Improving visuo-motor learning with cerebellar theta burst stimulation: Behavioral and neurophysiological evidence

Giacomo Koch, Romina Esposito, Caterina Motta, Elias Paolo Casula, Francesco Di Lorenzo, Sonia Bonnì, Alex Martino Cinnera, Viviana Ponzo, Michele Maiella, Silvia Picazio, Martina Assogna, Fabrizio Sallustio, Carlo Caltagirone, Maria Concetta Pellicciari

Research output: Contribution to journalArticlepeer-review


The cerebellum is strongly implicated in learning new motor skills. Theta burst stimulation (TBS), a form of repetitive transcranial magnetic stimulation, can be used to influence cerebellar activity. Our aim was to explore the potential of cerebellar TBS in modulating visuo-motor adaptation, a form of motor learning, in young healthy subjects. Cerebellar TBS was applied immediately before the learning phase of a visuo-motor adaptation task (VAT), in two different experiments. Firstly, we evaluated the behavioral effects of continuous (cTBS), intermittent (iTBS) or sham TBS on the learning, re-adaptation and de-adaptation phases of VAT. Subsequently, we investigated the changes induced by iTBS or sham TBS on motor cortical activity related to each phase of VAT, as measured by concomitant TMS/EEG recordings. We found that cerebellar TBS induced a robust bidirectional modulation of the VAT performance. More specifically, cerebellar iTBS accelerated visuo-motor adaptation, by speeding up error reduction in response to a novel perturbation. This gain of function was still maintained when the novel acquired motor plan was tested during a subsequent phase of re-adaptation. On the other hand, cerebellar cTBS induced the opposite effect, slowing the rate of error reduction in both learning and re-adaptation phases. Additionally, TMS/EEG recordings showed that cerebellar iTBS induced specific changes of cortical activity in the interconnected motor networks. The improved performance was accompanied by an increase of TMS-evoked cortical activity and a generalized desynchronization of TMS-evoked cortical oscillations. Taken together, our behavioral and neurophysiological findings provide the first-time multimodal evidence of the potential efficacy of cerebellar TBS in improving motor learning, by promoting successful cerebellar-cortical reorganization.

Original languageEnglish
Article number116424
Publication statusE-pub ahead of print - Nov 30 2019


  • Cerebellum
  • Cortical excitability
  • Motor cortex
  • Motor learning
  • Oscillatory activity
  • TBS

ASJC Scopus subject areas

  • Neurology
  • Cognitive Neuroscience


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