@article{discovery10178844,
           month = {October},
            year = {2022},
          number = {10},
           title = {The Effect of Coil Orientation on the Stimulation of the Pre-Supplementary Motor Area: A Combined TMS and EEG Study},
       publisher = {MDPI},
          volume = {12},
            note = {Copyright {\copyright} 2022 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article distributed under the terms and
conditions of the Creative Commons Attribution (CC BY) license
(https://creativecommons.org/licenses/by/4.0/).},
         journal = {Brain Sciences},
        abstract = {Studies using transcranial magnetic stimulation (TMS) have demonstrated the importance of direction and intensity of the applied current when the primary motor cortex (M1) is targeted. By varying these, it is possible to stimulate different subsets of neural elements, as demonstrated by modulation of motor evoked potentials (MEPs) and motor behaviour. The latter involves premotor areas as well, and among them, the presupplementary motor area (pre-SMA) has recently received significant attention in the study of motor inhibition. It is possible that, similar to M1, different neuronal populations can be activated by varying the direction and intensity of TMS; however, the absence of a direct electrophysiological outcome has limited this investigation. The problem can be solved by quantifying direct cortical responses by means of combined TMS and electroencephalography (TMS-EEG). We investigated the effect of variable coil orientations (0o, 90o, 180o and 270o) and stimulation intensities (100\%, 120\% and 140\% of resting motor threshold) on local mean field potential (LMFP), transcranial evoked potential (TEP) peaks and TMS-related spectral perturbation (TRSP) from pre-SMA stimulation. As a result, early and late LMFP and peaks were larger, with the coil handle pointing posteriorly (0o) and laterally (90o). This was true also for TRSP in the {\ensuremath{\beta}}-{\ensuremath{\gamma}} range, but, surprisingly, {\ensuremath{\theta}}-{\ensuremath{\alpha}} TRSP was larger with the coil pointing at 180o. A 90o orientation activated the right M1, as shown by MEPs elicitation, thus limiting the spatial specificity of the stimulation. These results suggest that coil orientation and stimulation intensity are critical when stimulating the pre-SMA.},
          author = {Casula, Elias P and Leodori, Giorgio and Ib{\'a}{\~n}ez, Jaime and Benussi, Alberto and Rawji, Vishal and Tremblay, Sara and Latorre, Anna and Rothwell, John C and Rocchi, Lorenzo},
             url = {https://doi.org/10.3390/brainsci12101358},
        keywords = {Transcranial magnetic stimulation; electroencephalography; motor evoked potentials; TMS-EEG; presupplementary motor area; coil direction},
            issn = {2076-3425}
}