Excitatory‐inhibitory modulation of transcranial focus ultrasound stimulation on human motor cortex

AIMS: Transcranial focus ultrasound stimulation (tFUS) is a promising non‐invasive neuromodulation technology. This study aimed to evaluate the modulatory effects of tFUS on human motor cortex (M1) excitability and explore the mechanism of neurotransmitter‐related intracortical circuitry and plasticity. METHODS: Single pulse transcranial magnetic stimulation (TMS)‐eliciting motor‐evoked potentials (MEPs) were used to assessed M1 excitability in 10 subjects. Paired‐pulse TMS was used to measure the effects of tFUS on GABA‐ and glutamate‐related intracortical excitability and (1)H‐MRS was used to assess the effects of repetitive tFUS on GABA and Glx (glutamine + glutamate) neurometabolic concentrations in the targeting region in nine subjects. RESULTS: The etFUS significantly increased M1 excitability, decreased short interval intracortical inhibition (SICI) and long interval intracortical inhibition (LICI). The itFUS significantly suppressed M1 excitability, increased SICI, LICI, and decreased intracortical facilitation (ICF). Seven times of etFUS decreased the GABA concentration (6.32%), increased the Glx concentration (12.40%), and decreased the GABA/Glx ratio measured by MRS, while itFUS increased the GABA concentration (18.59%), decreased Glx concentration (0.35%), and significantly increased GABA/Glx ratio. CONCLUSION: The findings support that tFUS with different parameters can exert excitatory and inhibitory neuromodulatory effects on the human motor cortex. We provide novel insights that tFUS change cortical excitability and plasticity by regulating excitatory‐inhibition balance related to the GABAergic and glutamatergic receptor function and neurotransmitter metabolic level.