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. 2025 Jun 12:09727531251340157.
doi: 10.1177/09727531251340157. Online ahead of print.

Optimising Paediatric Brain Mapping with Single-Pulse Transcranial Magnetic Stimulation: A New Protocol and Insights

Rudraksh Banga  1 , Aliya Mufti  1 , Suman Jain  1 , Sheffali Gulati  2 , Kanwal Preet Kochhar  1 , Md Iqbal Alam  3 , Sanjay Wadhwa  4 , Kapil Sikka  5 , Rohit Saxena  6
Affiliations

Optimising Paediatric Brain Mapping with Single-Pulse Transcranial Magnetic Stimulation: A New Protocol and Insights

Rudraksh Banga et al. Ann Neurosci. .

Abstract

Background: Single-pulse paradigms of transcranial magnetic stimulation (TMS) have been used to understand cortical excitability and reorganisation.

Purpose: This study aims to develop a protocol for mapping of the primary motor cortex (M1) using single-pulse TMS in children.

Methods: A 11×11 manual grid was created around the hotspot of abductor pollicis brevis (APB). Motor-evoked potential (MEP) amplitude was recorded from 41 sites around the hotspot of APB and analysed.

Results: Maximum MEP amplitude was recorded from the hotspot that reduced as distance increased. Heat maps generated were consistent among the participants.

Conclusion: In children, 41 single-pulse TMS stimulations with interstimulus interval of two seconds provide reliable information about motor maps. This procedure will aid in understanding cortical reorganisation in children with neurodevelopmental disorders.

Keywords: Motor cortex maps; cerebral palsy; cortical reorganisation; motor-evoked potential; transcranial magnetic stimulation.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1.
Figure 1.. Schematic Drawing (A) Shows the Steps Involved in Localising the Primary Motor Cortex (M1), Hand Motor Area. (B) The Placement of the 11×11 cm Grid with Eight Mentioned Cardinal Directions on It Marked with Total 41 Stimulation Sites Including the Hotspot (1 cm of Spacing Between Each Selected Point) for Single-Pulse TMS Brain Mapping Procedure, and (C) The Placement as well as Manual Motion of the Handheld Figure-of-8 Coil.
Figure 2.
Figure 2.. (A) Representation of the Aligned MEP Data According to the Stimulation Sites (Total 41 Sites) on the Manually Designed Grid Plotted on x-y Plane. H = Hotspot (Origin); S(n) = Stimulation Site, Where n Is an Integer. (B) Chronology of the Directions Followed in Which the TMS Coil Was Moved to Stimulate the Marked Sites in Part (A).
Figure 3.
Figure 3.. A Detailed 2D Contour Heat Map of the Four Participants. The Colour Ranges from Dark Blue to Light Yellow Indicate MEP Amplitude from Not Recordable or Least Values to Maximum.
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