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1 Institute of Neurology, Università Cattolica, L. go A. Gemelli 8, 00168 Rome, Italy
2 Unidad de Neurologia Funcional, Hospital Nacional de Paraplejicos, Finca la Peraleda, 45071 Toledo, Spain
3 Neurochirurgia CTO, Via S. Nemesio 21, 00145 Rome, Italy
4 Neurofisiologia CTO, Via S. Nemesio 21, 00145 Rome, Italy
5 Sobell Department of Neurophysiology, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
6 Chang Gung Memorial Hospital, Taipei City 10507, Taiwan
In four conscious patients who had electrodes implanted in the cervical epidural space for the control of pain, we recorded corticospinal volleys evoked by single-pulse transcranial magnetic stimulation (TMS) over the motor cortex before and after a 20 s period of continuous theta-burst stimulation (cTBS). It has previously been reported that this form of repetitive TMS reduces the amplitude of motor-evoked potentials (MEPs), with the maximum effect occurring at 5–10 min after the end of stimulation. The present results show that cTBS preferentially decreases the amplitude of the corticospinal I1 wave, with approximately the same time course. This is consistent with a cortical origin of the effect on the MEP. However, other protocols that lead to MEP suppression, such as short-interval intracortical inhibition, are characterized by reduced excitability of late I waves (particularly I3), suggesting that cTBS suppresses MEPs through different mechanisms, such as long-term depression in excitatory synaptic connections.
(Received 23 March 2005;
accepted after revision 15 April 2005;
first published online 21 April 2005)
Corresponding author V. Di Lazzaro: Istituto di Neurologia, Universita Cattolica, L. go A. Gemelli 8, Rome, Italy. Email: vdilazzaro{at}rm.unicatt.it
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