[Assessment of motor cranial nerve functions using transcranial magnetic stimulation]

Transcranial magnetic stimulation applied over one cerebral hemisphere evokes bilateral responses in the muscles supplied by cranial nerves (masseter, mentalis, sternomastoid, genioglossus) (Tabl. 1). The relatively long latencies of these responses and the influence that preactivation of the muscle has on them, suggests that they are cortically evoked. Shorter latency and exclusively ipsilateral responses can be obtained if the position of the stimulating coil over the head is more lateral. These responses are uninfluenced by pre-activation of the muscle which suggests that they arise from stimulation of the peripheral nerve itself. By considering the conduction velocity of the nerve and the response latency such stimulation probably occurs in the proximal intracisternal segment (Fig. 2). The results obtained using magnetic stimulation of the cortex in patients with unilateral cerebral hemisphere lesions lend support to the idea of a bilateral projection from each cerebral hemisphere to the motor nuclei of the facial and hypoglossal nerves on both sides: stimulations over the intact hemisphere produces bilateral responses, whereas stimulations over the damaged hemisphere produce no responses (Fig. 1). In patients with idiopathic facial palsy no short latency responses were obtained on the affected side either during the acute (less than 10 days) or during the chronic phase (greater than 3 months) of the illness-despite clinical improvement during the chronic stage (Fig. 3, 4). However cortically evoked responses were obtainable in patients seen during the chronic phase indicating that facial motoneurones could be excited transsynaptically (Fig. 3).(ABSTRACT TRUNCATED AT 250 WORDS)