TMS experiments were conducted at the New York State Psychiatric Institute. We used single‐pulse TMS (Magstim 200 stimulator, 70mm figure‐of‐eight coil) to assess the cortical control of the more‐affected upper extremity. Frameless stereotaxy (Brainsight) allowed for online tracking of the position of the TMS coil relative to a child's MRI. We used an electromyography (EMG) recording system (Brainvision, Morrisville, NC, USA) during TMS stimulation for simultaneously recording bilateral muscle responses using surface electrodes over the first dorsal interosseous and flexor carpi radialis muscles.7 We mapped the motor representation of the more‐affected first dorsal interosseous and flexor carpi radialis by probing the more‐ and the less‐affected motor cortex (as in Fig. 2 ). Details of TMS procedures are presented in Appendix S1 (online supporting information).
200 stimulator
Manufactured by Magstim
Sourced in United Kingdom
The Magstim 200 stimulator is a lab equipment device used to generate transcranial magnetic stimulation (TMS). It is designed to deliver brief, high-intensity magnetic pulses to targeted areas of the brain. The device's core function is to produce these controlled magnetic pulses for research and clinical applications.
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Lab products found in correlation
Bistim module, by Magstim (4 mentions)
Signa hd, by GE Healthcare (3 mentions)
Figure of eight coil, by Magstim (1 mentions)
Powerlab, by ADInstruments (1 mentions)
Ab 611j, by Nihon Kohden (1 mentions)
Zerowire emg, by Aurion (1 mentions)
Nm 131t, by Nihon Kohden (1 mentions)
Axoscopesoftware9, by Molecular Devices (1 mentions)
Super rapid2, by Magstim (1 mentions)
70 mm figure eight coil, by Magstim (1 mentions)
Brainsight 2, by Rogue Research (1 mentions)
Bistim unit, by Magstim (1 mentions)
58 protocols using 200 stimulator
1
TMS Assessment of Motor Cortical Control
2
Evaluating Cortical Excitability with TMS
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Single-pulse transcranial magnetic stimuli (TMS) were delivered using a figure-of-eight coil and a Magstim 200 stimulator (Magstim Co. Ltd.). The coil was placed over the left hemisphere at a 45-degree angle to the sagittal plane to preferentially induce current in a posterior-to-anterior direction. The optimal cortical site (the "hotspot") to evoke responses in the right FDI muscle was determined as the coil position that elicited a maximal peak-to-peak motor evoked potential (MEP) for a given stimulation intensity. All TMS procedures adhered to the TMS checklist for methodological quality (Chipchase et al. 2012) . Two measures of the cortical excitability were recorded during complete rest: (1) Resting motor threshold (rMT), defined as the minimum TMS intensity at which 5 out of 10 stimuli applied at the optimal scalp site evoked a response with a peak-to-peak amplitude of at least 50 μV. (2) Ten MEPs were recorded at 120% of rMT over the hotspot site to evaluate corticomotor excitability. MEP responses were measured as peak-to-peak amplitudes and averaged for analysis.
3
Measuring Motor Cortex Excitability with TMS
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TMS pulses were administered to the left motor cortex to obtain the resting motor threshold and 1 mV intensity and to the left DLPFC (for PrePAS, PAS and PostPAS) using a 7 cm figure-of-eight coil, and a Magstim 200 stimulator (Magstim Company Ltd., UK) connected via a Bistim module and electromyography (EMG) data was collected using dedicated software (Cambridge Electronics Design, UK). The RMT was determined according to the protocol outlined by Rossini et al., 199423 (link). The RMT was defined as the minimum stimulus intensity that elicits a MEP of more than 50 µV in five of ten trials. The intensity of stimulation was estimated based on the RMT (120% RMT) from the left motor cortex. The intensity of stimulation was then adjusted as necessary to produce a mean peak-to-peak MEP amplitude of 1 mV24 (link) in the left motor cortex. In stimulating the left motor cortex, the TMS coil was placed at the optimal position for eliciting MEPs from the right abductor pollicis brevis (APB) muscle. EMG was captured by placing two disposable disc electrodes over the right APB muscle. The signal was amplified using a Model 2024F amplifier (Intronix Technologies Corporation, Bolton, Ontario Canada). The signal was filtered at band pass of 2 Hz to 2.5 kHz and digitized using the Micro 1401 (Cambridge Electronics Design, Cambridge UK).
4
Transcranial Magnetic Stimulation Protocol
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TMS was performed using a Magstim 200 stimulator connected to a figure-of-eight-shaped coil with an internal wing diameter of 7 cm (Magstim Company Ltd, Whitland, UK). The coil was held with the handle pointing backward and laterally 45° to the interhemispheric line to evoke anteriorly directed current in the brain and was optimally positioned to obtain motor-evoked potentials (MEPs) in the abductor pollicis brevis (APB) muscle in the dominant hand. Stimulation intensities are quoted as percentage of maximal stimulator output (mean ± SEM).
5
Transcranial Magnetic Stimulation of Biceps Brachii
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MEP responses of the biceps brachii were elicited via TMS over the motor cortex in the left or right hemisphere (depending on arm dominance) using a circular coil (13.5 cm outside diameter) attached to a Magstim 200 stimulator (Magstim, Dyfed, UK). The coil was placed horizontally over the vertex with the direction of the current flow to specifically activate the left or right cortex. To locate vertex, the distances from nasion to inion and from tragus to tragus were measured and marks were placed halfway directly on the scalp for both measurements. The intersection of both halfway marks was defined as vertex. During a 5% MVC, the stimulation intensity was altered to elicit a MEP amplitude that was between 10–20% of the Mmax amplitude. The stimulator setting used to evoke MEP amplitude that was between 10–20% of the Mmax amplitude was then used for the remainder of the experiment.
6
Transcranial Magnetic Stimulation and tsDCS
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TMS was applied over the M1 using a Magstim 200 stimulator (Magstim Company Ltd.) connected to a figure‐of‐eight coil with a loop‐diameter of 7 cm. At the beginning of each experiment, the coil was systematically moved to the spot that consistently evoked the largest MEPs in the soleus muscle of the respective participant at rest (i.e., the motor hotspot), and the position of the coil was registered using Brainsight® frameless stereotactic neuronavigation system (Brainsight‐Frameless 2.3 Rogue Research, Canada). Next, the resting motor threshold (rMT) was found by altering the stimulation intensity on the magnetic stimulator until an intensity that elicited MEPs with an amplitude of at least 50 µV in 5/10 cases for the soleus muscle was reached. A stimulus intensity of 1.2 rMT was then used throughout the experiment before and after tsDCS (see below).
7
Transcranial Magnetic Stimulation of Motor Cortex
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We delivered single-pulse TMS to the left motor cortex with a 7-cm figure-of-eight coil and a Magstim 200 stimulator (Magstim Company, Whitland, UK). We used a moderately suprathreshold stimulus to identify the optimal APB stimulation location, marking it with a felt-tipped marker to ensure consistent coil placement across trials. The handle of the coil pointed backward at 45° to the mid-sagittal line and perpendicular to the central sulcus.
We determined the resting motor threshold (RMT) at the optimal stimulation position. We defined the RMT as the minimum stimulus intensity needed to produce a response of at least 50 µV in the relaxed APB in 5 of 10 consecutive trials. The stimulus intensity required to evoke a 1-mV peak-to-peak response (SImV) was then determined. Stefan and colleagues found the SI1mV to be approximately 120% of the RMT (13 (link)). We defined the SI1mV as the stimulus intensity required to evoke, on average, a MEP of 1 mV in amplitude over 15 trials. If the average MEP over 15 trials was not 1 mV upon using 120% of RMT, the intensity was adjusted in 2% increments until we determined the SI1mV. Upon determining the SI1mV to be used in the study, we measured MEP over 20 trials and computed the average MEP.
We determined the resting motor threshold (RMT) at the optimal stimulation position. We defined the RMT as the minimum stimulus intensity needed to produce a response of at least 50 µV in the relaxed APB in 5 of 10 consecutive trials. The stimulus intensity required to evoke a 1-mV peak-to-peak response (SImV) was then determined. Stefan and colleagues found the SI1mV to be approximately 120% of the RMT (13 (link)). We defined the SI1mV as the stimulus intensity required to evoke, on average, a MEP of 1 mV in amplitude over 15 trials. If the average MEP over 15 trials was not 1 mV upon using 120% of RMT, the intensity was adjusted in 2% increments until we determined the SI1mV. Upon determining the SI1mV to be used in the study, we measured MEP over 20 trials and computed the average MEP.
8
Transcranial Magnetic Stimulation Protocol for Evaluating Motor Evoked Potentials
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A double-cone coil (outside diameter of 110 mm) was placed over the leg area of the left motor cortex to obtain MEPs from the right SOL, TA, VL, and BF by TMS (Magstim 200 stimulator, Magstim, Dyfed, UK). At the beginning of the measurements, the optimal stimulating site (i.e., “hot spot”) providing the largest amplitude for the SOL evoked response was identified. The head of each subject was secured on a head rest. The TMS coil position was marked on the non-elastic cap to ensure that the same area of the cortex was stimulated throughout the experiment. Next, the resting motor threshold (RMT) was determined while subjects rested quietly. The RMT was defined as the lowest stimulation intensity for which peak-to-peak amplitudes of MEP were larger than 50 μV for at least three of five stimuli. The TMS intensity was set to 130% of the RMT of SOL (Abdelmoula et al. 2016 (link)). The stimulation intensity in the present study was 76.4 ± 14.7% of maximal stimulator output. MEPs were evoked during the resting and weak voluntary contraction conditions, and ten stimuli with an inter-pulse interval of 6 s were delivered in each condition.
9
Transcranial Magnetic Stimulation Protocols
10
Transcranial Magnetic Stimulation Protocol
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In Experiment 1, single-and paired-pulses were delivered from a Magstim 200 stimulator (Magstim Company, Dyfed, UK) through an 80-mm figure-of-eight coil oriented with the handle at $45 posterolaterally to the midline. The coil was placed on the scalp over an optimal spot relative to the M1 by exploring the estimated centre of the non-target-FDI cortical representation and marking this spot with a permanent marker where a known suprathreshold intensity stimulus produced the largest response. The resting motor threshold and the active motor threshold were obtained and used to set the stimulation intensity during the experiment. Resting and active motor thresholds were, respectively, defined as the minimal stimulation intensity producing three out of five motor evoked potentials (MEPs) of a peak-to-peak amplitude of at least 50 μV at rest or 200 μV during a 5% MVC. Three single-and three-paired-pulse stimulations were obtained during each of the three 30-s unilateral isometric index finger abductions performed in each experimental or control protocols. For paired-pulse stimulation, the intensity of the conditioning stimulus was set at $70% of the active motor threshold whilst the intensity for the test stimulus, delivered 3 ms later, was set at 120% of the resting motor threshold in order to measure short-interval intracortical inhibition (SICI) (Kujirai et al., 1993) (link).
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