Use of theta-burst stimulation in changing excitability of motor cortex: A systematic review and meta-analysis

Chung, Sung Wook; Hill, Aron T.; Rogasch, Nigel C.; Hoy, Kate Elizabeth; Fitzgerald, Paul B.

doi:10.1016/j.neubiorev.2016.01.008

Cited by 207 publications

(207 citation statements)

References 122 publications

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“…The researchers therefore proposed that cTBS reduces the effectiveness of synaptic connections, whereas iTBS does the opposite in both glutamatergic and GABAergic circuits under the TMS coil (Huang et al, 2005). A comprehensive meta-analysis indicated that cTBS reduced the MEP amplitude for up to 60 min (pooled standard mean difference [SMD] of −0.9, p < .00001), whereas iTBS increases the MEP amplitude for up to 30 min (pooled SMD = 0.71, p < .00001) (Chung, Hill, Rogasch, Hoy, & Fitzgerald, 2016) ( Figure 1b). By contrast, findings on the effects of TBS on SICI and ICF have been inconsistent, with the exception of a reported decrease in SICI during the initial 5 min of cTBS (SMD = 0.42, p = .00036) (Chung et al, 2016).…”

Section: Theta Burst Stimulation Overview and Ltp-/ Ltd-like After-mentioning

confidence: 99%

“…A comprehensive meta-analysis indicated that cTBS reduced the MEP amplitude for up to 60 min (pooled standard mean difference [SMD] of −0.9, p < .00001), whereas iTBS increases the MEP amplitude for up to 30 min (pooled SMD = 0.71, p < .00001) (Chung, Hill, Rogasch, Hoy, & Fitzgerald, 2016) ( Figure 1b). By contrast, findings on the effects of TBS on SICI and ICF have been inconsistent, with the exception of a reported decrease in SICI during the initial 5 min of cTBS (SMD = 0.42, p = .00036) (Chung et al, 2016). The changes in corticospinal excitability may involve LTP-and LTD-like effects on the cortical synapses (Huang et al, 2009(Huang et al, , 2011(Huang et al, , 2017Huang, Rothwell, Edwards, & Chen, 2008).…”

Section: Theta Burst Stimulation Overview and Ltp-/ Ltd-like After-mentioning

confidence: 99%

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Critical role of glutamatergic and GABAergic neurotransmission in the central mechanisms of theta‐burst stimulation

Huang

Bai

et al. 2019

Human Brain Mapping

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Theta‐burst stimulation (TBS) is a varied form of repetitive transcranial magnetic stimulation (rTMS) and has more rapid and powerful effects than rTMS. Experiments on the human motor cortex have demonstrated that intermittent TBS has facilitatory effects, whereas continuous TBS has inhibitory effects. Huang's simplified model provides a solid basis for elucidating such after‐effects. However, evidence increasingly indicates that not all after‐effects of TBS are as expected, and high variability among individuals has been observed. Studies have suggested that the GABAergic and glutamatergic neurotransmission play a vital role in the aforementioned after‐effects, which might explain the interindividual differences in these after‐effects. Herein, we reviewed the latest findings on TBS from animal and human experiments on glutamatergic and GABAergic neurotransmissions in response to TBS. Furthermore, an updated theoretical model integrating glutamatergic and GABAergic neurotransmissions is proposed.

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Section: Theta Burst Stimulation Overview and Ltp-/ Ltd-like After-mentioning

confidence: 99%

Section: Theta Burst Stimulation Overview and Ltp-/ Ltd-like After-mentioning

confidence: 99%

Critical role of glutamatergic and GABAergic neurotransmission in the central mechanisms of theta‐burst stimulation

Huang

Bai

et al. 2019

Human Brain Mapping

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“…A large body of evidence, mainly in studies with small sample sizes (e.g., n < 15), has suggested that iTBS paradigms increase excitability in the motor cortex (Wischnewski & Schutter, 2015). Furthermore, a recent meta-analysis demonstrated a degree of publication bias which suggests overestimation of the stimulation effect in the literature (Chung et al, 2016). Furthermore, a recent meta-analysis demonstrated a degree of publication bias which suggests overestimation of the stimulation effect in the literature (Chung et al, 2016).…”

Section: Effect Of Individualised Itbs On Plastic Effects In the Prmentioning

confidence: 99%

“…While it is speculative, the correlations between working memory performance and the ratio of P60 and N100 may partially be explained by the well-maintained modulation of potential inhibition (N100) and excitation (P60) (Noda, Zomorrodi, Cash, et al, 2017d). In general, the effect of 50 Hz iTBS in the motor cortex lasts up to 30 min (Chung et al, 2016). The physiological changes, namely Δ P60 and Δ N100, did not correlate with the performance change by themselves, but rather the ratio between the changes in these peaks corresponded with the change in performance.…”

Section: Relationship Between Neurophysiological Changes and The Chmentioning

confidence: 99%

The effects of individualised intermittent theta burst stimulation in the prefrontal cortex: A TMS‐EEG study

Chung

Sullivan

Rogasch

et al. 2018

Human Brain Mapping

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Recent studies have highlighted variability in response to theta burst stimulation (TBS) in humans. TBS paradigm was originally developed in rodents to mimic gamma bursts coupled with theta rhythms, and was shown to elicit long‐term potentiation. The protocol was subsequently adapted for humans using standardised frequencies of stimulation. However, each individual has different rhythmic firing pattern. The present study sought to explore whether individualised intermittent TBS (Ind iTBS) could outperform the effects of two other iTBS variants. Twenty healthy volunteers received iTBS over left prefrontal cortex using 30 Hz at 6 Hz, 50 Hz at 5 Hz, or individualised frequency in separate sessions. Ind iTBS was determined using theta‐gamma coupling during the 3‐back task. Concurrent use of transcranial magnetic stimulation and electroencephalography (TMS‐EEG) was used to track changes in cortical plasticity. We also utilised mood ratings using a visual analogue scale and assessed working memory via the 3‐back task before and after stimulation. No group‐level effect was observed following either 30 or 50 Hz iTBS in TMS‐EEG. Ind iTBS significantly increased the amplitude of the TMS‐evoked P60, and decreased N100 and P200 amplitudes. A significant positive correlation between neurophysiological change and change in mood rating was also observed. Improved accuracy in the 3‐back task was observed following both 50 Hz and Ind iTBS conditions. These findings highlight the critical importance of frequency in the parameter space of iTBS. Tailored stimulation parameters appear more efficacious than standard paradigms in neurophysiological and mood changes. This novel approach presents a promising option and benefits may extend to clinical applications.

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“…It produces a moderate but highly variable facilitation of motor evoked potentials (MEPs) (potentiation of ∼20–30% and ∼50% of responders) [5], [6], [7]. Previous work has shown the concurrent application of TDCS can modulate the response to theta burst protocols when TDCS is applied directly over the motor cortex [8].…”

Section: Introductionmentioning

confidence: 99%

Modulation of iTBS after-effects via concurrent directional TDCS: A proof of principle study

et al. 2017

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BackgroundPolarising currents can modulate membrane potentials in animals, affecting the after-effect of theta burst stimulation (TBS) on synaptic strength.ObjectiveWe examined whether a similar phenomenon could also be observed in human motor cortex (M1) using transcranial direct current stimulation (TDCS) during monophasic intermittent TBS (iTBS).MethodsTDCS was applied during posterior-anterior iTBS using three different conditions: posterior-anterior TDCS (anode 3.5 cm posterior to M1, cathode 3.5 cm anterior to M1), anterior-posterior TDCS (cathode 3.5 cm posterior to M1, anode 3.5 cm anterior to M1), and sham TDCS.ResultsWhen the direction of TDCS (posterior-anterior) matched the direction of the electrical field induced by iTBS, we found a 19% non-significant increase in excitability changes in comparison with iTBS combined with sham TDCS. When the TDCS was reversed (anterior-posterior), the excitatory effect of iTBS was abolished.ConclusionOur findings suggest that excitatory after-effects of iTBS can be modulated by directionally-specific TDCS.

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Use of theta-burst stimulation in changing excitability of motor cortex: A systematic review and meta-analysis

Cited by 207 publications

References 122 publications

Critical role of glutamatergic and GABAergic neurotransmission in the central mechanisms of theta‐burst stimulation

Critical role of glutamatergic and GABAergic neurotransmission in the central mechanisms of theta‐burst stimulation

The effects of individualised intermittent theta burst stimulation in the prefrontal cortex: A TMS‐EEG study

Modulation of iTBS after-effects via concurrent directional TDCS: A proof of principle study

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