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First published online on October 28, 2004.
 Copyright © 2004 by The Physiological Society
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Received July 1, 2004
Revised July 28, 2004
Accepted after revision October 22, 2004

Increased corticospinal excitability after 5 Hz rTMS over the human supplementary motor area

Kaoru Matsunaga1, Atsuo Maruyama2, Toshiyuki Fujiwara3, Ryoji Nakanishi1, Sadatoshi Tsuji4, and John C Rothwell5*

1 Department of Neurology, Kumamoto Kinoh Hospital
2 Department of Physical Education, Faculty of Education, Kagoshima University
3 Department of Rehabilitation Medicine, Keio University, School of Medicine
4 Department of Neurology, University of Occupational and Environmental Health
5 Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology

* To whom correspondence should be addressed. E-mail: j.rothwell{at}ion.ucl.ac.uk.

Transcranial magnetic stimulation (TMS) can produce effects not only at the site of stimulation but also at distant sites to which it projects. Here we examined the connection between supplementary motor area (SMA) and the hand area of the primary motor cortex (M1Hand) by testing whether prolonged rTMS over the SMA can produce changes in excitability of the M1Hand after the end of train. We evaluated motor evoked potentials (MEP) and the cortical silent period (CSP) evoked by a single-pulse TMS, short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) produced by a paired-pulse TMS, and forearm flexor H-reflexes before and after 750 pulses of 5 Hz rTMS over SMA at an intensity of 110% active motor threshold (AMT) for the first dorsal interosseous (FDI) muscle. The amplitude of MEPs recorded from the right FDI muscle at rest as well as during voluntary contraction increased for at least 10 minutes after the end of rTMS, although the duration of the CSP, SICI and ICF did not change. There was no effect on H-reflexes in the flexor carpi radialis muscle, even though the amplitude of the MEP obtained from the same muscle increased after rTMS. The effects on MEPs depended on the intensity of rTMS and were spatially specific to the SMA proper. We suggest that 5 Hz rTMS over SMA can induce a short-lasting facilitation in excitability of the M1Hand compatible with the anatomical connections between SMA and the M1Hand.


Key words: Corticospinal tract • Motor cortex • Transcranial magnetic stimulation




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