Mechanisms and Applications of Theta-burst rTMS on the Human Motor Cortex

Cárdenas-Morales, Lizbeth; Nowak, Dennis A.; Kammer, Thomas; Wolf, Robert Christian; Schönfeldt‐Lecuona, Carlos

doi:10.1007/s10548-009-0084-7

Cited by 165 publications

(121 citation statements)

References 102 publications

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“…ITBS applied to the primary motor cortex (M1) generates a facilitatory effect reflected by an increase in the amplitude of compound muscle action potentials (cMAPs) evoked by single-pulse TMS. By contrast, cTBS induces inhibitory effects [Cárdenas-Morales et al, 2010;Huang et al, 2005].…”

Section: Introductionmentioning

confidence: 89%

Exploring the after‐effects of theta burst magnetic stimulation on the human motor cortex: A functional imaging study

Cárdenas-Morales¹,

Grön²,

Kammer³

2010

Human Brain Mapping

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Theta burst stimulation (TBS) is a protocol of subthreshold repetitive transcranial magnetic stimulation (rTMS) inducing changes in cortical excitability. From functional imaging studies with conventional subthreshold rTMS protocols, it remains unclear what type of modulation occurs (direction and dependency to neural activity) and whether putative effects are bound to unspecific changes in cerebral perfusion or require a functional challenge. In a within-subjects (n = 17) repeated measurement design including real TBS and a control session without stimulation, we examined neural activation in a choice-reaction task after application of intermittent TBS, a protocol, which enhances cortical excitability over the left motor cortex (M1). Brain activity was monitored by blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging interleaved with measuring regional cerebral blood flow (rCBF) at rest using MR-based perfusion imaging. On a separate day, TMS-induced compound muscle action potentials (cMAPs) amplitude of the right hand was measured after excitatory TBS. Compared to control, a significant decrease in BOLD signal due to right hand motor activity during the choice-reaction task was observed mainly in the stimulated M1 and motor-related remote areas after stimulation. This decrease might represent a facilitating effect, because cMAPs amplitude increased upon TBS compared to control. No changes in rCBF at rest were observed. The data demonstrate that subthreshold intermittent TBS targets both the stimulated cortical area as well as remote areas. The facilitation changing the efficacy of neural signal transmission seems to be reflected by a BOLD signal decrease, whereas the network at rest does not appear to be affected.

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Section: Introductionmentioning

confidence: 89%

Exploring the after‐effects of theta burst magnetic stimulation on the human motor cortex: A functional imaging study

Cárdenas-Morales¹,

Grön²,

Kammer³

2010

Human Brain Mapping

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“…cTBS was specifically developed to probe plasticity mechanisms (Huang et al 2005(Huang et al , 2007Cardenas-Morales et al 2010) and involves application of three pulses of 50-Hz rTMS repeated every 200 ms for a total of 40 seconds (for total of 600 pulses) at an intensity of 80% of the active motor threshold (AMT) (Huang et al 2005(Huang et al , 2008. After cTBS is applied to the motor cortex, TMS-induced MEPs typically show decreased amplitude for a period of 20-30 minutes in healthy adult brains.…”

Section: Introductionmentioning

confidence: 99%

Abnormal Mechanisms of Plasticity and Metaplasticity in Autism Spectrum Disorders and Fragile X Syndrome

ObermanLindsay

Ifert-MillerFritz

Najib

et al. 2016

Journal of Child and Adolescent Psychopharmacology

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Objectives: Multiple lines of evidence from genetic linkage studies to animal models implicate aberrant cortical plasticity and metaplasticity in the pathophysiology of autism spectrum disorder (ASD) and fragile X syndrome (FXS). However, direct experimental evidence of these alterations in humans with these disorders is scarce. Transcranial magnetic stimulation (TMS) is a noninvasive tool for probing mechanisms of plasticity and metaplasticity in vivo, in humans. The aim of the current study was to examine mechanisms of plasticity and metaplasticity in humans with ASD and FXS. We employed a repetitive TMS protocol developed specifically to probe cortical plasticity, namely continuous theta burst stimulation (cTBS).Methods: We applied a 40-second train of cTBS to primary motor cortex (M1) to healthy control participants and individuals with ASD or FXS, and we measured the cTBS-induced modulation in motor-evoked potentials (MEPs) in a contralateral intrinsic hand muscle. Each participant completed two sessions of the same protocol on two consecutive days. The degree of modulation in MEPs after cTBS on the first day was evaluated as a putative index of cortical plasticity. Examination of the changes in the effects of cTBS on the second day, as conditioned by the effects on the first day, provided an index of metaplasticity, or the propensity of a given cortical region to undergo plastic change based on its recent history. Results: After a 40-second cTBS train, individuals with ASD show a significantly longer duration of suppression in MEP amplitude as compared with healthy controls, whereas individuals with FXS show a significantly shorter duration. After a second train of cTBS, 24 hours later, the ASD group was indistinguishable from the control group, and while in the FXS group MEPs were paradoxically facilitated by cTBS. Conclusion: These findings offer insights into the pathophysiology of ASD and FXS, specifically providing direct experimental evidence that humans with these disorders show distinct alterations in plasticity and metaplasticity, consistent with the findings in animal models. If confirmed in larger test-retest studies, repeated TMS measures of plasticity and metaplasticity may provide a valuable physiologic phenotype for ASD and FXS.

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“…Two main modalities of TBS have been tested. Intermittent TBS (iTBS) induces the facilitation of motor cortical excitability, whereas continuous TBS (cTBS) leads to inhibition for 15-30 min after application [25,26].…”

Section: Transcranial Magnetic Stimulation (Tms)mentioning

confidence: 99%

Repetitive Transcranial Magnetic Stimulation for Clinical Applications in Neurological and Psychiatric Disorders: An Overview

Machado¹,

Arias-Carrión

Paes

et al. 2013

EAJM

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Neurological and psychiatric disorders are characterized by several disabling symptoms for which effective, mechanism-based treatments remain elusive. Consequently, more advanced non-invasive therapeutic methods are required. A method that may modulate brain activity and be viable for use in clinical practice is repetitive transcranial magnetic stimulation (rTMS). It is a non-invasive procedure whereby a pulsed magnetic field stimulates electrical activity in the brain. Here, we focus on the basic foundation of rTMS, the main stimulation parametters, the factors that influence individual responses to rTMS and the experimental advances of rTMS that may become a viable clinical application to treat neurological and psychiatric disorders. The findings showed that rTMS can improve some symptoms associated with these conditions and might be useful for promoting cortical plasticity in patients with neurological and psychiatric disorders. However, these changes are transient and it is premature to propose these applications as realistic therapeutic options, even though the rTMS technique has been evidenced as a potential modulator of sensorimotor integration and neuroplasticity. Functional imaging of the region of interest could highlight the capacity of rTMS to bring about plastic changes of the cortical circuitry and hint at future novel clinical interventions. Thus, we recommend that further studies clearly determine the role of rTMS in the treatment of these conditions. Finally, we must remember that however exciting the neurobiological mechanisms might be, the clinical usefulness of rTMS will be determined by its ability to provide patients with neurological and psychiatric disorders with safe, long-lasting and substantial improvements in quality of life.

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Mechanisms and Applications of Theta-burst rTMS on the Human Motor Cortex

Cited by 165 publications

References 102 publications

Exploring the after‐effects of theta burst magnetic stimulation on the human motor cortex: A functional imaging study

Exploring the after‐effects of theta burst magnetic stimulation on the human motor cortex: A functional imaging study

Abnormal Mechanisms of Plasticity and Metaplasticity in Autism Spectrum Disorders and Fragile X Syndrome

Repetitive Transcranial Magnetic Stimulation for Clinical Applications in Neurological and Psychiatric Disorders: An Overview

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