Elsevier

Brain Stimulation

Volume 1, Issue 3, July 2008, Pages 164-182
Brain Stimulation

Original Research
Consensus: Motor cortex plasticity protocols

https://doi.org/10.1016/j.brs.2008.06.006Get rights and content

Summary

Noninvasive transcranial stimulation is being increasingly used by clinicians and neuroscientists to alter deliberately the status of the human brain. Important applications are the induction of virtual lesions (for example, transient dysfunction) to identify the importance of the stimulated brain network for a certain sensorimotor or cognitive task, and the induction of changes in neuronal excitability, synaptic plasticity or behavioral function outlasting the stimulation, for example, for therapeutic purposes. The aim of this article is to review critically the properties of the different currently used stimulation protocols, including a focus on their particular strengths and weaknesses, to facilitate their appropriate and conscientious application.

Section snippets

Protocols

Some early studies tested motor-evoked potential (MEP) amplitude during a short rTMS train of 20 pulses or less applied to the hand area of the primary motor cortex (M1).1, 2 MEP amplitude does not change during a short low-frequency (1 Hz) rTMS train1, 2 but increases throughout a short high-frequency rTMS (≥2 Hz) train.1, 2, 3 At a stimulation frequency of 5 Hz, this MEP increase depends on stimulus intensity: MEP facilitation is observed at an intensity higher than 110% of resting motor

Protocols

PAS was first described by Classen et al.135 The (right) median nerve is activated by bipolar electrical stimulation at the wrist (cathode proximal, constant current square wave pulses, duration 200 μs, intensity 3× sensory perception threshold). Single-pulse TMS is applied to the hand representation (hot spot of the right abductor pollicis brevis muscle) of the contralateral (left) primary motor cortex through a focal figure-of-eight stimulating coil (monophasic waveform, induced current

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