• Masashi Hamada, Ritsuko Hanajima, Yasuo Terao, Noritoshi Arai, Toshiaki Furubayashi, Satomi Inomata-Terada, Akihiro Yugeta, Hideyuki Matsumoto, Yuichiro Shirota, and Yoshikazu Ugawa.
• Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. mhamada-tky@umin.ac.jp
• Clin Neurophysiol. 2007 Dec 1; 118 (12): 2672-82.

ObjectiveRepetitive paired-pulse transcranial magnetic stimulation (TMS) at I-wave periodicity has been shown to induce a motor-evoked potential (MEP) facilitation. We hypothesized that a greater enhancement of motor cortical excitability is provoked by increasing the number of pulses per train beyond those by paired-pulse stimulation (PPS).MethodsWe explored motor cortical excitability changes induced by repetitive application of trains of four monophasic magnetic pulses (quadro-pulse stimulation: QPS) at 1.5-ms intervals, repeated every 5s over the motor cortex projecting to the hand muscles. The aftereffects of QPS were evaluated with MEPs to a single-pulse TMS, motor threshold (MT), and responses to brain-stem stimulation. These effects were compared to those after PPS. To evaluate the QPS safety, we also studied the spread of excitation and after discharge using surface electromyograms (EMGs) of hand and arm muscles.ResultsSizes of MEPs from the hand muscle were enhanced for longer than 75min after QPS; they reverted to the baseline at 90min. Responses to brain-stem stimulation from the hand muscle and cortical MEPs from the forearm muscle were unchanged after QPS over the hand motor area. MT was unaffected by QPS. No spreads of excitation were detected after QPS. The appearance rate of after discharges during QPS was not different from that during sham stimulation.ConclusionsResults show that QPS can safely induce long-lasting, topographically specific enhancement of motor cortical excitability.SignificanceQPS is more effective than PPS for inducing motor cortical plasticity.

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