SY1.3. Probing the pathophysiology of movement disorders with transcranial magnetic stimulation

Abstract

Transcranial magnetic stimulation (TMS) is a widely-used noninvasive brain stimulation method for research in the field of neurology, psychiatry, and rehabilitation. TMS can be used to study connectivity and therefore help to shed light on brain networks. This mode of noninvasive brain stimulation is particularly useful to study brain regions relevant to movement, as stimulating the primary motor cortex results in motor-evoked potential (MEP)s, which can be useful for interpreting the effects of various brain regions on the motor cortex. Connectivity among the primary motor cortex and other movement-relevant regions can be studied by using a paired- or multiple-pulse technique. This is possible by assessing the effects of a pre- conditioning stimulus on the conditioning-test pair or a conditioning stimulus on the test pulse. TMS can also be used in conjunction with electroencephalography (EEG), magnetoencephalography (MEG) or imaging tools such as functional magnetic resonance imaging (fMRI) or positron emission tomography (PET) to further assess TMS-induced changes. Combining these techniques can enable researchers to obtain spatial or temporal information of the effects of TMS on the brain. Movement in healthy human subjects has been studied using TMS, and information obtained from these studies has been useful in understanding which brain regions are relevant in producing movement. Furthermore, there are various TMS measures of the motor cortex that reflect different aspects of cortical excitability. Some examples are short and long intracortical inhibition (SICI and LICI), intracortical facilitation (ICF), short- and long- afferent inhibition (SAI and LAI), transcallosal inhibition, premotor cortex inhibition, etc. TMS has also been used to study movement disorders such as Parkinson’s disease, dystonia, essential tremor, and Huntington’s disease. While TMS still has limited use in the clinical realm, it has provided a wealth of data in our understanding of movement disorders. In this talk, I will give an overview of TMS studies that probe the physiology of normal human movement and also discuss those focusing on movement disorders. I will also review limitations of TMS and the findings of TMS studies to date, and briefly discuss the need for future studies.