title: Inter- and intraobserver variability in motor mapping of the hotspot for the abductor policis brevis muscle.
abstract: BACKGROUND
  For accuracy in navigated transcranial magnetic stimulation (nTMS), determination of the hotspot location of small hand muscles is crucial because it is the basis for the resting motor threshold (RMT) and, therefore, its spatial resolution. We investigated intra- and interobserver differences of hotspot mapping to provide evidence for the reproducibility of this method.Ten subjects underwent nTMS motor mapping of the hotspot for the abductor pollicis brevis muscle (APB) three times. The first two sessions were performed by the same examiner; the third mapping was performed by a different examiner. Distances between the first and second mappings (intraobserver variability) and between the second and third mappings (interobserver variability) were measured.
  
  
  RESULTS
  Intraobserver variability had a mean of 8.1 ± 3.3 mm (limits of agreement (LOA) 1.7 to 14.6 mm), whereas mean interobserver variability was 10.3 ± 3.3 mm (LOA 3.8 to 16.7 mm). Concerning RMT, CCC was 0.725 (95% CI: 0.276; 0.914). The mean variability in the same cortical depth was measured as 5.7 ± 3.3 mm (LOA -0.7 to 12.2 mm) for intraobserver and 9.2 ± 3.3 mm (LOA 2.7 to 15.8 mm) for interobserver examinations. When evaluating the RMT, CCC was 0.709 (95% CI: 0.244; 0.909).
  
  
  CONCLUSIONS
  Overall, intraobserver variability showed higher reliability than interobserver variability. Our findings show that we can achieve good reliability in hotspot determination, ranging within the calculated precision of the system.
authors.affiliation: Department of Neurosurgery, Klinikum rechts der Isar, München, Germany. Sandro.Krieg@lrz.tum.de.
authors.forename: Nico
authors.initials: N
authors.lastname: Sollmann
authors.forename: Theresa
authors.initials: T
authors.lastname: Hauck
authors.forename: Thomas
authors.initials: T
authors.lastname: Obermüller
authors.forename: Alexander
authors.initials: A
authors.lastname: Hapfelmeier
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meyer
authors.forename: Florian
authors.initials: F
authors.lastname: Ringel
authors.forename: Sandro M
authors.initials: SM
authors.lastname: Krieg
mesh_terms: D000328:Adult; D001931:Brain Mapping; D005260:Female; D006225:Hand / Q000294:innervation*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018482:Muscle, Skeletal / Q000294:innervation*; D015588:Observer Variation; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D055815:Young Adult