title: Daily iTBS worsens hand motor training--a combined TMS, fMRI and mirror training study.
abstract: BACKGROUND
  Repetitive transcranial magnetic stimulation (rTMS) is used to increase regional excitability to improve motor function in combination with training after neurological diseases or events such as stroke. We investigated whether a daily application of intermittent theta burst stimulation (iTBS; a short-duration rTMS that increases regional excitability) improves the training effect compared with sham stimulation in association with a four-day hand training program using a mirror (mirror training, MT). The right dorsal premotor cortex (dPMC right) was chosen as the target region for iTBS because this region has recently been emphasized as a node within a network related to MT.
  
  
  METHODS
  Healthy subjects were randomized into the iTBS group or sham group (control group CG). In the iTBS group, iTBS was applied daily over dPMC right, which was functionally determined in an initial fMRI session prior to starting MT. MT involved 20 min of hand training daily in a mirror over four days. The hand tests, the intracortical excitability and fMRI were evaluated prior to and at the end of MT.
  
  
  RESULTS
  The results of the hand training tests of the iTBS group were surprisingly significantly poorer compared with those from the CG group. Both groups showed a different course of excitability in both M1 and a different course of fMRI activation within the supplementary motor area and M1 left.
  
  
  CONCLUSIONS
  We suggest the inter-regional functional balance was affected by daily iTBS over dPMC right. Maybe an inter-regional connectivity within a network is differentially balanced. An excitability increase within an inhibitory-balanced network would therefore disturb the underlying network.
authors.affiliation: Department of Neurology, University Medical Centre, Freiburg, Germany. Electronic address: claus.henning.laeppchen@uniklinik-freiburg.de.
authors.forename: C H
authors.initials: CH
authors.lastname: Läppchen
authors.affiliation: Section of Neurological Rehabilitation, Hans Berger Department of Neurology, Jena University Hospital, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Ringer
authors.affiliation: Section of Neurological Rehabilitation, Hans Berger Department of Neurology, Jena University Hospital, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Blessin
authors.affiliation: Section of Neurological Rehabilitation, Hans Berger Department of Neurology, Jena University Hospital, Germany; Department of Neurology, Moritz Klinik Bad Klosterlausnitz, Germany; Center for Sepsis Control and Care, Jena University Hospital, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Schulz
authors.affiliation: Section of Neurological Rehabilitation, Hans Berger Department of Neurology, Jena University Hospital, Germany; Department of Neurology, Moritz Klinik Bad Klosterlausnitz, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Seidel
authors.affiliation: Department of Neurology, Nuremberg Municipal Hospital, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Lange
authors.affiliation: Section of Neurological Rehabilitation, Hans Berger Department of Neurology, Jena University Hospital, Germany; Department of Neurology, Moritz Klinik Bad Klosterlausnitz, Germany; Center for Sepsis Control and Care, Jena University Hospital, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Hamzei
mesh_terms: D000328:Adult; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007858:Learning / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D059167:Mirror Neurons / Q000502:physiology; D009044:Motor Cortex / Q000502:physiology; D009048:Motor Skills / Q000502:physiology*; D009473:Neuronal Plasticity / Q000502:physiology; D011597:Psychomotor Performance / Q000502:physiology; D011897:Random Allocation; D013826:Theta Rhythm / Q000502:physiology; D050781:Transcranial Magnetic Stimulation; D055815:Young Adult
keywords: Motor training; Neuroplasticity; TBS; TMS; Theta burst stimulation; fMRI