title: Quadro-pulse stimulation is more effective than paired-pulse stimulation for plasticity induction of the human motor cortex.
abstract: OBJECTIVE
  Repetitive paired-pulse transcranial magnetic stimulation (TMS) at I-wave periodicity has been shown to induce a motor-evoked potential (MEP) facilitation. We hypothesized that a greater enhancement of motor cortical excitability is provoked by increasing the number of pulses per train beyond those by paired-pulse stimulation (PPS).
  
  
  METHODS
  We explored motor cortical excitability changes induced by repetitive application of trains of four monophasic magnetic pulses (quadro-pulse stimulation: QPS) at 1.5-ms intervals, repeated every 5s over the motor cortex projecting to the hand muscles. The aftereffects of QPS were evaluated with MEPs to a single-pulse TMS, motor threshold (MT), and responses to brain-stem stimulation. These effects were compared to those after PPS. To evaluate the QPS safety, we also studied the spread of excitation and after discharge using surface electromyograms (EMGs) of hand and arm muscles.
  
  
  RESULTS
  Sizes of MEPs from the hand muscle were enhanced for longer than 75min after QPS; they reverted to the baseline at 90min. Responses to brain-stem stimulation from the hand muscle and cortical MEPs from the forearm muscle were unchanged after QPS over the hand motor area. MT was unaffected by QPS. No spreads of excitation were detected after QPS. The appearance rate of after discharges during QPS was not different from that during sham stimulation.
  
  
  CONCLUSIONS
  Results show that QPS can safely induce long-lasting, topographically specific enhancement of motor cortical excitability.
  
  
  CONCLUSIONS
  QPS is more effective than PPS for inducing motor cortical plasticity.
authors.affiliation: Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. mhamada-tky@umin.ac.jp
authors.forename: Masashi
authors.initials: M
authors.lastname: Hamada
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Hanajima
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Terao
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Arai
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Furubayashi
authors.forename: Satomi
authors.initials: S
authors.lastname: Inomata-Terada
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yugeta
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Shirota
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Ugawa
mesh_terms: D000200:Action Potentials / Q000502:physiology; D000328:Adult; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D006225:Hand / Q000294:innervation / Q000502:physiology; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000033:anatomy & histology / Q000502:physiology*; D009068:Movement / Q000502:physiology; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000294:innervation / Q000502:physiology*; D009431:Neural Conduction / Q000502:physiology; D009473:Neuronal Plasticity / Q000502:physiology*; D011712:Pyramidal Tracts / Q000502:physiology*; D011930:Reaction Time / Q000502:physiology; D050781:Transcranial Magnetic Stimulation / Q000379:methods*