The effect of stimulation interval on plasticity following repeated blocks of intermittent theta burst stimulation

This study assessed the effect of interval duration on the direction and magnitude of changes in cortical excitability and inhibition when applying repeated blocks of intermittent theta burst stimulation (iTBS) over motor cortex. 15 participants received three different iTBS conditions on separate days: single iTBS; repeated iTBS with a 5 minute interval (iTBS-5-iTBS); and with a 15 minute interval (iTBS-15-iTBS). Changes in cortical excitability and short-interval cortical inhibition (SICI) were assessed via motor-evoked potentials (MEPs) before and up to 60 mins following stimulation. iTBS-15-iTBS increased MEP amplitude for up to 60 mins post stimulation, whereas iTBS-5-iTBS decreased MEP amplitude. In contrast, MEP amplitude was not altered by single iTBS. Despite the group level findings, only 53% of individuals showed facilitated MEPs following iTBS-15-iTBS, and only 40% inhibited MEPs following iTBS-5-iTBS. Modulation of SICI did not differ between conditions. These results suggest interval duration between spaced iTBS plays an important role in determining the direction of plasticity on excitatory, but not inhibitory circuits in human motor cortex. While repeated iTBS can increase the magnitude of MEP facilitation/inhibition in some individuals compared to single iTBS, the response to repeated iTBS appears variable between individuals in this small sample.