• Fabrizio Vernieri, Claudia Altamura, Paola Palazzo, Riccardo Altavilla, Emma Fabrizio, Rita Fini, Jean-Marc Melgari, Matteo Paolucci, Patrizio Pasqualetti, and Paola Maggio.
• Neurology Unit, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy. Electronic address: f.vernieri@unicampus.it.
• Brain Stimul. 2014 Mar 1;7(2):281-6.

BackgroundNeuromodulation techniques, i.e. repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), can modify cerebral hemodynamics. High frequency rTMS appeared to decrease cerebral vasomotor reactivity (VMR), while there is still poor evidence about the effect of low frequency (LF) rTMS on cerebral blood flow (CBF) and VMR.HypothesisThe present study aimed to test if LF rTMS decreases CBF and increases cerebral VMR. Monolateral or bilateral hemispheric involvement and duration of the effect were considered. A possible role of autonomic nervous system in CBF and VMR modulation was also investigated.MethodsTwenty-four right-handed healthy subjects underwent randomly real (12) or sham (12) 20-min 1-Hz rTMS on left primary motor cortex. Mean flow velocity and VMR of middle cerebral arteries were evaluated by means of transcranial Doppler before (T0), after 10 min (T1) and after 2 (T2), 5 (T3) and 24 h (T4) from rTMS. Heart rate variability (HRV) was studied within the same timing interval, assessing low frequency/high frequency (LF/HF) ratio as index of autonomic balance.ResultsAfter real rTMS compared with sham stimulation, MFV decreased bilaterally at T1 (F = 3.240, P = .030) while VMR increased bilaterally (F = 5.116, P = .002) for at least 5 h (T3). LF/HF ratio decreased early after real rTMS (F = 2.881, P = .040).Conclusion1-Hz rTMS may induce a bilateral long-lasting increase of VMR, while its effect on MFV is short-lasting. Moreover, HRV changes induced by rTMS suggest a possible autonomic nervous system modulation.Copyright © 2014 Elsevier Inc. All rights reserved.

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