title: Effects of low frequency and low intensity repetitive paired pulse stimulation of the primary motor cortex.
abstract: OBJECTIVE
  Following a previous report [Bestmann et al. Clin Neurophysiol 2004;115:755-64] that pairs of subthreshold pulses of transcranial magnetic stimulation (TMS) can show temporal summation, we explored whether repeated application of pairs of stimulation could produce long-lasting after effects on the excitability of the human motor cortex.
  
  
  METHODS
  Twelve healthy subjects received 25 min repetitive paired pulse magnetic stimulation (paired rTMS) given at a frequency of about 0.6 Hz over the left primary motor cortex (500 paired stimuli in total). The interval between the paired stimuli was 3 ms and the intensity of both stimuli was 80% of active motor threshold. The resting and active motor threshold, MEP recruitment curve, short interval intracortical inhibition (SICI) and facilitation, and the duration of the cortical silent period (SP) were tested for the right first interosseous muscle (FDI) before and two times after the end of 25 min paired rTMS.
  
  
  RESULTS
  Prolonged subthreshold paired rTMS produced a significant decrease in excitability in the corticospinal projection to FDI: resting motor threshold was significantly increased and MEP recruitment was significantly decreased, SICI was significantly increased at 2 and 4 ms and the SP was significantly increased in duration.
  
  
  CONCLUSIONS
  Prolonged low frequency paired rTMS at subthreshold intensity can modulate cortical excitability by producing inhibitory effects that outlast the period of stimulation.
authors.affiliation: Department of Neurology, The University Hospital, Assiut, Egypt.
authors.forename: Eman M
authors.initials: EM
authors.lastname: Khedr
authors.forename: Francesca
authors.initials: F
authors.lastname: Gilio
authors.forename: John
authors.initials: J
authors.lastname: Rothwell
mesh_terms: D000293:Adolescent; D000328:Adult; D004558:Electric Stimulation; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D006801:Humans; D008280:Magnetics; D008297:Male; D009044:Motor Cortex / Q000502:physiology*