Modulation of motor cortex neuronal networks by rTMS: Comparison of local and remote effects of six different protocols of stimulation

V. di Lazzaro, M. Dileone, F. Pilato, F. Capone, G. Musumeci, F. Ranieri, V. Ricci, P. Bria, R. Di Iorio, C. de Waure, P. Pasqualetti, P. Profice

Research output: Contribution to journalArticlepeer-review


Repetitive transcranial magnetic stimulation (rTMS) of human motor cortex can produce long-lasting changes in the excitability of excitatory and inhibitory neuronal networks. The effects of rTMS depend critically on stimulus frequency. The aim of our present study was to compare the effects of different rTMS protocols. We compared the aftereffects of 6 different rTMS protocols [paired associative stimulation at interstimulus intervals of 25 (PAS 25) and 10 ms (PAS 10); theta burst stimulation delivered as continuous (cTBS) or intermittent delivery pattern (iTBS); 1- and 5-Hz rTMS] on the excitability of stimulated and contralateral motor cortex in 10 healthy subjects. A pronounced increase of cortical excitability, evaluated by measuring the amplitude of motor evoked potentials (MEPs), was produced by iTBS (+56%) and PAS 25 (+45%). Five-hertz rTMS did not produce a significant increase of MEPs. A pronounced decrease of cortical excitability was produced by PAS 10 (-31%), cTBS (-29%), and 1-Hz rTMS (-20%). Short-interval intracortical inhibition was suppressed by PAS 10. Cortical silent period duration was increased by 1-Hz stimulation. No significant effect was observed in the contralateral hemisphere. Head-to-head comparison of the different protocols enabled us to identify the most effective paradigms for modulating the excitatory and inhibitory circuits activated by TMS.

Original languageEnglish
Pages (from-to)2150-2156
Number of pages7
JournalJournal of Neurophysiology
Issue number5
Publication statusPublished - May 2011


  • Brain plasticity
  • Brain stimulation
  • Long-term depression
  • Long-term potentiation
  • Repetitive transcranial magnetic stimulation

ASJC Scopus subject areas

  • Physiology
  • Neuroscience(all)


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