title: Factors influencing cortical silent period: optimized stimulus location, intensity and muscle contraction.
abstract: Inhibitory silent period (SP) is a transient suppression of voluntary muscle activity after depolarization of representative motor neuronal populations following transcranial magnetic stimulation (TMS). Our aim was to evaluate and present an optimal protocol for the measurement of SP by (1) determining the impact of muscle activation level and stimulus intensity (SI) on the duration of SP, and, (2) studying the relationship between motor evoked potential (MEP) and SP, using targeted stimulus delivery. Single magnetic pulses were focused on the optimal representation area of the thenar musculature on primary motor cortex. We utilized real-time 3D-positioning of TMS-evoked electric field on anatomical structures derived from individual MR-images. The SI varied from 80% to 120% of individual resting motor threshold (MT). Muscle activation levels varied from 20% to 80% of the maximal voluntary contraction (MVC). Contralateral SP lengthened significantly with increasing SI independent of target muscle activation. The peak amplitude of the MEP was affected by SI and force. Latency and duration of the MEP were practically unaffected by SI or force. Focal stimulation at 110-120% MT and approximately 50% MVC (with only negligible need for control) provides most stable and informative SP. MEP should be included in SP as the error from marking the onset diminishes. This study provides a guideline for the consistent measurement of SP, which is applicable when using navigated or traditional TMS.
authors.affiliation: Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland. laura.saisanen@kuh.fi
authors.forename: Laura
authors.initials: L
authors.lastname: Säisänen
authors.forename: Eriikka
authors.initials: E
authors.lastname: Pirinen
authors.forename: Selja
authors.initials: S
authors.lastname: Teitti
authors.forename: Mervi
authors.initials: M
authors.lastname: Könönen
authors.forename: Petro
authors.initials: P
authors.lastname: Julkunen
authors.forename: Sara
authors.initials: S
authors.lastname: Määttä
authors.forename: Jari
authors.initials: J
authors.lastname: Karhu
mesh_terms: D000328:Adult; D001931:Brain Mapping / Q000379:methods; D004574:Electromagnetic Fields; D004576:Electromyography / Q000379:methods; D019054:Evoked Potentials, Motor / Q000502:physiology* / Q000528:radiation effects; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000033:anatomy & histology / Q000502:physiology* / Q000528:radiation effects; D009119:Muscle Contraction / Q000502:physiology* / Q000528:radiation effects; D018482:Muscle, Skeletal / Q000294:innervation / Q000502:physiology; D009433:Neural Inhibition / Q000502:physiology* / Q000528:radiation effects; D009482:Neurophysiology / Q000379:methods*; D011712:Pyramidal Tracts / Q000502:physiology / Q000528:radiation effects; D011930:Reaction Time / Q000502:physiology; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation / Q000379:methods*