The role of the human motor cortex in the control of complex and simple finger movement sequences.

We evaluated the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) at different stimulus intensities on finger sequences of varying complexity. Eighteen subjects played unimanual finger sequences of different complexity on an electronic piano. For each finger sequence, 16 notes were played to the 2 Hz beat of a metronome. After the first four notes, rTMS was applied to the scalp location overlying the hand motor representation for approximately 2 s. Accuracy and timing errors were analysed. Stimulation over the M1 had a differential effect on sequences of different complexity. Stimulus intensities capable of disrupting the performance of a complex sequence did not affect simple sequences. To disrupt simple sequences, the stimulus strength had to be augmented. This effect was characteristic of the contralateral M1 position (five other scalp locations were also stimulated). It is argued that the differential effect of rTMS on simple and complex sequences is probably due to interference with M1 function. Interference with the lateral premotor cortex (PMC) may play an additional role. The particular relevance of the M1 is supported by results in a patient with PMC stroke. The present findings suggest that the human M1 plays a greater role in the performance of complex than of simple finger movement sequences. One possible explanation could be that the human M1 is not only an executive motor area but can also contribute to movement sequence organization.