Theta Burst Stimulation of the Human Motor Cortex

Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK.
Neuron (Impact Factor: 15.05). 02/2005; 45(2):201-6. DOI: 10.1016/j.neuron.2004.12.033
Source: PubMed


It has been 30 years since the discovery that repeated electrical stimulation of neural pathways can lead to long-term potentiation in hippocampal slices. With its relevance to processes such as learning and memory, the technique has produced a vast literature on mechanisms of synaptic plasticity in animal models. To date, the most promising method for transferring these methods to humans is repetitive transcranial magnetic stimulation (rTMS), a noninvasive method of stimulating neural pathways in the brain of conscious subjects through the intact scalp. However, effects on synaptic plasticity reported are often weak, highly variable between individuals, and rarely last longer than 30 min. Here we describe a very rapid method of conditioning the human motor cortex using rTMS that produces a controllable, consistent, long-lasting, and powerful effect on motor cortex physiology and behavior after an application period of only 20-190 s.

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    • "ortical excitability ( Boroojerdi et al . , 2000b ; Brighina et al . , 2002 ; Fierro et al . , 2005 ) . Additionally , rTMS differentially modified the effects of light deprivation on PTs depending on stimulation frequency ( Fierro et al . , 2005 ) . As shown by Franca et al . ( 2006 ) theta burst stimulation ( TBS ) , a particular rTMS protocol ( Huang et al . , 2005 ) , applied with 80% of the individual PT intensity is also able to modulate PTs . Whereas increased PTs were found following continuous TBS ( cTBS ) , intermittent TBS ( iTBS ) showed no modification of PTs ( Franca et al . , 2006 ) ."
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    ABSTRACT: Modulatory effects of repetitive transcranial magnetic stimulation (TMS) depend on the activity of the stimulated cortical area before, during, and even after application. In the present study, we investigated the effects of theta burst stimulation (TBS) on visual cortex excitability using phosphene threshold (PTs). In a between-group design either continuous or intermittent TBS was applied with 100% of individual PT intensity. We varied visual demand following stimulation in form of high demand (acuity task) or low demand (looking at the wall). No change of PTs was observed directly after TBS. We found increased PTs only if subjects had high visual demand following continuous TBS. With low visual demand following stimulation no change of PT was observed. Intermittent TBS had no effect on visual cortex excitability at all. Since other studies showed increased PTs following continuous TBS using subthreshold intensities, our results highlight the importance of stimulation intensity applying TBS to the visual cortex. Furthermore, the state of the neurons in the stimulated cortex area not only before but also following TBS has an important influence on the effects of stimulation, making it necessary to scrupulously control for activity during the whole experimental session in a study.
    Frontiers in Human Neuroscience 10/2015; 9. DOI:10.3389/fnhum.2015.00591 · 3.63 Impact Factor
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    • "This reduction has consistently been seen for durations up to 50 -60 min when cTBS is delivered in a 40- second train of 600 pulses (Gamboa et al., 2011; Gentner, Wankerl, Reinsberger, Zeller, & Classen, 2008; Huang et al., 2005; Wilkinson et al., 2015). A 20-second train of 300 pulses delivered to M1 reduces the MEP for up to 20-30 minutes (Di Lazzaro et al., 2005; Gentner et al., 2008; Huang et al., 2005). Both cTBS durations temporarily impair motor sequence learning on the pSRTT when delivered to M1 (Rosenthal et al., 2009; Wilkinson et al., 2015; Wilkinson et al., 2010). "
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    ABSTRACT: Inhibitory transcranial magnetic stimulation, of which continuous theta burst stimulation (cTBS) is a common form, has been used to inhibit cortical areas during investigations of their function. cTBS applied to the primary motor area (M1) depresses motor output excitability via a local effect and impairs procedural motor learning. This could be due to an effect on M1 itself and/or to changes in its connectivity with other nodes in the learning network. To investigate this issue, we used functional magnetic resonance imaging to measure changes in brain activation and connectivity during implicit procedural learning after real and sham cTBS of M1. Compared to sham, real cTBS impaired motor sequence learning, but caused no local or distant changes in brain activation. Rather, it reduced functional connectivity between motor (M1, dorsal premotor & supplementary motor areas) and visual (superior & inferior occipital gyri) areas. It also increased connectivity between frontal associative (superior & inferior frontal gyri), cingulate (dorsal & middle cingulate), and temporal areas. This potentially compensatory shift in coupling, from a motor-based learning network to an associative learning network accounts for the behavioral effects of cTBS of M1. The findings suggest that the inhibitory transcranial magnetic stimulation affects behavior via relatively subtle and distributed effects on connectivity within networks, rather than by taking the stimulated area “offline.”
    Cortex 10/2015; DOI:10.1016/j.cortex.2015.10.004 · 5.13 Impact Factor
    • "Since other interventions (e.g., antidepressant medication) have been demonstrated to be effective in both psychiatric disorders, its successful use in the treatment of depression makes TMS a promising therapeutic option in anxiety disorders. As there is not enough evidence which suggests to favor one over the other stimulation technique (Lefaucheur et al., 2014), we decided to investigate iTBS over the left DLPFC which is comparable to high frequency rTMS (Huang et al., 2005), since this suits the model of prefrontal top–down control as well as the " valence hypothesis " . However, it should be kept in mind that these hypotheses simplify both, the underlying neural network as well as the mode of action of TMS, which are not fully understood yet and are for sure more complex and involve more brain regions than just the PFC and amygdala. "
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    ABSTRACT: Preliminary evidence suggests beneficial effects of transcranial magnetic stimulation (TMS) on anxiety. The objective of this study was to investigate the effects of intermittent theta burst stimulation (iTBS) as a form of TMS on acute anxiety provoked by a virtual reality (VR) scenario. Participants with spider phobia (n=41) and healthy controls (n=42) were exposed to a spider scenario in VR after one session of iTBS over the prefrontal cortex or sham treatment. Participants with spider phobia reacted with more anxiety compared to healthy controls. Their heart rate and skin conductance increased compared to baseline. Contrary to expectations, iTBS did not influence these reactions, but modulated heart rate variability (HRV). Sympathetic influence on HRV showed an increase in the active iTBS group only. This study does not support the idea of beneficial effects of a single session of iTBS on anxiety, although other protocols or repeated sessions might be effective.
    Biological psychology 10/2015; 112. DOI:10.1016/j.biopsycho.2015.10.003 · 3.40 Impact Factor
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