Using repetitive paired-pulse transcranial magnetic stimulation for evaluation motor cortex excitability

In this study, we investigated the effects of repetitive paired-pulse transcranial magnetic stimulation (TMS) on the motor cortex excitability. The interstimulus intervals (ISIs) between the conditioning (first) stimulus and test (second) stimulus were 1,000, 200 and 100 ms. A total of 20 stimuli were delivered to the primary motor cortex using paired-pulse TMS at 10 s intervals, and the intensity of the magnetic stimulus was 110% of the resting motor threshold for each subject. For all ISIs, there was no significant correlation between the number of stimuli and the motor evoked potential (MEP) amplitude. However, there was slight correlation between the number of stimuli and the MEP amplitude in the 200 and 100 ms ISIs (200 and 100 ms ISIs: approximately r = −0.40; 1,000 ms ISI: r = −0.17). In addition, MEP amplitude increased during the second paired pulse stimulation when an ISI of 200 ms was used, but it decreased dramatically when an ISI of 100 ms was used. In contrast, MEP amplitude did not change significantly when a 1,000 ms ISI was employed. Therefore, 10 consecutive paired-pulse TMS stimuli with a 1,000 ms ISI may not have a cumulative effect on cortical excitability. Previous studies used a long duration (e.g., 6 minutes or longer by 0.1 Hz magnetic stimulation) of magnetic stimulation to evaluate cortical excitability. In evaluating cortical excitability by magnetic stimulation, it is important to shorten the period to reduce the subject’s burden and to prevent body movement. Thus, our present findings suggest that repetitive paired-pulse TMS with an ISI of 1,000 ms is suitable for the rapid evaluation of cortical excitability.