Direct comparison of corticospinal volleys in human subjects to transcranial magnetic and electrical stimulation.

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Abstract
1. The effects of graded transcranial magnetic and anodal electrical stimulation of the human motor cortex were compared in human subjects undergoing orthopaedic operations on the spine, before and after withdrawal of volatile anaesthesia. Corticospinal volleys were recorded from the spinal cord in the low‐cervical and low‐thoracic regions (six subjects) or the mid‐thoracic region (two subjects) using bipolar electrodes inserted into the epidural space. 2. Electrical stimuli were delivered using anode at the vertex and cathode 7 cm laterally. The corticospinal volley at threshold consisted of a single deflection with a mean latency to peak of 4.17 ms at the rostral recording site. With further increases in stimulus strength the latency of this D wave shortened in two steps, first by 0.89 ms (seven subjects) and then by a further 0.8 ms (two subjects), indicating that the site of activation of some corticospinal neurones had shifted to deep subcortical sites. 3. When volatile anaesthetics were given, a corticospinal volley could not be defined in three subjects with magnetic stimuli of 70, 80 and 100% maximal stimulator output with the coil at the vertex (Novametrix Magstim 200, round coil, external diameter 14 cm). In the remaining five subjects, the component of lowest threshold was a D wave recorded at the rostral site at 4.0 ms when stimulus intensity was, on average, 70%. With stimuli of 90‐100% a total of five small I waves could be defined in the five subjects (i.e. on average one I wave per subject). 4. After cessation of volatile anaesthetics in seven subjects, the thresholds for D and I waves were lower and their amplitudes were greater. The D wave remained the component of lowest threshold in all subjects, appearing at the low‐cervical level with magnetic stimuli of 50%. However, in three subjects I waves also appeared at D wave threshold, and the D wave was smaller than with electrical stimulation at I wave threshold. There was no consistent change in latency of the magnetic D wave as stimulus intensity was increased to 100%. 5. These findings suggest that the previously reported difference in latency of the EMG potentials produced in upper‐limb muscles by anodal stimulation and magnetic stimulation of the human motor cortex is not because the corticospinal volley induced by magnetic stimulation lacks a D wave.(ABSTRACT TRUNCATED AT 400 WORDS)