CC BY-NC-ND 4.0 · International Journal of Epilepsy 2016; 03(01): 002-006
DOI: 10.1016/j.ijep.2016.02.003
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Comparison of low frequency repetitive transcranial magnetic stimulation parameters on motor cortex excitability in normal subjects

Lara M. Schrader
a   David Geffen School of Medicine at UCLA, Department of Neurology, Los Angeles, CA 90095, USA
,
Sima Sadeghinejad
a   David Geffen School of Medicine at UCLA, Department of Neurology, Los Angeles, CA 90095, USA
c   Ahmanson-Lovelace Brain Mapping Center, Brain Research Center, David Geffen School of Medicine at UCLA, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
,
Jalleh Sadeghinejad
a   David Geffen School of Medicine at UCLA, Department of Neurology, Los Angeles, CA 90095, USA
c   Ahmanson-Lovelace Brain Mapping Center, Brain Research Center, David Geffen School of Medicine at UCLA, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
,
Movses Kazanchyan
a   David Geffen School of Medicine at UCLA, Department of Neurology, Los Angeles, CA 90095, USA
c   Ahmanson-Lovelace Brain Mapping Center, Brain Research Center, David Geffen School of Medicine at UCLA, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
,
Lisa Koski
b   McGill University, Department of Medicine, Montreal, Quebec, Canada
,
John M. Stern
a   David Geffen School of Medicine at UCLA, Department of Neurology, Los Angeles, CA 90095, USA
,
Allan D. Wu
a   David Geffen School of Medicine at UCLA, Department of Neurology, Los Angeles, CA 90095, USA
,
Marco Iacoboni
c   Ahmanson-Lovelace Brain Mapping Center, Brain Research Center, David Geffen School of Medicine at UCLA, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095, USA
,
Marc R. Nuwer
a   David Geffen School of Medicine at UCLA, Department of Neurology, Los Angeles, CA 90095, USA
› Author Affiliations
Further Information

Publication History

Received: 02 January 2015

Accepted: 22 October 2015

Publication Date:
06 May 2018 (online)

Abstract

Background/objectives Optimal low frequency repetitive transcranial magnetic stimulation (LF-rTMS) parameters for treating epilepsy and other brain disorders are unknown. To address this question, a systematic study of the effects of LF-rTMS frequency and intensity on cortical excitability was performed.

Methods Using a four-period crossover design, subjects were scheduled for four LF-rTMS sessions that were at least four weeks apart. LF-rTMS was delivered as 900 pulses directed at primary motor cortex using four protocols: 0.5 Hz at 90% resting motor threshold (RMT), 0.5 Hz at 110% RMT, 1 Hz at 90% RMT, and 1 Hz at 110% RMT. Motor evoked potential (MEP) amplitude, resting motor threshold (RMT), and cortical silent period (CSP) were measured before, immediately after, and 60 min after LF-rTMS. Each of the four protocols was analyzed separately to compare baseline measurements to those after LF-rTMS.

Results None of the four LF-rTMS protocols produced a trend or significant change in MEP amplitude, RMT, or CSP.

Conclusion The lack of significant effect from the four LF-rTMS protocols indicates that none produced evidence for alteration of cortical excitability. The direct comparison of four LF-rTMS protocols is distinct to this investigation, as most similar studies were exploratory and studied only one or two protocols. The negative result relates only to the methods used in this investigation and does not indicate that LF-rTMS does not alter cortical excitability with other parameters. These results may be useful when designing additional investigations into the effect of LF-rTMS on epilepsy, other disorders, and cortical excitability.

 
  • References

  • 1 Fitzgerald PB, Fountain S, Daskalakis ZJ. A comprehensive review of the effects of rTMS on motor cortical excitability and inhibition. Clin Neurophysiol 117 2006; 2584-2596
  • 2 Wassermann EM, Lisanby SH. Therapeutic application of repetitive transcranial magnetic stimulation: a review. Clin Neurophysiol 112 2001; 1367-1377
  • 3 Cincotta M, Borgheresi A, Gambetti C. et al. Suprathreshold 0.3 Hz repetitive TMS prolongs the cortical silent period: potential implications for therapeutic trials in epilepsy. Clin Neurophysiol 114 2003; 1827-1833
  • 4 Lefaucher JP, Andre-Obadia N, Antal A. et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol 125 2014; 2150-2206
  • 5 Kimiskidis VK, Kugiumtzis D, Papagiannopoulos S, Vlaikidis N. Transcranial magnetic stimulation modulates epileptiform discharges in patients with frontal lobe epilepsy: a preliminary EEG-TMS study. Int J Neural Sys 23 2013; 1250035
  • 6 Brodbeck V, Thut G, Spinelli L. et al. Effects of repetitive transcranial magnetic stimulation on spike pattern and topography in patients with focal epilepsy. Brain Topogr 22 2010; 267-280
  • 7 Kimiskidis VK, Valentin A, Kalviainen R. Transcranial magnetic stimulation for the diagnosis and treatment of epilepsy. Curr Opin Neurol 27 2014; 236-241
  • 8 Pascual-Leone A, Valls-Sole J, Wassermann EM, Hallett M. Responses to rapid-rate transcranial magnetic stimulation of the human motor cortex. Brain 117 Pt (04) 1994; 847-858
  • 9 Chen R, Classen J, Gerloff C. et al. Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation. Neurology 48 1997; 1398-1403
  • 10 Fierro B, Piazza A, Brighina F. et al. Modulation of intracortical inhibition induced by low- and high-frequency repetitive transcranial magnetic stimulation. Exp Brain Res 138 2001; 452-457
  • 11 Fitzgerald PB, Brown TL, Daskalakis ZJ, Chen R, Kulkarni J. Intensity-dependent effects of 1 Hz rTMS on human corticospinal excitability. Clin Neurophysiol 113 2002; 1136-1141
  • 12 Lang N, Harms J, Weyh T. et al. Stimulus intensity and coil characteristics influence the efficacy of rTMS to suppress cortical excitability. Clin Neurophysiol 117 2006; 2292-2301
  • 13 Oldfield RC. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia 9 1971; 97-113
  • 14 Fritz C, Braune HJ, Pylatiuk C, Pohl M. Silent period following transcranial magnetic stimulation: a study of intra- and inter-examiner reliability. Electroencephalogr Clin Neurophysiol 105 1997; 235-240
  • 15 Boroojerdi B, Kopylev L, Battaglia F. et al. Reproducibility of intracortical inhibition and facilitation using the paired-pulse paradigm. Muscle Nerve 23 2000; 1594-1597
  • 16 Brasil-Neto JP, Cohen LG, Panizza M. et al. Optimal focal transcranial magnetic activation of the human motor cortex: effects of coil orientation, shape of the induced current pulse, and stimulus intensity. J Clin Neurophysiol 9 1992; 132-136
  • 17 Romero JR, Anschel D, Sparing R, Gangitano M, Pascual-Leone A. Subthreshold low frequency repetitive transcranial magnetic stimulation selectively decreases facilitation in the motor cortex. Clin Neurophysiol 113 2002; 101-107
  • 18 Modugno N, Curra A, Conte A. et al. Depressed intracortical inhibition after long trains of subthreshold repetitive magnetic stimuli at low frequency. Clin Neurophysiol 114 2003; 2416-2422
  • 19 Daskalakis ZJ, Moller B, Christensen BK. et al. The effects of repetitive transcranial magnetic stimulation on cortical inhibition in healthy human subjects. Exp Brain Res 174 2006; 403-412
  • 20 Pell GS, Roth Y, Zangen A. Modulation of cortical excitability induced by repetitive transcranial magnetic stimulation: influence of timing and geometrical parameters and underlying mechanisms. Prog Neurobiol 93 2011; 59-98
  • 21 Arai N, Okabe S, Furubayashi T. et al. Comparison between short train, monophasic and biphasic repetitive transcranial magnetic stimulation (rTMS) of the human motor cortex. Clin Neurophysiol 116 2005; 605-613
  • 22 Taylor JL, Loo CK. Stimulus waveform influences the efficacy of repetitive transcranial magnetic stimulation. J Affect Disord 97 2007; 271-276
  • 23 Kammer T, Beck S, Erb M, Grodd W. The influence of current direction on phosphene thresholds evoked by transcranial magnetic stimulation. Clin Neurophysiol 112 2001; 2015-2021
  • 24 Kammer T, Beck S, Thielscher A, Laubis-Herrmann U, Topka H. Motor thresholds in humans: a transcranial magnetic stimulation study comparing different pulse waveforms, current directions and stimulator types. Clin Neurophysiol 112 2001; 250-258
  • 25 Antal A, Kincses TZ, Nitsche MA. et al. Pulse configuration-dependent effects of repetitive transcranial magnetic stimulation on visual perception. Neuroreport 13 2002; 2229-2233
  • 26 Gugino LD, Romero JR, Aglio L. et al. Transcranial magnetic stimulation coregistered with MRI: a comparison of a guided versus blind stimulation technique and its effect on evoked compound muscle action potentials. Clin Neurophysiol 112 2001; 1781-1792
  • 27 Wassermann EM. Variation in the response to transcranial magnetic brain stimulation in the general population. Clin Neurophysiol 113 2002; 1165-1171
  • 28 Koski L, Schrader LM, Wu AD, Stern JM. Normative data on changes in transcranial magnetic stimulation measures over a ten hour period. Clin Neurophysiol 116 2005; 2099-2109
  • 29 Sun W, Mao W, Meng X. et al. Low-frequency repetitive transcranial magnetic stimulation for the treatment of refractory partial epilepsy: a controlled clinical study. Epilepsia 53 2012; 1782-1789
  • 30 Rotenberg A. Prospects for clinical applications of transcranial magnetic stimulation and real-time EEG in epilepsy. Brain Topogr 22 2010; 257-266
  • 31 Engel Jr J. Progress in epilepsy: reducing the treatment gap and the promise of biomarkers. Curr Opin Neurol 21 2008; 150-154