Multimodal finger-printing of the human precentral cortex forming the motor hand knob

Transcranial magnetic stimulation (TMS) of the precentral hand knob can evoke motor evoked potentials (MEP) in contralateral hand muscles. Biophysical modelling points to the dorsal premotor cortex (PMd) in the superficial crown-lip region as primary site of TMS-induced neuronal excitation. Here, we used a sulcus-aligned MRI-informed TMS mapping approach to determine the optimal site (hotspot) for evoking MEPs in the precentral hand knob. Individual precentral hotspot location varied along the rostro-caudal axis. Individuals with a more rostral location had longer MEP latencies. Spatiotemporal "hotspot rostrality" was associated with higher precentral myelin-related signals, stronger movement-related activation of PMd in the precentral crown, and higher temporal precision during paced finger tapping. Together, our multimodal mapping approach provides first-time evidence for behaviourally relevant, structural and functional phenotypic variation in the crown of human precentral motor hand knob. The results have important implications for physiological and interventional TMS studies targeting the precentral hand knob.