title: Pseudo-bilateral hand motor responses evoked by transcranial magnetic stimulation in patients with deep brain stimulators.
abstract: OBJECTIVE
  In 3 of 5 patients with dystonia and bilaterally implanted deep brain stimulating electrodes, focal transcranial magnetic stimulation (TMS) of one motor cortex elicited bilateral hand motor responses. The aim of this study was to clarify the origin of these ipsilateral responses.
  
  
  METHODS
  TMS and electrical stimulation of corticospinal fibres by the implanted electrodes were performed and the evoked hand motor potentials were analysed.
  
  
  RESULTS
  In comparison with responses elicited by contralateral motor cortex stimulation, ipsilateral responses were smaller in amplitude (3.0+/-1.4 versus 5.8+/-1.5 mV), had shorter peak latencies (first negative peak: 20.9+/-0.8 versus 25.1+/-0.4 ms) and were followed by a shorter-lasting silent period (46+/-4 versus 195+/-35 ms). Ipsilateral responses following TMS had similar peak latencies to responses elicited subcortically by deep brain stimulation (DBS) (20.4+/-0.9 ms).
  
  
  CONCLUSIONS
  Hand motor responses ipsilateral to TMS result from a subcortical activation of corticospinal fibres, via the implanted electrode in the other hemisphere, secondary to currents induced by TMS in subcutaneous wire loops that underlie the magnetic coil. Studies of TMS in patients with DBS have to take this potential source of confounding into account.
authors.affiliation: Department of Neurology, Charité, Campus Virchow-Klinikum, Humboldt University Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. andrea.kuehn@charite.de
authors.forename: A A
authors.initials: AA
authors.lastname: Kühn
authors.forename: T
authors.initials: T
authors.lastname: Trottenberg
authors.forename: A
authors.initials: A
authors.lastname: Kupsch
authors.forename: B-U
authors.initials: BU
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D000328:Adult; D004421:Dystonia / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D004558:Electric Stimulation / Q000295:instrumentation; D004599:Electric Stimulation Therapy / Q000295:instrumentation* / Q000379:methods; D004567:Electrodes, Implanted; D004574:Electromagnetic Fields; D004576:Electromyography; D019054:Evoked Potentials, Motor; D005260:Female; D007839:Functional Laterality; D005917:Globus Pallidus / Q000503:physiopathology; D006225:Hand / Q000294:innervation / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology; D009046:Motor Neurons / Q000502:physiology; D011712:Pyramidal Tracts / Q000503:physiopathology; D011930:Reaction Time; D020651:Ventral Thalamic Nuclei / Q000503:physiopathology