title: Frequency specific changes in regional cerebral blood flow and motor system connectivity following rTMS to the primary motor cortex.
abstract: Repetitive transcranial magnetic stimulation (rTMS) to the human primary motor cortex (M1) causes bidirectional changes in corticospinal excitability depending on the stimulation frequency used. We used functional brain imaging to compare the effects of 5 Hz and 1 Hz-rTMS on local and inter-regional connectivity within the motor system. Regional cerebral blood flow (rCBF) was measured as a marker of synaptic activity at rest and during freely selected finger movements. We hypothesized that increased cortical excitability induced by 5 Hz-rTMS over M1 has an opposite effect on the synaptic activity and the connectivity of the motor network from the decreased cortical excitability induced by 1 Hz-rTMS. rTMS at both frequencies induced similar changes in rCBF at the site of stimulation and within areas of the motor network engaged by the task. The two frequencies showed different effects on movement-related coupling between motor areas. Connectivity analyses also indicated a differential effect of 5 and 1 Hz-rTMS on motor network connectivity, suggesting a role for an inferomedial portion of left M1 and left dorsal premotor cortex in maintaining performance. These results suggest that rapid reorganization of the motor system occurs to maintain task performance during periods of altered cortical excitability. This reorganization differs according to the modulation of excitability which is a function of rTMS frequency. This study extends the work of Lee et al. (Lee, L., Siebner, H.R., Rowe, J.B., Rizzo, V. Rothwell, J.C. Frackowiak, R.S. Friston, K.J., 2003. Acute remapping within the motor system induced by low-frequency repetitive transcranial magnetic stimulation. J. Neurosci. 23, 5308-5318.) by providing evidence that the pattern of acute reorganization in the motor network following rTMS depends on the direction of conditioning.
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, UK. e.rounis@ion.ucl.ac.uk
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Rounis
authors.forename: Lucy
authors.initials: L
authors.lastname: Lee
authors.forename: Hartwig R
authors.initials: HR
authors.lastname: Siebner
authors.forename: James B
authors.initials: JB
authors.lastname: Rowe
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Friston
authors.forename: John C
authors.initials: JC
authors.lastname: Rothwell
authors.forename: Richard S J
authors.initials: RS
authors.lastname: Frackowiak
mesh_terms: D000328:Adult; D000368:Aged; D002560:Cerebrovascular Circulation / Q000502:physiology*; D004525:Efferent Pathways / Q000000981:diagnostic imaging / Q000502:physiology*; D004574:Electromagnetic Fields; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000000981:diagnostic imaging / Q000502:physiology*; D009068:Movement / Q000502:physiology; D049268:Positron-Emission Tomography; D011597:Psychomotor Performance / Q000502:physiology