Within-subject effect of coil-to-cortex distance on cortical electric field threshold and motor evoked potentials in transcranial magnetic stimulation

Motor threshold (MT) is a global measure of corticospinal excitability in transcranial magnetic stimulation determined over the primary motor cortex. It is commonly quantified as stimulation intensity (SIMT) able to induce a muscle response over certain threshold amplitude after 5/10 consecutive stimuli. SIMT is known to be dependent on coil-to-cortex distance (CCD). Hypothetically, the effect of CCD on SIMT could be removed by using a computed estimate for the stimulus-induced maximum cortical electric field at MT level (EFMT). The CCDs of six volunteers were artificially increased by a maximum of 16.3 ± 3.5 mm in 5–7 steps. At each CCD, the MT was estimated for the first dorsal interosseous muscle of the right hand as SIMT and EFMT as well as threshold curves. We found that SIMT correlated with CCD while EFMT did not. CCD had a significant effect on the within-subject variation in SIMT (F(6, 28) = 80.16, p < 0.0001), but not in EFMT (F(6, 28) = 0.69, p = 0.656) (analysis of variance). Furthermore, CCD had a minor, but significant within-subject effect on single-trial motor evoked potentials induced at different stimulation intensities, whereas the obvious major effect was caused by stimulation intensity. In conclusion, EFMT can be used as a measure of corticospinal excitability instead of SIMT to reduce the effect of within-subject variation in CCD.

► Commonly quantified motor threshold (MT) depends on coil-to-cortex distance (CCD).
► The effect of CCD on MT may be removed by use of computed electric field (EFMT).
► The CCDs of six volunteers were increased by a maximum of 16.3 ± 3.5 mm in 5–7 steps.
► CCD affected the commonly measured MT, but not EFMT within the subjects.
► EFMT can be used as a measure of MT to reduce the within-subject effect of CCD.