title: Direct recording of the output of the motor cortex produced by transcranial magnetic stimulation in a patient with cerebral cortex atrophy.
abstract: OBJECTIVE
  To examine the descending motor activity evoked by transcranial magnetic stimulation (TMS) in a chronic alcoholic patient with a slight atrophy of the peri-central cortex and compare with that observed in neurologically intact subjects.
  
  
  METHODS
  EMGs from the first dorsal interosseous (FDI) muscle, and descending activity from an electrode implanted in the high cervical epidural space for relief of pain were recorded after TMS of the hand area of motor cortex. A figure-of-8 coil was used to induce either a posterior-anterior (PA) or a latero-medial (LM) flow across the central sulcus.
  
  
  RESULTS
  In intact subjects, LM stimulation evoked the earliest volley, which we termed a D wave. This was followed by later, presumed I waves at intervals of about 1.5 ms. At a stimulus intensity of 120% resting threshold (RMT), up to 5 I waves were seen. PA stimulation rarely evoked D waves at intensities up to 120% RMT, but 3 or 4 I waves were visible in all subjects. The patient had an increased resting threshold, and the descending volleys were dominated by a D wave. I waves were unclear, with two possible small peaks at 5.5 and 7.2 ms.
  
  
  CONCLUSIONS
  The lack of I waves in the patient was probably due to an impairment of interneuronal circuitry in the context of the brain damage related to chronic alcohol abuse, and is consistent with a trans-synaptic origin of the I waves in humans. The intact D wave is consistent with the assumption that the D wave represents direct stimulation of the axons of intact corticospinal neurones in the subcortical white matter. The patient's increased RMT reflects the fact that usually multiple descending volleys are needed to discharge resting spinal motoneurones.
authors.affiliation: Institute of Neurology, Università Cattolica, L.go A. Gemelli 8, 00168 Rome, Italy. vdilazzaro@rm.unicatt.it
authors.forename: V
authors.initials: V
authors.lastname: Di Lazzaro
authors.forename: A
authors.initials: A
authors.lastname: Oliviero
authors.forename: F
authors.initials: F
authors.lastname: Pilato
authors.forename: E
authors.initials: E
authors.lastname: Saturno
authors.forename: M
authors.initials: M
authors.lastname: Dileone
authors.forename: M
authors.initials: M
authors.lastname: Meglio
authors.forename: B
authors.initials: B
authors.lastname: Cioni
authors.forename: C
authors.initials: C
authors.lastname: Colosimo
authors.forename: P A
authors.initials: PA
authors.lastname: Tonali
authors.forename: J C
authors.initials: JC
authors.lastname: Rothwell
mesh_terms: D000437:Alcoholism / Q000503:physiopathology; D000787:Angina Pectoris / Q000503:physiopathology / Q000628:therapy; D001284:Atrophy; D002540:Cerebral Cortex / Q000503:physiopathology*; D004558:Electric Stimulation; D004567:Electrodes, Implanted; D004574:Electromagnetic Fields; D004576:Electromyography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D011712:Pyramidal Tracts / Q000503:physiopathology; D013116:Spinal Cord / Q000503:physiopathology