title: Reliability and Variability of tDCS Induced Changes in the Lower Limb Motor Cortex.
abstract: BACKGROUND
  Transcranial direct current stimulation (tDCS) is emerging as a promising adjuvant to enhance motor function. However, there has been increasing reservations about the reliability and variability of the neuromodulatory effects evoked by tDCS.
  
  
  OBJECTIVE
  The main purpose of this study was to explore the test-retest reliability and inter-individual variability of tDCS of the lower limb M1 and the relationship between transcranial magnetic stimulation (TMS)-related measures and tDCS-induced changes.
  
  
  METHODS
  Fifteen healthy participants received anodal tDCS of the lower limb M1 either when performing a lower limb motor task or when the limb was at rest. Each condition was tested twice. tDCS induced changes in corticomotor excitability of the tibialis anterior muscle were measured using TMS. A repeated measures ANOVA was performed to examine efficacy of tDCS between the two task conditions. Intraclass correlation coefficients (ICC) and variance component analyses were performed to examine reliability and variability respectively.
  
  
  RESULTS
  A significant increase in in corticomotor excitability was noted for the tDCS-task condition at 140% active motor threshold (AMT) and when comparing recruitment curve slopes, but not at 120% and 130% AMT. Overall, ICC values between testing days for each stimulation condition ranged from 0.6-0.9. Higher ICCs were seen for higher TMS intensities (140% AMT) and recruitment curve slopes. Inter-individual variability contributed to 34% of the exhibited variance.
  
  
  CONCLUSIONS
  Our data suggest that the TMS-related measure used to assess neuromodulation after tDCS has an effect on its perceived test-retest reliability and inter-individual variability. Importantly, we noticed that a high reliability and low variability does not necessarily indicate clinical efficacy of tDCS as some participants showed little to no modulation of corticomotor excitability consistently.
authors.affiliation: Department of Physical Therapy, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL 60612, USA. smadhava@uic.edu.
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Madhavan
authors.affiliation: Department of Physical Therapy, University of Illinois at Chicago, 1919 W. Taylor St., MC 898, Chicago, IL 60612, USA. aishsriraman@gmail.com.
authors.forename: Aishwarya
authors.initials: A
authors.lastname: Sriraman
authors.affiliation: Department of Epidemiology and Biostatistics, University of Illinois at Chicago, 1603 W. Taylor Street, Chicago, IL 60612, USA. sallyf@uic.edu.
authors.forename: Sally
authors.initials: S
authors.lastname: Freels
keywords: TMS; lower limb; motor cortex; reliability; tDCS; tibialis anterior; variability