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. 2013 Apr;9(2):75-82.
doi: 10.3988/jcn.2013.9.2.75. Epub 2013 Apr 4.

Cortico-cortical modulation induced by 1-Hz repetitive transcranial magnetic stimulation of the temporal cortex

Mina Lee  1 , Song E Kim, Won Sup Kim, Jooman Han, Hee-Jin Kim, Bom Sahn Kim, Ji Young Kim, Seung Bong Hong, Byung Gon Kim, Hyang Woon Lee
Affiliations

Cortico-cortical modulation induced by 1-Hz repetitive transcranial magnetic stimulation of the temporal cortex

Mina Lee et al. J Clin Neurol. 2013 Apr.

Erratum in

  • J Clin Neurol. 2013 Jul;9(3):199. Kim, Hee Jin [corrected to Kim, Hee-Jin]

Abstract

Background and purpose: Repetitive transcranial magnetic stimulation (rTMS) has potential as a noninvasive neuromodulation treatment method for various neuropsychiatric disorders, and repeated sessions of rTMS are more likely to enhance the therapeutic efficacy. This study investigated neurophysiologic and spatiodynamic changes induced by repeated 1-Hz rTMS of the temporal cortex using transcranial magnetic stimulation (TMS) indices and fluorodeoxyglucose positron emission tomography (FDG-PET).

Methods: Twenty-seven healthy subjects underwent daily 1-Hz active or sham rTMS of the right temporal cortex for 5 consecutive days. TMS indices of motor cortical excitability were measured in both hemispheres daily before and after each rTMS session, and 2 weeks after the last stimulation. FDG-PET was performed at baseline and after the 5 days of rTMS sessions.

Results: All subjects tolerated all of the sessions well, with only three of them (11.1%) reporting mild transient side effects (i.e., headache, tinnitus, or local irritation). One-Hz rTMS decreased motor evoked potential amplitudes and delayed cortical silent periods in the stimulated hemisphere. Statistical parametric mapping of FDG-PET data revealed a focal reduction of glucose metabolism in the stimulated temporal area and an increase in the bilateral precentral, ipsilateral superior and middle frontal, prefrontal and cingulate gyri.

Conclusions: Repeated rTMS sessions for 5 consecutive days were tolerated in all subjects, with only occasional minor side effects. Focal 1-Hz rTMS of the temporal cortex induces cortico-cortical modulation with widespread functional changes in brain neural networks via long-range neural connections.

Keywords: cortical excitability; cortico-cortical modulation; fluorodeoxyglucose positron emission tomography (FDG-PET); repetitive transcranial magnetic stimulation (rTMS).

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Schematic demonstration of the experimental design. All subjects received daily 1-Hz rTMS of the right temporal cortex for 30 min (1800 pulses) over 5 consecutive days. TMS indices of cortical excitability were measured before and after daily rTMS and 2 weeks after the last rTMS session. FDG-PET images were obtained at baseline before the first session and after the last session on the fifth day of rTMS. FDG-PET: fluorodeoxyglucose positron emission tomography, rTMS: repetitive transcranial magnetic stimulation, TMS: transcranial magnetic stimulation.
Fig. 2
Fig. 2
SPM analysis of FDG-PET data at the baseline before the first session and after the last session of rTMS. A: Glucose metabolism decreased focally at the stimulated temporal area (uncorrected p<0.0001), but no difference was observed in the primary motor cortex despite the changes in TMS indices of motor excitability. B: Glucose metabolism was markedly increased in the bilateral precentral, ipsilateral superior and middle frontal, prefrontal and cingulate gyri, which are cortical areas remote from the stimulated site (uncorrected p<0.0001). FDG-PET: fluorodeoxyglucose positron emission tomography, rTMS: repetitive transcranial magnetic stimulation, SPM: statistical parametric mapping, TMS: transcranial magnetic stimulation.
See this image and copyright information in PMC

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