Cortico-cortical and motor evoked potentials to single and paired-pulse stimuli: An exploratory transcranial magnetic and intracranial electric brain stimulation study.
Paired-pulse (PP) paradigms are commonly employed to assess in vivo cortical excitability using transcranial magnetic stimulation (TMS) to stimulate the primary motor cortex and modulate the induced motor evoked potential (MEP). Single-pulse cortical direct electrical stimulation (DES) during intracerebral EEG monitoring allows the investigation of brain connectivity by eliciting cortico-cortical evoked potentials (CCEPs). However, PP paradigm using intracerebral DES has rarely been reported and has never been previously compared with TMS.



The work was intended (i) to verify that the well-established modulations of MEPs following PP TMS remain similar using DES in the motor cortex, and (ii) to evaluate if a similar pattern could be observed in distant cortico-cortical connections through modulations of CCEP.



Three patients undergoing intracerebral EEG monitoring with electrodes implanted in the central region were studied. Single-pulse DES (1-3 mA, 1 ms, 0.2 Hz) and PP DES using six interstimulus intervals (5, 15, 30, 50, 100, and 200 ms) in the motor cortex with concomitant recording of CCEPs and MEPs in contralateral muscles were performed. Finally, a navigated PP TMS session targeted the intracranial stimulation site to record TMS-induced MEPs in two patients.



MEP modulations elicited by PP intracerebral DES proved similar among the three patients and to those obtained by PP TMS. CCEP modulations elicited by PP intracerebral DES usually showed a pattern comparable to that of MEP, although a different pattern could be observed occasionally.



PP intracerebral DES seems to involve excitatory and inhibitory mechanisms similar to PP TMS and allows the recording of intracortical inhibition and facilitation modulation on cortico-cortical connections. Hum Brain Mapp 37:3767-3778, 2016. © 2016 Wiley Periodicals, Inc.
Department of Functional Neurology and Epileptology, Hospices Civils De Lyon, 59 Boulevard Pinel, Bron, 69675, France. sebastien.boulogne@chu-lyon.fr.|Lyon's Research Neuroscience Center, Institut National De La Santé Et De La Recherche Médicale U1028, Centre National De La Recherche Scientifique 5292, Lyon, France, CH Le Vinatier, Bâtiment 452, 95 Boulevard Pinel, 69675 Bron, France. sebastien.boulogne@chu-lyon.fr.|Lyon 1 University, 43 Boulevard Du 11 Novembre 1918, Villeurbanne, 69100, France. sebastien.boulogne@chu-lyon.fr.
Sébastien
0000-0001-8681-7369
S
Boulogne
Department of Functional Neurology and Epileptology, Hospices Civils De Lyon, 59 Boulevard Pinel, Bron, 69675, France.
Nathalie
N
Andre-Obadia
Laboratory of Clinical Neurophysiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece.
Vasilios K
VK
Kimiskidis
Department of Functional Neurology and Epileptology, Hospices Civils De Lyon, 59 Boulevard Pinel, Bron, 69675, France.|Lyon's Research Neuroscience Center, Institut National De La Santé Et De La Recherche Médicale U1028, Centre National De La Recherche Scientifique 5292, Lyon, France, CH Le Vinatier, Bâtiment 452, 95 Boulevard Pinel, 69675 Bron, France.|Lyon 1 University, 43 Boulevard Du 11 Novembre 1918, Villeurbanne, 69100, France.|Department of Clinical neurosciences, CHU Vaudois, 46 Rue Du Bugnon, Lausanne, 1011, Switzerland.
Philippe
P
Ryvlin
Department of Functional Neurology and Epileptology, Hospices Civils De Lyon, 59 Boulevard Pinel, Bron, 69675, France.|Lyon's Research Neuroscience Center, Institut National De La Santé Et De La Recherche Médicale U1028, Centre National De La Recherche Scientifique 5292, Lyon, France, CH Le Vinatier, Bâtiment 452, 95 Boulevard Pinel, 69675 Bron, France.|Lyon 1 University, 43 Boulevard Du 11 Novembre 1918, Villeurbanne, 69100, France.
Sylvain
S
Rheims
D000328:Adult; D002540:Cerebral Cortex / Q000502:physiology* / Q000503:physiopathology; D000069279:Drug Resistant Epilepsy / Q000503:physiopathology; D004558:Electric Stimulation; D000069280:Electrocorticography; D004828:Epilepsies, Partial / Q000503:physiopathology; D019054:Evoked Potentials, Motor / Q000502:physiology*; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000502:physiology; D050781:Transcranial Magnetic Stimulation; D055815:Young Adult
cortical excitability; cortico-cortical evoked potentials; epilepsy; motor cortex; motor evoked potentials; paired-pulse; transcranial magnetic stimulation