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      Modulation of iTBS after-effects via concurrent directional TDCS: A proof of principle study

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          Abstract

          Background

          Polarising currents can modulate membrane potentials in animals, affecting the after-effect of theta burst stimulation (TBS) on synaptic strength.

          Objective

          We examined whether a similar phenomenon could also be observed in human motor cortex (M1) using transcranial direct current stimulation (TDCS) during monophasic intermittent TBS (iTBS).

          Methods

          TDCS was applied during posterior-anterior iTBS using three different conditions: posterior-anterior TDCS (anode 3.5 cm posterior to M1, cathode 3.5 cm anterior to M1), anterior-posterior TDCS (cathode 3.5 cm posterior to M1, anode 3.5 cm anterior to M1), and sham TDCS.

          Results

          When the direction of TDCS (posterior-anterior) matched the direction of the electrical field induced by iTBS, we found a 19% non-significant increase in excitability changes in comparison with iTBS combined with sham TDCS. When the TDCS was reversed (anterior-posterior), the excitatory effect of iTBS was abolished.

          Conclusion

          Our findings suggest that excitatory after-effects of iTBS can be modulated by directionally-specific TDCS.

          Highlights

          • •

            M1 excitability can be modulated by concurrent TDCS and iTBS.

          • •

            Posterior-anterior TDCS during iTBS induces a qualitative increase in M1 iTBS after-effects.

          • •

            Anterior-posterior TDCS during iTBS abolishes the after-effects of iTBS over M1.

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          Most cited references20

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          Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation.

          M A Nitsche, W Paulus (2000)
          In this paper we demonstrate in the intact human the possibility of a non-invasive modulation of motor cortex excitability by the application of weak direct current through the scalp. Excitability changes of up to 40 %, revealed by transcranial magnetic stimulation, were accomplished and lasted for several minutes after the end of current stimulation. Excitation could be achieved selectively by anodal stimulation, and inhibition by cathodal stimulation. By varying the current intensity and duration, the strength and duration of the after-effects could be controlled. The effects were probably induced by modification of membrane polarisation. Functional alterations related to post-tetanic potentiation, short-term potentiation and processes similar to postexcitatory central inhibition are the likely candidates for the excitability changes after the end of stimulation. Transcranial electrical stimulation using weak current may thus be a promising tool to modulate cerebral excitability in a non-invasive, painless, reversible, selective and focal way.
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            The role of interneuron networks in driving human motor cortical plasticity.

            Masashi Hamada, Nagako Murase, Alkomiet Hasan … (2013)
            The after-effects of repetitive transcranial magnetic stimulation (rTMS) are highly variable between individuals. Because different populations of cortical neurons are stimulated more easily or are more excitable in different people at different times, the variability may not be due to differences between individuals in the plasticity of cortical synapses, but may instead be due to individual differences in the recruitment of cortical neurons. In this study, we examined the effects of rTMS in 56 healthy volunteers. The responses to excitatory and inhibitory theta burst stimulation (TBS) protocols were highly variable between individuals. Surprisingly, the TBS effect was highly correlated with the latency of motor-evoked potentials (MEPs) evoked by TMS pulses that induced an anterior-posterior (AP) directed current across the central sulcus. Finally, we devised a new plasticity protocol using closely timed pairs of oppositely directed TMS current pulses across the central sulcus. Again, the after-effects were related to the latency of MEPs evoked by AP current. Our results are consistent with the idea that variation in response to rTMS plasticity probing protocols is strongly influenced by which interneuron networks are recruited by the TMS pulse.
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              Ten Years of Theta Burst Stimulation in Humans: Established Knowledge, Unknowns and Prospects.

              A Suppa, Y.-Z. Huang, K Funke … (2016)
              Over the last ten years, an increasing number of authors have used the theta burst stimulation (TBS) protocol to investigate long-term potentiation (LTP) and long-term depression (LTD)-like plasticity non-invasively in the primary motor cortex (M1) in healthy humans and in patients with various types of movement disorders. We here provide a comprehensive review of the LTP/LTD-like plasticity induced by TBS in the human M1.
              Article 0 comments Cited 189 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Sara Tremblay
                Journal
                Journal ID (nlm-ta): Brain Stimul
                Journal ID (iso-abbrev): Brain Stimul
                Title: Brain Stimulation
                Publisher: Elsevier
                ISSN (Print): 1935-861X
                ISSN (Electronic): 1876-4754
                Publication date PMC-release: 1 July 2017
                Publication date (Print): Jul-Aug 2017
                Volume: 10
                Issue: 4
                Pages: 744-747
                Affiliations
                [1]Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
                Author notes
                [∗ ]Corresponding author. UCL Institute of Neurology, London, WC1N 3BG, UK.UCL Institute of NeurologyLondonWC1N 3BGUK s.tremblay@ 123456ucl.ac.uk
                Article
                Publisher ID: S1935-861X(17)30654-X
                DOI: 10.1016/j.brs.2017.03.009
                PMC ID: 5487022
                PubMed ID: 28404455
                SO-VID: c30eb353-b02e-48be-a1d6-420f591a6505
                Copyright © © 2017 The Authors
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 2 November 2016
                Date revision received : 16 March 2017
                Date accepted : 20 March 2017
                Categories
                Subject: Article

                ScienceOpen disciplines: Neurosciences
                Keywords: transcranial magnetic stimulation,intermittent theta burst stimulation,transcranial direct current stimulation,primary motor cortex,ap, anterior-posterior,itbs, intermittent theta burst stimulation,m1, primary motor cortex,mep, motor evoked potential,pa, posterior-anterior,tdcs, transcranial direct current stimulation
                Data availability:
                ScienceOpen disciplines: Neurosciences
                Keywords: transcranial magnetic stimulation, intermittent theta burst stimulation, transcranial direct current stimulation, primary motor cortex, ap, anterior-posterior, itbs, intermittent theta burst stimulation, m1, primary motor cortex, mep, motor evoked potential, pa, posterior-anterior, tdcs, transcranial direct current stimulation

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