title: Preconditioning with transcranial direct current stimulation sensitizes the motor cortex to rapid-rate transcranial magnetic stimulation and controls the direction of after-effects.
abstract: BACKGROUND
  Rapid-rate repetitive transcranial magnetic stimulation (rTMS) can produce a lasting increase in cortical excitability in healthy subjects or induce beneficial effects in patients with neuropsychiatric disorders; however, the conditioning effects of rTMS are often subtle and variable, limiting therapeutic applications. Here we show that magnitude and direction of after-effects induced by rapid-rate rTMS depend on the state of cortical excitability before stimulation and can be tuned by preconditioning with transcranial direct current stimulation (tDCS).
  
  
  METHODS
  Ten healthy volunteers received a 20-sec train of 5-Hz rTMS given at an intensity of individual active motor threshold to the left primary motor hand area. This interventional protocol was preconditioned by 10 min of anodal, cathodal, or sham tDCS. We used single-pulse TMS to assess corticospinal excitability at rest before, between, and after the two interventions.
  
  
  RESULTS
  The 5-Hz rTMS given after sham tDCS failed to produce any after-effect, whereas 5-Hz rTMS led to a marked shift in corticospinal excitability when given after effective tDCS. The direction of rTMS-induced plasticity critically depended on the polarity of tDCS conditioning.
  
  
  CONCLUSIONS
  Preconditioning with tDCS enhances cortical plasticity induced by rapid-rate rTMS and can shape the direction of rTMS-induced after-effects.
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom. nlang@gwdg.de
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lang
authors.forename: Hartwig R
authors.initials: HR
authors.lastname: Siebner
authors.forename: Diana
authors.initials: D
authors.lastname: Ernst
authors.forename: Michael A
authors.initials: MA
authors.lastname: Nitsche
authors.forename: Walter
authors.initials: W
authors.lastname: Paulus
authors.forename: Roger N
authors.initials: RN
authors.lastname: Lemon
authors.forename: John C
authors.initials: JC
authors.lastname: Rothwell
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D004056:Differential Threshold / Q000528:radiation effects; D004558:Electric Stimulation; D004566:Electrodes; D004576:Electromyography / Q000379:methods; D019054:Evoked Potentials, Motor / Q000502:physiology / Q000528:radiation effects; D005260:Female; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000528:radiation effects*; D009473:Neuronal Plasticity / Q000528:radiation effects*; D050781:Transcranial Magnetic Stimulation