Motor function in multiple sclerosis assessed by navigated transcranial magnetic stimulation mapping.

Cortical motor mapping Cortical plasticity Motor evoked potentials Multiple sclerosis Neuronavigation Transcranial magnetic stimulation

Journal

Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161

Informations de publication

Date de publication:
06 May 2024
Historique:
received: 09 02 2024
accepted: 22 04 2024
revised: 21 04 2024
medline: 6 5 2024
pubmed: 6 5 2024
entrez: 6 5 2024
Statut: aheadofprint

Résumé

Impaired motor function is a major cause of disability in multiple sclerosis (MS), involving various neuroplasticity processes typically assessed by neuroimaging. This study aimed to determine whether navigated transcranial magnetic stimulation (nTMS) could also provide biomarkers of motor cortex plasticity in patients with MS (pwMS). nTMS motor mapping was performed for hand and leg muscles bilaterally. nTMS variables included the amplitude and latency of motor evoked potentials (MEPs), corticospinal excitability measures, and the size of cortical motor maps (CMMs). Clinical assessment included disability (Expanded Disability Status Scale, EDSS), strength (MRC scale, pinch and grip), and dexterity (9-hole Pegboard Test). nTMS motor mapping was performed in 68 pwMS. PwMS with high disability (EDSS ≥ 3) had enlarged CMMs with less dense distribution of MEPs and various MEP parameter changes compared to pwMS with low disability (EDSS < 3). Patients with progressive MS had also various MEP parameter changes compared to pwMS with relapsing remitting form. MRC score correlated positively with MEP amplitude and negatively with MEP latency, pinch strength correlated negatively with CMM volume and dexterity with MEP latency. This is the first study to perform 4-limb cortical motor mapping in pwMS using a dedicated nTMS procedure. By quantifying the cortical surface representation of a given muscle and the variability of MEP within this representation, nTMS can provide new biomarkers of motor function impairment in pwMS. Our study opens perspectives for the use of nTMS as an objective method for assessing pwMS disability in clinical practice.

Identifiants

pubmed: 38709305
doi: 10.1007/s00415-024-12398-x
pii: 10.1007/s00415-024-12398-x
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.

Références

Compston A, Coles A (2008) Multiple sclerosis. Lancet 372:1502–1517. https://doi.org/10.1016/S0140-6736(08)61620-7
doi: 10.1016/S0140-6736(08)61620-7 pubmed: 18970977
da Chagas LS, Sandre PC, Ribeiro e Ribeiro NCA, Marcondes H, Oliveira Silva P, Savino W (2020) Environmental signals on microglial function during brain development neuroplasticity, and diseASE. Int J Mol Sci 21:2111. https://doi.org/10.3390/ijms21062111
doi: 10.3390/ijms21062111 pubmed: 32204421 pmcid: 7139373
Li Q, Barres BA (2018) Microglia and macrophages in brain homeostasis and disease. Nat Rev Immunol 18:225–242. https://doi.org/10.1038/nri.2017.125
doi: 10.1038/nri.2017.125 pubmed: 29151590
Rocca MA, Colombo B, Falini A, Ghezzi A, Martinelli V, Scotti G et al (2005) Cortical adaptation in patients with MS: a cross-sectional functional MRI study of disease phenotypes. Lancet Neurol 4:618–626. https://doi.org/10.1016/S1474-4422(05)70171-X
doi: 10.1016/S1474-4422(05)70171-X pubmed: 16168930
Lefaucheur J-P (2010) Why image-guided navigation becomes essential in the practice of transcranial magnetic stimulation. Neurophysiol Clin 40:1–5. https://doi.org/10.1016/j.neucli.2009.10.004
doi: 10.1016/j.neucli.2009.10.004 pubmed: 20230930
Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G et al (2018) Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 17:162–173. https://doi.org/10.1016/S1474-4422(17)30470-2
doi: 10.1016/S1474-4422(17)30470-2 pubmed: 29275977
Krieg SM, Lioumis P, Mäkelä JP, Wilenius J, Karhu J, Hannula H et al (2017) Protocol for motor and language mapping by navigated TMS in patients and healthy volunteers; workshop report. Acta Neurochir (Wien) 159:1187–1195. https://doi.org/10.1007/s00701-017-3187-z
doi: 10.1007/s00701-017-3187-z pubmed: 28456870
Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin J-C, Pujol S et al (2012) 3D Slicer as an image computing platform for the quantitative imaging network. Magn Reson Imaging 30:1323–1341. https://doi.org/10.1016/j.mri.2012.05.001
doi: 10.1016/j.mri.2012.05.001 pubmed: 22770690 pmcid: 3466397
Pieper S, Halle M, Kikinis R (2004) 3D Slicer. In 2004 2nd IEEE International Symposium on Biomedical Imaging: Macro to Nano (IEEE Cat No 04EX821) 2:632–635. https://doi.org/10.1109/ISBI.2004.1398617
Egger C, Opfer R, Wang C, Kepp T, Sormani MP, Spies L et al (2016) MRI FLAIR lesion segmentation in multiple sclerosis: Does automated segmentation hold up with manual annotation? Neuroimage Clin 13:264–270. https://doi.org/10.1016/j.nicl.2016.11.020
doi: 10.1016/j.nicl.2016.11.020 pubmed: 28018853 pmcid: 5175993
Friston KJ, Ashburner J, Kiebel SJ, Nichols TE, Penny WD (2007) Statistical Parametric Mapping: The Analysis of Functional Brain Images. Academic Press. https://doi.org/10.1016/B978-0-12-372560-8.X5000-1
Fan L, Li H, Zhuo J, Zhang Y, Wang J, Chen L et al (2016) The human brainnetome atlas: a new brain atlas based on connectional architecture. Cereb Cortex 26:3508–3526. https://doi.org/10.1093/cercor/bhw157
doi: 10.1093/cercor/bhw157 pubmed: 27230218 pmcid: 4961028
Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452
doi: 10.1212/WNL.33.11.1444 pubmed: 6685237
Meca-Lallana V, Brañas-Pampillón M, Higueras Y, Candeliere-Merlicco A, Aladro-Benito Y, Rodríguez-De la Fuente O et al (2019) Assessing fatigue in multiple sclerosis: psychometric properties of the five-item Modified Fatigue Impact Scale (MFIS-5). Mult Scler J Exp Transl Clin 5:2055217319887987. https://doi.org/10.1177/2055217319887987
doi: 10.1177/2055217319887987 pubmed: 31741743 pmcid: 6843745
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370
doi: 10.1111/j.1600-0447.1983.tb09716.x pubmed: 6880820
Smith A (1982) Symbol digit modalities test (SDMT). Manual (Revised). Western Psychological Services, Los Angeles
Llinàs-Reglà J, Vilalta-Franch J, López-Pousa S, Calvó-Perxas L, Torrents Rodas D, Garre-Olmo J (2017) The trail making test. Assessment 24:183–196. https://doi.org/10.1177/1073191115602552
doi: 10.1177/1073191115602552 pubmed: 26318386
Compston A (2010) Aids to the investigation of peripheral nerve injuries. Medical Research Council: Nerve Injuries Research Committee. His Majesty’s Stationery Office: 1942; pp. 48 (iii) and 74 figures and 7 diagrams; with aids to the examination of the peripheral nervous system. By Michael O’Brien for the Guarantors of Brain. Saunders Elsevier: 2010; pp. [8] 64 and 94 Figures. Brain 133:2838–2844. https://doi.org/10.1093/brain/awq270
doi: 10.1093/brain/awq270 pubmed: 20928945
Oldfield RC (1971) The assessment and analysis of handedness: the edinburgh inventory. Neuropsychologia 9:97–113
doi: 10.1016/0028-3932(71)90067-4 pubmed: 5146491
Elias LJ, Bryden MP, Bulman-Fleming MB (1998) Footedness is a better predictor than is handedness of emotional lateralization. Neuropsychologia 36:37–43. https://doi.org/10.1016/s0028-3932(97)00107-3
doi: 10.1016/s0028-3932(97)00107-3 pubmed: 9533385
Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S (1985) Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil 66:69–74
pubmed: 3970660
Truong CTL, Le HV, Kamauu AW, Holmen JR, Fillmore CL, Kobayashi MG et al (2021) Creating a real-world data, united states healthcare claims-based adaptation of Kurtzke functional systems scores for assessing multiple sclerosis severity and progression. Adv Ther 38:4786–4797. https://doi.org/10.1007/s12325-021-01858-9
doi: 10.1007/s12325-021-01858-9 pubmed: 34333756 pmcid: 8408077
Sayao A-L, Devonshire V, Tremlett H (2007) Longitudinal follow-up of “benign” multiple sclerosis at 20 years. Neurology 68:496–500. https://doi.org/10.1212/01.wnl.0000253185.03943.66
doi: 10.1212/01.wnl.0000253185.03943.66 pubmed: 17296915
Thickbroom GW, Byrnes ML, Archer SA, Kermode AG, Mastaglia FL (2005) Corticomotor organisation and motor function in multiple sclerosis. J Neurol 252:765–771. https://doi.org/10.1007/s00415-005-0728-9
doi: 10.1007/s00415-005-0728-9 pubmed: 15750708
Chieffo R, Straffi L, Inuggi A, Coppi E, Moiola L, Martinelli V et al (2019) Changes in cortical motor outputs after a motor relapse of multiple sclerosis. Mult Scler J Exp Transl Clin 5:2055217319866480. https://doi.org/10.1177/2055217319866480
doi: 10.1177/2055217319866480 pubmed: 31598329 pmcid: 6764060
Weiss Lucas C, Tursunova I, Neuschmelting V, Nettekoven C, Oros-Peusquens A-M, Stoffels G et al (2017) Functional MRI vs. navigated TMS to optimize M1 seed volume delineation for DTI tractography. A prospective study in patients with brain tumours adjacent to the corticospinal tract. Neuroimage Clin 13:297–309. https://doi.org/10.1016/j.nicl.2016.11.022
doi: 10.1016/j.nicl.2016.11.022 pubmed: 28050345
Lefaucheur J-P, Picht T (2016) The value of preoperative functional cortical mapping using navigated TMS. Neurophysiol Clin 46:125–133. https://doi.org/10.1016/j.neucli.2016.05.001
doi: 10.1016/j.neucli.2016.05.001 pubmed: 27229765
Kraus D, Gharabaghi A (2015) Projecting navigated TMS sites on the Gyral anatomy decreases inter-subject variability of cortical motor maps. Brain Stimul 8:831–837. https://doi.org/10.1016/j.brs.2015.03.006
doi: 10.1016/j.brs.2015.03.006 pubmed: 25865772
Julkunen P (2014) Methods for estimating cortical motor representation size and location in navigated transcranial magnetic stimulation. J Neurosci Methods 232:125–133. https://doi.org/10.1016/j.jneumeth.2014.05.020
doi: 10.1016/j.jneumeth.2014.05.020 pubmed: 24875623
Rocca MA, Filippi M (2017) Functional reorganization is a maladaptive response to injury–YES. Mult Scler 23:191–193. https://doi.org/10.1177/1352458516667242
doi: 10.1177/1352458516667242 pubmed: 27932694
Filippi M, Agosta F (2009) Magnetic resonance techniques to quantify tissue damage, tissue repair, and functional cortical reorganization in multiple sclerosis. Prog Brain Res 175:465–482. https://doi.org/10.1016/S0079-6123(09)17531-3
doi: 10.1016/S0079-6123(09)17531-3 pubmed: 19660674
Laura DG, Silvia T, Nikolaos P, Patrizia P (2018) The role of fMRI in the Assessment Of Neuroplasticity in MS: a systematic review. Neural Plast 2018:3419871. https://doi.org/10.1155/2018/3419871
doi: 10.1155/2018/3419871 pubmed: 30693023 pmcid: 6332922
Filippi M, Preziosa P, Rocca MA (2019) Brain mapping in multiple sclerosis: lessons learned about the human brain. Neuroimage 190:32–45. https://doi.org/10.1016/j.neuroimage.2017.09.021
doi: 10.1016/j.neuroimage.2017.09.021 pubmed: 28917696
Tavazzi E, Cazzoli M, Pirastru A, Blasi V, Rovaris M, Bergsland N et al (2021) Neuroplasticity and motor rehabilitation in multiple sclerosis: a systematic review on MRI markers of functional and structural changes. Front Neurosci 15:707675. https://doi.org/10.3389/fnins.2021.707675
doi: 10.3389/fnins.2021.707675 pubmed: 34690670 pmcid: 8526725
Mezzapesa DM, Rocca MA, Rodegher M, Comi G, Filippi M (2008) Functional cortical changes of the sensorimotor network are associated with clinical recovery in multiple sclerosis. Hum Brain Mapp 29:562–573. https://doi.org/10.1002/hbm.20418
doi: 10.1002/hbm.20418 pubmed: 17538952
Enzinger C, Pinter D, Rocca MA, De Luca J, Sastre-Garriga J, Audoin B et al (2016) Longitudinal fMRI studies: exploring brain plasticity and repair in MS. Mult Scler 22:269–278. https://doi.org/10.1177/1352458515619781
doi: 10.1177/1352458515619781 pubmed: 26683590
Stampanoni Bassi M, Mori F, Buttari F, Marfia GA, Sancesario A, Centonze D et al (2017) Neurophysiology of synaptic functioning in multiple sclerosis. Clin Neurophysiol 128:1148–1157. https://doi.org/10.1016/j.clinph.2017.04.006
doi: 10.1016/j.clinph.2017.04.006 pubmed: 28511127
Lenzi D, Conte A, Mainero C, Frasca V, Fubelli F, Totaro P et al (2007) Effect of corpus callosum damage on ipsilateral motor activation in patients with multiple sclerosis: a functional and anatomical study. Hum Brain Mapp 28:636–644. https://doi.org/10.1002/hbm.20305
doi: 10.1002/hbm.20305 pubmed: 17080438
Kiers L, Cros D, Chiappa KH, Fang J (1993) Variability of motor potentials evoked by transcranial magnetic stimulation. Electroencephalogr Clin Neurophysiol 89:415–423. https://doi.org/10.1016/0168-5597(93)90115-6
doi: 10.1016/0168-5597(93)90115-6 pubmed: 7507428
Rossini PM, Burke D, Chen R, Cohen LG, Daskalakis Z, Di Iorio R et al (2015) Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee Clin Neurophysiol 126:1071–1107. https://doi.org/10.1016/j.clinph.2015.02.001
doi: 10.1016/j.clinph.2015.02.001 pubmed: 25797650
Reijonen J, Säisänen L, Könönen M, Mohammadi A, Julkunen P (2020) The effect of coil placement and orientation on the assessment of focal excitability in motor mapping with navigated transcranial magnetic stimulation. J Neurosci Methods 331:108521. https://doi.org/10.1016/j.jneumeth.2019.108521
doi: 10.1016/j.jneumeth.2019.108521 pubmed: 31733284
Opitz A, Legon W, Rowlands A, Bickel WK, Paulus W, Tyler WJ (2013) Physiological observations validate finite element models for estimating subject-specific electric field distributions induced by transcranial magnetic stimulation of the human motor cortex. Neuroimage 81:253–264. https://doi.org/10.1016/j.neuroimage.2013.04.067
doi: 10.1016/j.neuroimage.2013.04.067 pubmed: 23644000
Bergmann TO, Mölle M, Schmidt MA, Lindner C, Marshall L, Born J et al (2012) EEG-guided transcranial magnetic stimulation reveals rapid shifts in motor cortical excitability during the human sleep slow oscillation. J Neurosci 32:243–253. https://doi.org/10.1523/JNEUROSCI.4792-11.2012
doi: 10.1523/JNEUROSCI.4792-11.2012 pubmed: 22219286 pmcid: 6621327
Keil J, Timm J, Sanmiguel I, Schulz H, Obleser J, Schönwiesner M (2014) Cortical brain states and corticospinal synchronization influence TMS-evoked motor potentials. J Neurophysiol 111:513–519. https://doi.org/10.1152/jn.00387.2013
doi: 10.1152/jn.00387.2013 pubmed: 24198325
de Goede AA, van Putten MJAM (2019) Infraslow activity as a potential modulator of corticomotor excitability. J Neurophysiol 122:325–335. https://doi.org/10.1152/jn.00663.2018
doi: 10.1152/jn.00663.2018 pubmed: 31116669
Potter-Baker KA, Lin Y-L, Machado AG, Conforto AB, Cunningham DA, Sankarasubramanian V et al (2018) Variability of motor evoked potentials in stroke explained by corticospinal pathway integrity. Brain Stimul 11:929–931. https://doi.org/10.1016/j.brs.2018.03.004
doi: 10.1016/j.brs.2018.03.004 pubmed: 29563050
Sollmann N, Bulubas L, Tanigawa N, Zimmer C, Meyer B, Krieg SM (2017) The variability of motor evoked potential latencies in neurosurgical motor mapping by preoperative navigated transcranial magnetic stimulation. BMC Neurosci 18:5. https://doi.org/10.1186/s12868-016-0321-4
doi: 10.1186/s12868-016-0321-4 pubmed: 28049425 pmcid: 5209850
Picht T, Strack V, Schulz J, Zdunczyk A, Frey D, Schmidt S et al (2012) Assessing the functional status of the motor system in brain tumor patients using transcranial magnetic stimulation. Acta Neurochir (Wien) 154:2075–2081. https://doi.org/10.1007/s00701-012-1494-y
doi: 10.1007/s00701-012-1494-y pubmed: 22948747
Britton TC, Meyer BU, Benecke R (1991) Variability of cortically evoked motor responses in multiple sclerosis. Electroencephalogr Clin Neurophysiol 81:186–194. https://doi.org/10.1016/0168-5597(91)90071-5
doi: 10.1016/0168-5597(91)90071-5 pubmed: 1710967
Thickbroom GW, Byrnes ML, Mastaglia FL (1999) A model of the effect of MEP amplitude variation on the accuracy of TMS mapping. Clin Neurophysiol 110:941–943. https://doi.org/10.1016/s1388-2457(98)00080-7
doi: 10.1016/s1388-2457(98)00080-7 pubmed: 10400209
Simpson M, Macdonell R (2015) The use of transcranial magnetic stimulation in diagnosis, prognostication and treatment evaluation in multiple sclerosis. Mult Scler Relat Disord 4:430–436. https://doi.org/10.1016/j.msard.2015.06.014
doi: 10.1016/j.msard.2015.06.014 pubmed: 26346791
Snow NJ, Wadden KP, Chaves AR, Ploughman M (2019) Transcranial magnetic stimulation as a potential biomarker in multiple sclerosis: a systematic review with recommendations for future research. Neural Plast 2019:6430596. https://doi.org/10.1155/2019/6430596
doi: 10.1155/2019/6430596 pubmed: 31636661 pmcid: 6766108
Vucic S, Stanley Chen K-H, Kiernan MC, Hallett M, Benninger DH, Di Lazzaro V et al (2023) Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee. Clin Neurophysiol 150:131–175. https://doi.org/10.1016/j.clinph.2023.03.010
doi: 10.1016/j.clinph.2023.03.010 pubmed: 37068329
Lefaucheur J-P, Drouot X, Ménard-Lefaucheur I, Keravel Y, Nguyen JP (2006) Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain. Neurology 67:1568–1574. https://doi.org/10.1212/01.wnl.0000242731.10074.3c
doi: 10.1212/01.wnl.0000242731.10074.3c pubmed: 17101886
Krieg SM, Shiban E, Buchmann N, Gempt J, Foerschler A, Meyer B et al (2012) Utility of presurgical navigated transcranial magnetic brain stimulation for the resection of tumors in eloquent motor areas. J Neurosurg 116:994–1001. https://doi.org/10.3171/2011.12.JNS111524
doi: 10.3171/2011.12.JNS111524 pubmed: 22304452
Tarapore PE, Picht T, Bulubas L, Shin Y, Kulchytska N, Meyer B et al (2016) Safety and tolerability of navigated TMS for preoperative mapping in neurosurgical patients. Clin Neurophysiol 127:1895–1900. https://doi.org/10.1016/j.clinph.2015.11.042
doi: 10.1016/j.clinph.2015.11.042 pubmed: 26762952

Auteurs

Benjamin Bardel (B)

Excitabilité Nerveuse Et Thérapeutique (ENT), Univ Paris Est Creteil, EA 4391, 8 Rue du Général Sarrail, Créteil, 94000, France. benjamin.bardel@aphp.fr.
Service Des Explorations Fonctionnelles Non Invasives, Department of Clinical Neurophysiology, DMU FIxIT, AP-HP, Unité de Neurophysiologie Clinique, Hôpital Universitaire Henri Mondor, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, 94000, Creteil, France. benjamin.bardel@aphp.fr.
Centre de Ressources Et de Compétences SEP Grand-Paris Est, Hôpital Universitaire Henri Mondor, 1 Rue Gustave Eiffel, 94000, Creteil, France. benjamin.bardel@aphp.fr.

Alain Créange (A)

Excitabilité Nerveuse Et Thérapeutique (ENT), Univ Paris Est Creteil, EA 4391, 8 Rue du Général Sarrail, Créteil, 94000, France.
Centre de Ressources Et de Compétences SEP Grand-Paris Est, Hôpital Universitaire Henri Mondor, 1 Rue Gustave Eiffel, 94000, Creteil, France.
Department of Neurology, AP-HP, Henri Mondor University Hospital, DMU Médecine, 1 Rue Gustave Eiffel, 94000, Creteil, France.

Nathalie Bonardet (N)

Excitabilité Nerveuse Et Thérapeutique (ENT), Univ Paris Est Creteil, EA 4391, 8 Rue du Général Sarrail, Créteil, 94000, France.

Blanche Bapst (B)

Excitabilité Nerveuse Et Thérapeutique (ENT), Univ Paris Est Creteil, EA 4391, 8 Rue du Général Sarrail, Créteil, 94000, France.
Centre de Ressources Et de Compétences SEP Grand-Paris Est, Hôpital Universitaire Henri Mondor, 1 Rue Gustave Eiffel, 94000, Creteil, France.
Department of Neuroradiology, AP-HP, Henri Mondor University Hospital, DMU FIxIT, 1 Rue Gustave Eiffel, 94000, Creteil, France.

Mickael Zedet (M)

Centre de Ressources Et de Compétences SEP Grand-Paris Est, Hôpital Universitaire Henri Mondor, 1 Rue Gustave Eiffel, 94000, Creteil, France.
Department of Neurology, AP-HP, Henri Mondor University Hospital, DMU Médecine, 1 Rue Gustave Eiffel, 94000, Creteil, France.

Abir Wahab (A)

Centre de Ressources Et de Compétences SEP Grand-Paris Est, Hôpital Universitaire Henri Mondor, 1 Rue Gustave Eiffel, 94000, Creteil, France.
Department of Neurology, AP-HP, Henri Mondor University Hospital, DMU Médecine, 1 Rue Gustave Eiffel, 94000, Creteil, France.

Samar S Ayache (SS)

Excitabilité Nerveuse Et Thérapeutique (ENT), Univ Paris Est Creteil, EA 4391, 8 Rue du Général Sarrail, Créteil, 94000, France.
Service Des Explorations Fonctionnelles Non Invasives, Department of Clinical Neurophysiology, DMU FIxIT, AP-HP, Unité de Neurophysiologie Clinique, Hôpital Universitaire Henri Mondor, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, 94000, Creteil, France.
Centre de Ressources Et de Compétences SEP Grand-Paris Est, Hôpital Universitaire Henri Mondor, 1 Rue Gustave Eiffel, 94000, Creteil, France.
Department of Neurology, AP-HP, Henri Mondor University Hospital, DMU Médecine, 1 Rue Gustave Eiffel, 94000, Creteil, France.

Jean-Pascal Lefaucheur (JP)

Excitabilité Nerveuse Et Thérapeutique (ENT), Univ Paris Est Creteil, EA 4391, 8 Rue du Général Sarrail, Créteil, 94000, France.
Service Des Explorations Fonctionnelles Non Invasives, Department of Clinical Neurophysiology, DMU FIxIT, AP-HP, Unité de Neurophysiologie Clinique, Hôpital Universitaire Henri Mondor, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, 94000, Creteil, France.

Classifications MeSH