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Repetitive transcranial magnetic stimulation over the primary motor cortex (M1) was recently introduced to modulate pain perception. The aim of this double-blind cross-over study was to investigate the effect of a modified rTMS paradigm, called cTBS on experimentally induced laser-evoked pain applied over the left M1. cTBS inhibits the cortical excitability of the M1 for approximately 1 h. Subjective pain was measured using the verbal analogue scale prior to, immediately after and 30 min post-stimulation. cTBS, and not the sham stimulation resulted in a significant decrease in pain perception on both hands, accentuated on the right hand. Further studies are needed using motor cortex TBS in chronic pain to pave the way towards a therapeutic tool.

Transcranial direct current stimulation over the left motor area influenced both contralateral and ipsilateral finger sequence movements in seven healthy adults. Effects for the two hands were reversed: anodal stimulation improved right-hand performance significantly more than cathodal stimulation, whereas cathodal stimulation improved left-hand performance significantly more than anodal stimulation. The results show that stimulating a motor region directly, or indirectly by modulating activity in the homologous region on the opposite hemisphere, can affect motor skill acquisition, presumably by facilitating effective synaptic connectivity. This outcome provides evidence for the role of interhemispheric inhibition in corticomotor functioning, and also has implications for treatment methods aimed at facilitating motor recovery after stroke.

The effects of high frequency repetitive transcranial magnetic stimulation on sensory perception and the pain tolerance thresholds were investigated applying both motor cortex stimulation and medial frontal cortex stimulation in normal study participants. Both the sensory perception and pain tolerance thresholds were significantly increased in the motor cortex stimulation, whereas the pain tolerance thresholds, but not the sensory perception was significantly decreased in the medial frontal cortex stimulation. These results suggest the dissociable modulating effects of sensory and pain perception by the high frequency repetitive transcranial magnetic stimulation on the medial pain regulating system, but not the lateral pain regulating system.

We investigated the effects of cortical stimulation on mental rotation tasks in a patient with an electrode array placed over his left primary motor cortex. The array was implanted to relieve chronic pain resulting from right brachial plexus damage. Tasks involving motor imagery were slowed down by cortical stimulation, whereas those involving visual imagery were not. When the patient performed the motor-imagery task, the interference effect on response times disappeared if the stimulator was switched off. We also probed two of the sites (anterior-lateral and posterior-medial position), and found that stimulation of the more anterior-lateral one consistently disrupted motor imagery.

To study the role of the right dorsal premotor cortex in visuomotor association learning (association of four visual stimuli to four buttons), transcranial magnetic stimulation was applied to this area to interfere with the ongoing learning processes. Two transcranial magnetic stimulation pulses to the right dorsal premotor cortex at 150 and 200 ms after onset of the imperative stimulus resulted in the abolishing of reaction time decreases during learning. Transcranial magnetic stimulation applied to a control region revealed no influence on reaction time decreases. During both conditions, however, there were similar increases of accuracy scores. We conclude that the right dorsal premotor cortex is not directly involved in associating visual with motor cues. We suggest that this area is intimately involved in selection and preparation of forthcoming movements.

The role played by sensory information in maintaining motor cortical representations is still incompletely understood. We investigated the effect of digital anaesthesia of the index finger and thumb on the amplitude of motor evoked potentials to transcranial magnetic stimulation (TMS) recorded from the first dorsal interosseus, F-wave response probability and maximal key pinch force. Whereas digital anaesthesia led to a 29% decrease in maximal force, both motor evoked potential amplitudes and F-wave probability remained unchanged. This dramatic decrease in maximal voluntary contraction following digital anaesthesia may result from a lack of proper sensory feedback during the task.

Low- and high-frequency repetitive transcranial magnetic stimulation (rTMS) of the motor cortex results in lasting changes of excitatory neurotransmission. We investigated the effects of suprathreshold 1 Hz rTMS on brain derived neurotrophic factor (BDNF) plasma levels in 10 healthy subjects and effects of either 1 Hz or 20 Hz rTMS in four amyotrophic lateral sclerosis (ALS) patients. BDNF levels were progressively decreased by 1 Hz rTMS in healthy subjects; there was no effect of 1 Hz rTMS on BDNF plasma levels in ALS patients, an effect probably due to the loss of motor cortex pyramidal cells. High frequency rTMS determined a transitory decrease in BDNF plasma levels. Cumulatively these findings suggest that rTMS might influence the BDNF production by interfering with neuronal activity.

Motor and visual cortices of normal volunteers were activated by transcranial magnetic stimulation. The electrical brain activity resulting from the brief electromagnetic pulse was recorded with high-resolution electroencephalography (HR-EEG) and located using inversion algorithms. The stimulation of the left sensorimotor hand area elicited an immediate response at the stimulated site. The activation had spread to adjacent ipsilateral motor areas within 5-10 ms and to homologous regions in the opposite hemisphere within 20 ms. Similar activation patterns were generated by magnetic stimulation of the visual cortex. This new non-invasive method provides direct information about cortical reactivity and area-to-area neuronal connections.