title: Subthreshold low frequency repetitive transcranial magnetic stimulation selectively decreases facilitation in the motor cortex.
abstract: OBJECTIVE
  To investigate the modulatory effect of a subthreshold low frequency repetitive transcranial magnetic stimulation (rTMS) train on motor cortex excitability.
  
  
  METHODS
  The study consisted of two separate experiments. Subjects received a 10 min long subthreshold 1 Hz rTMS train. In the first experiment, (single pulse paradigm), cortical excitability was assessed by measuring the amplitude of motor evoked potentials (MEPs) before and after the rTMS train. In the second experiment, a paired pulse paradigm was employed.
  
  
  RESULTS
  Corticospinal excitability, as measured by the MEP amplitude, was reduced by the rTMS train (experiment 1), with a significant effect lasting for about 10 min after the train completion. There was notable inter-individual as well as intra-individual variability in the effect. rTMS produced a significant decrease in intra-cortical facilitation as measured by the paired pulse paradigm (experiment 2). This effect lasted for up to 15 min following the train. Intra-cortical inhibition was not significantly affected.
  
  
  CONCLUSIONS
  Subthreshold low frequency rTMS depresses cortical excitability beyond the duration of the train. This effect seems primarily due to cortical dysfacilitation. These results have implications on the therapeutic use of rTMS.
authors.affiliation: Laboratory for Magnetic Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Kirstein Building KS 454, Boston, MA 02215, USA.
authors.forename: Jose Rafael
authors.initials: JR
authors.lastname: Romero
authors.forename: David
authors.initials: D
authors.lastname: Anschel
authors.forename: Roland
authors.initials: R
authors.lastname: Sparing
authors.forename: Massimo
authors.initials: M
authors.lastname: Gangitano
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual-Leone
mesh_terms: D000328:Adult; D004574:Electromagnetic Fields; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009415:Nerve Net / Q000502:physiology