Y P O C T O Central Motor Conduction N Time (CMCT) O D E - - PowerPoint PPT Presentation

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Mar 06, 2023 660 likes •842 views

Y P O C T O Central Motor Conduction N Time (CMCT) O D E S A Paula Davila Prez, MD E Berenson-Allen Center for Noninvasive Brain Stimulation L Beth Israel Deaconess Medical Center P Harvard Medical School Y P O Outline C

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Central Motor Conduction Time (CMCT)

Paula Davila Pérez, MD Berenson-Allen Center for Noninvasive Brain Stimulation Beth Israel Deaconess Medical Center Harvard Medical School

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Outline

Physiological and technical aspects
Clinical applications
Hands-on!

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Definition of CMCT

Time taken for neural impulses to travel through central nervous system on their way to the target muscle.

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Método 1 Método 2

Kobayashi and Pascual-Leone 2003

F wave + M wave -1 2

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Stimulation of the roots: (TMS)

– Excites the roots at foramina

Overestimation of CMCT

– Lower limbs may be difficult to assess

F-Waves method:

– Assumes conduction is normal at proximal segments (Guillain-Barre S.) – Proximal muscles or muscles with no F-waves may be difficult – More accurate – Needs 2 stimulators

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Longer conduction time
Dispersed and more attenuated responses
Low amplitude or no responses

Udupa & Chen. Handbook of Clinical Neurology. 2013

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CMCT and Diseases

Udupa & Chen. Handbook of Clinical Neurology. 2013

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HANDS-ON !

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Cortical Silent Period (cSP)

cSP Conditions:

120% of RMT
<50% of total muscle

contraction The Cortical Silent Period translates GABAB inhibitory cortical processes The initial part of the cSP is thought to reflect spinal inhibition (≈50ms)

Time (ms) Amplitude (mV) TMS Pulse