1. Volume 92, Issue 2, Pages 134-144 (December 2010)
Non-invasive preoperative localization of primary motor cortex in epilepsy surgery by navigated transcranial magnetic stimulation 
Laura Säisänen, Mervi Könönen, Petro Julkunen, Sara Määttä, Ritva Vanninen, Arto Immonen, Leena Jutila, Reetta Kälviäinen, Juha E. Jääskeläinen, Esa Mervaala 
Epilepsy Research 
Volume 92, Issue 2, Pages (December 2010)
DOI: /j.eplepsyres
Copyright © 2010 Elsevier B.V. Terms and Conditions

2. Figure 1
Quantification of the mapping intensity. In the middle stimulation setup including TMS coil, EEG cap and goggles with reflecting balls for localizing. The infra-red camera is placed on the ceiling. 3D image of the brain and EMG-responses are shown on the screens. At first, the patient's head is registered to the MR images with a registration pen pointing out ear tragus bilaterally and nasion as well as nine points on the head surface (upper left corner). Thereafter both hemispheres are shortly stimulated with the TMS coil oriented perpendicularly to the central sulcus or using the 45° angle in parasagittal plane to localize the optimal stimulation site exhibiting the highest MEP-response (lower left corner). At that site the coil is rotated to optimize the coil orientation (upper right corner). On that stimulation location and orientation the resting motor threshold is determined as the lowest stimulation intensity eliciting a MEP of 50μV or greater for at least 5 out of 10 consecutive stimuli (Rossini et al., 1994; Rossini and Rossi, 2007) using the aiming tool (lower right corner).
Epilepsy Research  , DOI: ( /j.eplepsyres )
Copyright © 2010 Elsevier B.V. Terms and Conditions

3. Figure 2
nTMS mapping (n=8) and fMRI mapping (n=6) of M1 in the patients with intractable epilepsy evaluated for surgery of lesions close or within the presumed M1 in MRI. The patients are indicated according to their numbers in Table 1, with exclusion of the two children (7 and 8) in whom MEPs were not successfully elicited. The optimal cortical stimulation sites by nTMS at M1 for evoking MEPs at APB or TA (patient 4) muscles are shown bilaterally in all 8 adult patients. The optimal nTMS stimulation sites are indicated by red dots in the lesional hemispheres and by green dots in the healthy hemispheres. In 4 patients (1, 2, 3 and 9), the optimal sites were located symmetrically on the presumed precentral gyrus as indicated by the hand knob in MRI. In 2 patients (5 and 6), the site producing MEP with maximal amplitude by nTMS in the lesional hemisphere was located anteriorly to the precentral gyrus indicated by the hand knob. In patient 10 with focal cortical dysplasia, the optimal nTMS stimulation sites were bilaterally anterior to the precentral gyrus. The fMRI activation sites for the hand and foot motor paradigms in the lesional hemisphere are shown to the right for the 6 patients (2, 3, 4, 5, 9 and 10) studied. The fMRI and nTMS locations were on the precentral gyrus in 4 patients (2, 3, 4 and 9) whereas in 2 patients (5 and 10) the optimal nTMS sites were located one gyrus anterior to the fMRI activation site. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of the article.)
Epilepsy Research  , DOI: ( /j.eplepsyres )
Copyright © 2010 Elsevier B.V. Terms and Conditions

4. Figure 3
nTMS mapping of hand motor areas in seven lesional hemispheres. In the MRI images the patients’ brain are viewed from above as seen during the nTMS study, with the right hemisphere to the right. All stimulation sites are shown in dots. Turquoise dots indicate no motor response from the muscles recorded by EMG. Red dots indicate muscle responses at 110% motor threshold (MT). In patients 6 and 9, stimulations sites at 120% MT are indicated, and in patient 10 at 100% MT. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of the article.)
Epilepsy Research  , DOI: ( /j.eplepsyres )
Copyright © 2010 Elsevier B.V. Terms and Conditions

5. Figure 4
nTMS mapping of the left motor leg area adjacent to focal cortical dysplasia in patient 4. Orange dots indicate the stimulation sites. EDB: extensor digitorum brevis (blue); QF: quadriceps femoris (orange); GC: gastrocnemius (pink); TA: tibialis anterior (yellow); SOL: soleus (light yellow); TFL: tensor fascia latae (green). MT was determined at TA. At 120% MT (left), muscle responses were obtained from all the registered muscles. At 100% MT (right), the area eliciting responses was smaller and no responses were obtained from QF or TFL. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of the article.)
Epilepsy Research  , DOI: ( /j.eplepsyres )
Copyright © 2010 Elsevier B.V. Terms and Conditions