Magnetic stimulation of motor cortex in children: maturity of corticospinal pathway and problem of clinical application

The developmental profile of the electromyographic responses to transcranial magnetic stimulation (TMS) was studied in 46 neurologically normal children aged from one to 14 years, compared with data in 10 normal control adults. To obtain motor evoked potentials (MEPs) from the first dorsal interosseous muscle in the resting state, the motor cortex was stimulated through a circular coil with the stimulus intensity set at 10% above the threshold intensity for eliciting MEPs. Reproducible MEPs were obtained in all but the children aged below 2 years, and the threshold intensity and central motor conduction time (CMCT) showed a linear decrease with maturation. The MEP amplitude changed little until 9 years of age, but it tended to increase between 10 years and adulthood. The MEP duration, which was not influenced by age, was less than 16 ms over the ages studied. The present data suggest that maturity of the corticospinal motor pathway that controls the intrinsic hand muscles is electrophysiologically complete at 13 years of age. Among the parameters of MEPs, CMCT and MEP duration may be useful for evaluating impairment of the corticospinal tracts in children aged 2 years and older.