Potentiels évoqués moteurs obtenus par stimulation corticale en double choc: techniques et interprétations

Abstract

The technique of motor evoked potentials (MEP) obtained with single and double magnetic stimulation of the motor cortex in man has considerably improved over the past decade. We present the techniques and parameters involved in double magnetic stimulation for clinical purposes. The conditioning-test design is used to study modifications in the amplitudes of the muscular responses to the "test" shock, recorded on the first dorsal interosseus muscle. Enhanced amplitudes of conditioned responses indicate facilitation, reduced response inhibition. The effects vary according to the shock intensity, the delay between shocks and the position of the conditioning coil. The latter may be located at the same place as the test shock (to test interneural circuitry related to pyramidal tract), on the hand area opposite the test shock (to test interhemispheric influences), or over the cerebellar area contralateral to the test side (to test the effect of cerebellar stimulations over the motor cortex). When the coils were located on the same cortical hand area there was facilitation when the intensities were both set at the threshold with an interstimulus interval (ISI) between 1 and 2.5-3 ms. At conditioning shock intensities below the threshold and the test shock 150% above, inhibition occurred at ISI 1-5 ms followed by facilitation at ISI 15-35 ms. When the intensities of both shocks were 150% above threshold, there were two clear cut individual responses at ISI above 10 ms; facilitation was recorded at ISI 15-35 ms, and inhibition between 55 and 255 ms. When the conditioning coil was located on the opposite hand area from the test shock (conditioning shock intensity supramaximal, test shock intensity above the threshold), ISI 1-5 ms facilitation occurred followed by inhibition up to ISI 30 ms. When the conditioning shock (intensity supramaximal) was located on the cerebellar area contralateral to the test side (intensity above the threshold), inhibition occurred at ISI 5 ms. Double magnetic stimulations delivered over the same cortical area reflect facilitatory and inhibitory influences over the pyramidal tract controlled by interneurons, i.e., these tests investigate the intrinsic circuitry of the motor strip. Double magnetic stimulations delivered on each motor area study interhemispheric influences mediated by the corpus callosum, which are facilitatory and inhibitory. Double magnetic stimulations delivered on the cerebellar area demonstrates inhibitory influences over the contralateral cerebral motor cortex.