title: rTMS reveals premotor cortex dysfunction in frontal lobe epilepsy.
abstract: OBJECTIVE
  Studies of motor cortex excitability provided evidence that focal epilepsies may alter the excitability of cortical areas distant from the epileptogenic zone. In order to explore this hypothesis we studied the functional connectivity between premotor and motor cortex in seven patients with frontal lobe epilepsy and seizure onset zone outside the premotor or motor cortex.
  
  
  METHODS
  Low-frequency subthreshold repetitive transcranial magnetic stimulation was applied to the premotor cortex and its impact on motor cortex excitability was measured by the amplitude of motor-evoked potentials in response to direct suprathreshold stimulation of the motor cortex.
  
  
  RESULTS
  Stimulation of the premotor cortex of the non-epileptogenic hemisphere resulted in a progressive and significant inhibition of the motor cortex as evidenced by a reduction of motor evoked potential amplitude. On the other hand, stimulation of the premotor cortex of the epileptogenic hemisphere failed to inhibit the motor cortex. The reduced inhibition of the motor cortex by remote areas was additionally supported by the significantly shorter cortical silent periods obtained after stimulation of the motor cortex of the epileptogenic hemisphere.
  
  
  CONCLUSIONS
  These results show that the functional connectivity between premotor and motor cortex or motor cortex interneuronal excitability is impaired in the epileptogenic hemisphere in frontal lobe epilepsy while it is normal in the nonepileptogenic hemisphere.
authors.affiliation: Department of Neurology, University Innsbruck, Innsbruck, Austria. wolfgang.loescher@i-med.ac.at
authors.forename: Wolfgang N
authors.initials: WN
authors.lastname: Löscher
authors.forename: Judith
authors.initials: J
authors.lastname: Dobesberger
authors.forename: Christoph
authors.initials: C
authors.lastname: Szubski
authors.forename: Eugen
authors.initials: E
authors.lastname: Trinka
mesh_terms: D000328:Adult; D004569:Electroencephalography / Q000706:statistics & numerical data; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology / Q000601:surgery; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D009433:Neural Inhibition / Q000502:physiology; D009434:Neural Pathways / Q000503:physiopathology; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D015899:Tomography, Emission-Computed, Single-Photon; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome