PARESTHESIAS ARE ELICITED BY SINGLE PULSE, MAGNETIC COIL STIMULATION OF MOTOR CORTEX IN SUSCEPTIBLE HUMANS

A minority of normal humans experience paraesthesias (usually tingling) projected to the contralateral hand in response to individual transcranial magnetic coil (MC) pulses. The cortical source of the paraesthesias was sought by comparing their incidence with that of muscle responses to focal MC stimulation with either a figure 8 MC or with edge stimulation of a tilted round MC in 4 susceptible subjects. In all 4, paraesthesias were best felt with MC stimulation either at, or anterior to sites yielding movement, implying an initial source in precentral gyrus (and possible premotor cortex), rather than parietal cortex. In the two subjects exhibiting the strongest paraesthesias, the threshold for the paraesthesias was less than that for movement in the relaxed arm. The optimal site of the paraesthesias within the hand was usually in the digits, but differed among subjects. Motor responses and paraesthesias following a given stimulus occurred at different sites in the hand. implying that excitation of differing sets of motor cortical neurons subserved sensory and motor responses. In only one subject were the paraesthesias sufficiently reproducible to warrant interacting electrical digital and transcranial MC pulses. The data suggested that central processing of the response to the MC pulse is slowed by an antecedent digital stimulus, but the delay for perception of each type of stimulus does not greatly differ. The central sense of movement (Amassian et al., 1989a) elicited by MC stimulation of motor cortex is compared with the paraesthesias. Both are attributed to brief, high frequency discharge by motor cortical neurons accessing the perceptual system more readily than after excitation of post-central gyrus. which requires prolonged repetitive stimulation (Libet et al., 1964). Given also the normal pattern of muscle responses in the 4 subjects, their paraesthesias are best explained by a heightened sensitivity of the perceptual system to the motor cortical response to MC stimulation.