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The resting motor threshold (RMT), a measure of cortical excitability, has been linked to postoperative motor outcomes. However, RMT is influenced by many inter-individual factors, potentially limiting its interpretability. This study aimed to assess the influence of clinical and anatomical variables on RMT variability in neurosurgical patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 642 patients with motor-eloquent brain lesions underwent preoperative nTMS, yielding 1,193 bilateral RMT observations. Variables included age, sex, tumor volume, peritumoral edema, tumor side, skull-to-cortex distance (SCD), recurrence, motor deficits, tumor dominance, handedness, histology, anatomical location, and use of anticonvulsants, benzodiazepines, corticosteroids, or antidepressants. Linear mixed models were applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      RMT showed substantial inter-individual variability (mean 34\u2009\u00b1\u20098%, range 15\u201386%). Higher RMT included smaller peritumoral edema (estimate: -0.01; 95% CI:\n                      <jats:bold>-<\/jats:bold>\n                      0.03, -0.001;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032), greater SCD (estimate: 0.85; 95% CI: 0.63, 1.09;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and presence of motor deficits (estimate: 2.26; 95% CI: 0.89, 3.64;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). Tumors outside the central region were associated with lower RMT (estimate: -1.87; 95% CI: -3.26, -0.47;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010). Medication analysis revealed that carbamazepine (estimate: 3.82; 95% CI: 0.81, 6.87;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014), benzodiazepines (estimate: 3.45; 95% CI: 1.11, 5.78;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004), and corticosteroids increased RMT (estimate: 1.56; 95% CI: 0.03, 3.09;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.049), whereas antidepressants decreased it (estimate: -3.24; 95% CI: -5.90, -0.58;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019). Other factors showed no statistically significant effect.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study modeled the influence of clinical and anatomical factors on corticospinal excitability. This highlights the need for consideration of these variables when interpreting intervention-related changes in RMT or for risk stratification. Notably, the detailed analysis of common neurosurgical medications on RMT is unprecedented, emphasizing the importance of considering these factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-025-06726-x","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T20:26:03Z","timestamp":1764620763000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Resting motor threshold in navigated transcranial magnetic stimulation: relationship between inter-individual variance and distinct clinical and anatomical factors"],"prefix":"10.1007","volume":"167","author":[{"given":"Felipe Monte","family":"Santo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heike","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tizian","family":"Rosenstock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismael","family":"Moser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maren","family":"Denker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vajkoczy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Picht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melina","family":"Engelhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"6726_CR1","doi-asserted-by":"publisher","first-page":"146","DOI":"10.4161\/chan.24380","volume":"7","author":"M Abdelsayed","year":"2013","unstructured":"Abdelsayed M, Sokolov S (2013) Voltage-gated sodium channels: pharmaceutical targets via anticonvulsants to treat epileptic syndromes. 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