Simply longer is not better: reversal of theta burst after-effect with prolonged stimulation
Open accessAbstract
From all rTMS protocols at present, the theta burst stimulation (TBS) is considered the most efficient in terms of number of impulses and intensity required during a given stimulation. The aim of this study was to investigate the effects of inhibitory and excitatory TBS protocols on motor cortex excitability when the duration of stimulation was doubled. Fourteen healthy volunteers were tested under four conditions: intermittent theta bust stimulation (iTBS), continuous theta burst stimulation (cTBS), prolonged intermittent theta bust stimulation (ProiTBS) and prolonged continuous theta burst stimulation (ProcTBS). The prolonged paradigms were twice as long as the conventional TBS protocols. Conventional facilitatory iTBS converted into inhibitory when it was applied for twice as long, while the normally inhibitory cTBS became facilitatory when the stimulation duration was doubled. Our results show that TBS-induced plasticity cannot be deliberately enhanced simply by prolonging TBS protocols. Instead, when stimulating too long, after-effects will be reversed. This finding supplements findings at the short end of the stimulation duration range, where it was shown that conventional cTBS is excitatory in the first half and switches to inhibition only after the full length protocol. It is relevant for clinical applications for which an ongoing need for further protocol improvement is imminent.
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Studies demonstrate that this number of pulses results in an optimal window of cortical excitability, and additional pulses may have an inhibitory effect.
“Studies demonstrate that this number of pulses results in an optimal “window” of cortical excitability, and additional pulses may have an inhibitory effect [59-61].”
From Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial (2024) · cites this paper as [60]
The Results (iTBS versus ProiTBS; page unavailable) report that conventional intermittent theta-burst stimulation increased motor-cortex excitability, while prolonged stimulation suppressed it. The Introduction says pulse number and other parameters still need evaluation to optimize stimulation, so the study does not establish that the cited pulse count is an optimal window. (LLM, conf=0.84)
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- Authors
- Gamboa, O. L., Antal, A., Moliadze, V., & Paulus, W.
- Affiliations
- University of Göttingen (DE)
- Corresponding author
- Gamboa, Olga Lucía
- Venue
- Experimental Brain Research
- Published
- 2010-06-22
- Volume
- 204
- Issue
- 2
- Pages
- 181-187
- ISSN
- 0014-4819 (ISSN-L)
- 1432-1106
- PMC
- PMC2892066
- OpenAlex
- W2073595961
- Cited by
- 318
- References
- 30
- Citations by year
- 2026: 17 · 2025: 27 · 2024: 25 · 2023: 18 · 2022: 37 · 2021: 17 · 2020: 19 · 2019: 16 · 2018: 23 · 2017: 18 · 2016: 15 · 2015: 20 · 2014: 21 · 2013: 16 · 2012: 12
- FWCI
- 8.73
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Experimental Brain Research (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
- GRO (submittedVersion, cc-by)
- Funders
- Rose Foundation for Communities and the Environment (T298/14376/2004, T298/14375/2004)
- Bundesministerium für Bildung und Forschung (01GQ0782, 01GQ0810)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neuropharmacology Research
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Keywords
- theta burst stimulation, repetitive transcranial magnetic stimulation, stimulation duration, motor cortex excitability, long-term potentiation, long-term depression, intermittent theta burst stimulation, continuous theta burst stimulation
- MeSH terms
- Adult, Electric Stimulation, Electromyography, Female, Humans, Male, Motor Cortex, Neuronal Plasticity, Reaction Time, Theta Rhythm, Long-Term Potentiation, Evoked Potentials, Motor, Transcranial Magnetic Stimulation
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