Efficacious use of a cap shaped coil for transcranial magnetic stimulation of descending motor paths.
abstract: We report another technique of transcranial magnetic stimulation (TMS) for exciting the originating cells of the descending corticospinal tract. A cap shaped TMS coil has been described for simultaneously exciting muscles in all four extremities. This TMS coil is useful for monitoring the functional integrity of the descending motor paths during spinal cord surgery, because information regarding the integrity of both the left and right sides of the spinal cord motor paths can be obtained concurrently. Despite the improved design of the cap coil, careful placement is required for achieving bilateral spinal cord motor responses. Cortical mapping was used to identify the optimum scalp foci for the muscles studied. The cap coil must overlap these foci to simultaneously elicit compound muscle action potentials (CMAPs) in all four extremities. Increasing TMS stimulation intensity will increase the magnitude of the acquired CMAPs responses without significantly changing latency.
authors.affiliation: Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Aglio
authors.forename: Karl H
authors.initials: KH
authors.lastname: Kraus
authors.forename: Sukumar
authors.initials: S
authors.lastname: Desai
authors.forename: Rafael
authors.initials: R
authors.lastname: Romero
authors.forename: Marcela
authors.initials: M
authors.lastname: Ramirez
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Levy
authors.forename: Laverne D
authors.initials: LD
authors.lastname: Gugino
mesh_terms: D000200:Action Potentials; D004867:Equipment Design; D019054:Evoked Potentials, Motor; D006801:Humans; D011712:Pyramidal Tracts / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation