Protocol for motor and language mapping by navigated TMS in patients and healthy volunteers; workshop report

Sandro M. Krieg*, Pantelis Lioumis, Jyrki P. Mäkelä, Juha Wilenius, Jari Karhu, Henri Hannula, Petri Savolainen, Carolin Weiss Lucas, Kathleen Seidel, Aki Laakso, Mominul Islam, Selja Vaalto, Henri Lehtinen, Anne-Mari Vitikainen, Phiroz E. Tarapore, Thomas Picht

*Corresponding author for this work

Research output: Contribution to journalReview Articlepeer-review

73 Citations (Scopus)

Abstract

Introduction: Navigated transcranial magnetic stimulation (nTMS) is increasingly used for preoperative mapping of motor function, and clinical evidence for its benefit for brain tumor patients is accumulating. In respect to language mapping with repetitive nTMS, literature reports have yielded variable results, and it is currently not routinely performed for presurgical language localization. The aim of this project is to define a common protocol for nTMS motor and language mapping to standardize its neurosurgical application and increase its clinical value. Methods: The nTMS workshop group, consisting of highly experienced nTMS users with experience of more than 1500 preoperative nTMS examinations, met in Helsinki in January 2016 for thorough discussions of current evidence and personal experiences with the goal to recommend a standardized protocol for neurosurgical applications. Results: nTMS motor mapping is a reliable and clinically validated tool to identify functional areas belonging to both normal and lesioned primary motor cortex. In contrast, this is less clear for language-eloquent cortical areas identified by nTMS. The user group agreed on a core protocol, which enables comparison of results between centers and has an excellent safety profile. Recommendations for nTMS motor and language mapping protocols and their optimal clinical integration are presented here. Conclusion: At present, the expert panel recommends nTMS motor mapping in routine neurosurgical practice, as it has a sufficient level of evidence supporting its reliability. The panel recommends that nTMS language mapping be used in the framework of clinical studies to continue refinement of its protocol and increase reliability.

Original languageEnglish
Pages (from-to)1187-1195
Number of pages9
JournalACTA NEUROCHIRURGICA
Volume159
Issue number7
DOIs
Publication statusPublished - 2017
MoE publication typeA2 Review article in a scientific journal

Keywords

  • Brain tumor
  • Epilepsy surgery
  • Language
  • Motor
  • Preoperative mapping
  • Transcranial magnetic stimulation

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