Accurate Coil Positioning is Important for Single and Paired Pulse TMS on the Subject Level

Annika A. de Goede* (Corresponding Author), Esther M. ter Braack, Michel J.A.M. van Putten

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Function-guided navigation is commonly used when assessing cortical excitability using transcranial magnetic stimulation (TMS). However, the required accuracy, stability and the effect of a change in coil positioning are not entirely known. This study investigates the accuracy of function-guided navigation for determining the hotspot. Furthermore, it evaluates the effect of a change in coil location on the single and paired pulse excitability measures: motor evoked potential (MEP) amplitude, TMS evoked potential (TEP) and long intracortical inhibition (LICI), and of a change in coil orientation on LICI. Eight healthy subjects participated in the single pulse study, and ten in the paired pulse study. A robot-guided navigation system was used to ensure accurate and stable coil positioning at the motor hotspot as determined using function-guided navigation. In addition, we targeted four locations at 2 mm and four at 5 mm distance around the initially defined hotspot, and we increased and decreased the coil orientation by 10°. In none of the subjects, the largest MEP amplitudes were evoked at the originally determined hotspot, resulting in a poor accuracy of function-guided navigation. At the group level, a change in coil location had no significant effect on the MEP amplitude, TEP, or LICI, and a change in coil orientation did not significantly affected LICI. However, at the subject level significant effects on MEP amplitude, TEP, and LICI were found for changes in coil location or orientation, although absolute differences were relatively small and did not show a consistent pattern. This study indicates that a high accuracy in coil positioning is especially required to measure cortical excitability reliably in individual subjects using single or paired pulse TMS.

Original languageEnglish
Pages (from-to)917-930
Number of pages14
JournalBrain topography
Issue number6
Early online date25 Jun 2018
Publication statusPublished - Nov 2018


  • UT-Hybrid-D
  • Function-guided navigation
  • Location
  • Orientation
  • TMS
  • Transcranial magnetic stimulation
  • Coil positioning

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