• Marcel Simis, Bamidele O Adeyemo, Liciane F Medeiros, Forella Miraval, Rubens J Gagliardi, and Felipe Fregni.
• aDepartment of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts bDepartment of Physical Medicine and Rehabilitation, Emory University cDepartment of Physical Medicine and Rehabilitation, Marcus Stroke Science Center, Grady Hospital, Atlanta, Georgia, USA dDepartment of Neurology, Santa Casa de São Paulo Medical School, São Paulo ePost-graduation Program, Biological Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil fInstitute of Physical Medicine and Rehabilitation, Clinics Hospital of the University of Sao Paulo Medical School, Brazil.
• Neuroreport. 2013 Dec 4;24(17):973-5.

AbstractThe aim of this study was to test and compare the effects of a within-subject design of repetitive transcranial magnetic stimulation (rTMS) [coupled with sham transcranial direct current stimulation (tDCS)] and tDCS (coupled with sham rTMS) on the motor cortex excitability and also compare the results against sham tDCS/sham rTMS. We conducted a double-blinded, randomized, sham-controlled, cross-over trial. Eleven right-handed, healthy individuals (five women, mean age: 39.8 years, SD 13.4) received the three interventions (cross-over design) in a randomized order: (a) high-frequency (HF) rTMS (+sham tDCS), (b) anodal tDCS (+sham rTMS), and (c) sham stimulation (sham rTMS+sham tDCS). Cortical excitability measurements [motor threshold, motor evoked potential (MEP), intracortical facilitation and inhibition, and transcallosal inhibition] and motor behavioral assessments were used as outcome measures. Between-group analysis of variance showed that MEP amplitude after HF rTMS was significantly higher than MEP amplitude after anodal tDCS (P=0.001). Post-hoc analysis showed a significant increase in MEP amplitude after HF rTMS (25.3%, P=0.036) and a significant decrease in MEP amplitude after anodal tDCS (-32.7%, P=0.001). There was a similar increase in motor function as indexed by Jebsen-Taylor Hand Function Test in the two active groups compared with sham stimulation. In conclusion, here, we showed that although both techniques induced similar motor gains, they induce opposing results in cortical excitability. HF rTMS is associated with an increase in corticospinal excitability, whereas 20 min of tDCS induces the opposite effect. We discuss potential implications of these results to future clinical experiments using rTMS or tDCS for motor function enhancement.

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