title: Breaks during 5Hz rTMS are essential for facilitatory after effects.
abstract: OBJECTIVE
  Stimulation frequency has been considered the most important factor in conventional repetitive transcranial magnetic stimulation (rTMS) for determining the direction of after effects on corticospinal excitability. Here, we examined the functional relevance of breaks during high-frequency subthreshold rTMS for the induction of facilitatory after effects.
  
  
  METHODS
  The after effects on corticospinal excitability of a standard 5Hz rTMS protocol in a block design were compared to a continuous rTMS protocol using the same number of pulses. In addition the effect of current direction both for rTMS and single pulse TMS was included in the study design.
  
  
  RESULTS
  While 5Hz rTMS in a standard block design induces facilitatory after effects on corticospinal excitability, the continuous protocol does not induce facilitation but rather inhibition. In our study only rTMS using an initially posterior-anterior current direction in the brain leads to significant neuroplastic effects at all.
  
  
  CONCLUSIONS
  Breaks during conventional high-frequency rTMS are a crucial factor determining the direction of induced neuroplastic changes.
  
  
  CONCLUSIONS
  These results contribute to the understanding of rTMS-induced neuroplasticity and are important for the design of rTMS protocols both for experimental and clinical studies.
authors.affiliation: Department of Clinical Neurophysiology, University of Göttingen, Göttingen, Germany. hrothke@gwdg.de
authors.forename: H
authors.initials: H
authors.lastname: Rothkegel
authors.forename: M
authors.initials: M
authors.lastname: Sommer
authors.forename: W
authors.initials: W
authors.lastname: Paulus
mesh_terms: D000328:Adult; D004574:Electromagnetic Fields; D019054:Evoked Potentials, Motor / Q000502:physiology* / Q000528:radiation effects; D005260:Female; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000502:physiology* / Q000528:radiation effects; D018482:Muscle, Skeletal / Q000294:innervation / Q000502:physiology*; D009433:Neural Inhibition / Q000502:physiology; D009473:Neuronal Plasticity / Q000502:physiology; D011712:Pyramidal Tracts / Q000502:physiology* / Q000528:radiation effects; D011930:Reaction Time / Q000502:physiology; D009435:Synaptic Transmission / Q000502:physiology; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D055815:Young Adult