title: Opposite optimal current flow directions for induction of neuroplasticity and excitation threshold in the human motor cortex.
abstract: BACKGROUND
  Directional sensitivity is relevant for the excitability threshold of the human primary motor cortex, but its importance for externally induced plasticity is unknown.
  
  
  OBJECTIVE
  To study the influence of current direction on two paradigms inducing neuroplasticity by repetitive transcranial magnetic stimulation (rTMS).
  
  
  METHODS
  We studied short-lasting after-effects induced in the human primary motor cortex of 8 healthy subjects, using 5 Hz rTMS applied in six blocks of 200 pulses each, at 90% active motor threshold. We controlled for intensity, frequency, waveform and spinal effects.
  
  
  RESULTS
  Only biphasic pulses with the effective component delivered in an anterioposterior direction (henceforth posteriorly directed) in the brain yielded an increase of motor-evoked potential (MEP) amplitudes outlasting rTMS. MEP latencies and F-wave amplitudes remained unchanged. Biphasic pulses directed posteroanterior (i.e. anteriorly) were ineffective, as were monophasic pulses from either direction. A 1 Hz study in a group of 12 healthy subjects confirmed facilitation after posteriorly directed biphasic pulses only.
  
  
  CONCLUSIONS
  The anisotropy of the human primary motor cortex is relevant for induction of plasticity by subtreshold rTMS, with a current flow opposite to that providing lowest excitability thresholds. This is consistent with the idea of TMS primarily targeting cortical columns of the phylogenetically new M1 in the anterior bank of the central sulcus. For these, anteriorly directed currents are soma-depolarizing, therefore optimal for low thresholds, whereas posteriorly directed currents are soma-hyperpolarizing, likely dendrite-depolarizing and bested suited for induction of plasticity. Our findings should help focus and enhance rTMS effects in experimental and clinical settings.
authors.affiliation: Department of Clinical Neurophysiology, University Medical Center Göttingen, Robert-Koch-Str 40, 37075 Göttingen, Germany. msommer@gwdg.de
authors.forename: Martin
authors.initials: M
authors.lastname: Sommer
authors.forename: Christoph
authors.initials: C
authors.lastname: Norden
authors.forename: Lars
authors.initials: L
authors.lastname: Schmack
authors.forename: Holger
authors.initials: H
authors.lastname: Rothkegel
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lang
authors.forename: Walter
authors.initials: W
authors.lastname: Paulus
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001703:Biophysics; D004056:Differential Threshold; D004558:Electric Stimulation; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000502:physiology*; D009473:Neuronal Plasticity; D011930:Reaction Time / Q000502:physiology; D050781:Transcranial Magnetic Stimulation; D055815:Young Adult