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Article

Navigated TMS in the ICU: Introducing Motor Mapping to the Critical Care Setting

1
Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
2
Department of Neurosurgery, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA
3
TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
4
Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
*
Author to whom correspondence should be addressed.
Brain Sci. 2020, 10(12), 1005; https://doi.org/10.3390/brainsci10121005
Received: 23 November 2020 / Revised: 13 December 2020 / Accepted: 16 December 2020 / Published: 18 December 2020
Navigated transcranial magnetic stimulation (nTMS) is a modality for noninvasive cortical mapping. Specifically, nTMS motor mapping is an objective measure of motor function, offering quantitative diagnostic information regardless of subject cooperation or consciousness. Thus far, it has mostly been restricted to the outpatient setting. This study evaluates the feasibility of nTMS motor mapping in the intensive care unit (ICU) setting and solves the challenges encountered in this special environment. We compared neuronavigation based on computed tomography (CT) and magnetic resonance imaging (MRI). We performed motor mappings in neurocritical patients under varying conditions (e.g., sedation or hemicraniectomy). Furthermore, we identified ways of minimizing electromyography (EMG) noise in the interference-rich ICU environment. Motor mapping was performed in 21 patients (six females, median age: 69 years). In 18 patients, motor evoked potentials (MEPs) were obtained. In three patients, MEPs could not be evoked. No adverse reactions occurred. We found CT to offer a comparable neuronavigation to MRI (CT maximum e-field 52 ± 14 V/m vs. MRI maximum e-field 52 ± 11 V/m; p = 0.6574). We detailed EMG noise reduction methods and found that propofol sedation of up to 80 mcg/kg/h did not inhibit MEPs. Yet, nTMS equipment interfered with exposed pulse oximetry. nTMS motor mapping application and use was illustrated in three clinical cases. In conclusion, we present an approach for the safe and reliable use of nTMS motor mapping in the ICU setting and outline possible benefits. Our findings support further studies regarding the clinical value of nTMS in critical care settings. View Full-Text
Keywords: nTMS; brain stimulation; intensive care; motor mapping; ICU; neurocritical care; neuromonitoring; functional mapping; motor evoked potentials nTMS; brain stimulation; intensive care; motor mapping; ICU; neurocritical care; neuromonitoring; functional mapping; motor evoked potentials
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MDPI and ACS Style

Schramm, S.; Haddad, A.F.; Chyall, L.; Krieg, S.M.; Sollmann, N.; Tarapore, P.E. Navigated TMS in the ICU: Introducing Motor Mapping to the Critical Care Setting. Brain Sci. 2020, 10, 1005. https://doi.org/10.3390/brainsci10121005

AMA Style

Schramm S, Haddad AF, Chyall L, Krieg SM, Sollmann N, Tarapore PE. Navigated TMS in the ICU: Introducing Motor Mapping to the Critical Care Setting. Brain Sciences. 2020; 10(12):1005. https://doi.org/10.3390/brainsci10121005

Chicago/Turabian Style

Schramm, Severin, Alexander F. Haddad, Lawrence Chyall, Sandro M. Krieg, Nico Sollmann, and Phiroz E. Tarapore 2020. "Navigated TMS in the ICU: Introducing Motor Mapping to the Critical Care Setting" Brain Sciences 10, no. 12: 1005. https://doi.org/10.3390/brainsci10121005

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