A New Paired Associative Stimulation Protocol with High-Frequency Peripheral Component and High-Intensity 20 Hz Repetitive Transcranial Magnetic Stimulation—A Pilot Study

International Journal of Environmental Research and Public Health, 2021 · DOI: https://doi.org/10.3390/ijerph182111224 · Published: October 26, 2021

Spinal Cord Injury Neurology Neuroplasticity

Simple Explanation

Paired associative stimulation (PAS) combines transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS) to induce plastic changes in the human motor system. This study explores a new PAS protocol using high-frequency PNS and high-intensity 20 Hz repetitive TMS to enhance motor-evoked potentials (MEPs). The study compares the new protocol's effectiveness and safety against existing PAS protocols and rTMS alone in healthy subjects.

Study Duration

Not specified

Participants

5 healthy participants

Evidence Level

Not specified

Key Findings

1
The new three-pulse PAS protocol induced the strongest MEP potentiation 60 minutes after stimulation compared to other protocols.
2
The three-pulse rTMS alone also potentiated MEPs, but the new PAS variant showed more prolonged potentiation.
3
The new protocol caused strong involuntary twitches in some subjects, indicating a need for further safety evaluation.

Research Summary

This pilot study investigated a new paired associative stimulation (PAS) protocol combining high-frequency peripheral nerve stimulation (PNS) with high-intensity 20 Hz repetitive transcranial magnetic stimulation (rTMS). The study found that the new three-pulse PAS protocol induced stronger MEP potentiation at 60 minutes post-stimulation compared to other protocols and rTMS alone. The new protocol also caused stronger involuntary twitches, indicating a need for further safety evaluations before clinical application.

Practical Implications

Potential for Enhanced Neurorehabilitation

The new PAS protocol may offer a more effective method for inducing neuroplasticity and improving motor function in rehabilitation settings.

Further Safety Investigations Required

Due to the observed involuntary twitches, additional research is needed to ensure the safety and tolerability of the protocol before clinical trials.

Mechanism Exploration

Further studies should investigate the precise mechanisms underlying the enhanced MEP potentiation observed with the new PAS protocol.

Study Limitations

1
Small sample size (five participants)
2
Limited assessment of safety and tolerability
3
Preliminary data, not directly extrapolatable to clinical results in SCI patients

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