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The Journal of Neuroscience, March 31, 2004, 24(13):3379-3385; doi:10.1523/JNEUROSCI.5316-03.2004

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Behavioral/Systems/Cognitive
Preconditioning of Low-Frequency Repetitive Transcranial Magnetic Stimulation with Transcranial Direct Current Stimulation: Evidence for Homeostatic Plasticity in the Human Motor Cortex

Hartwig R. Siebner,1,2 Nicolas Lang,1,3 Vincenzo Rizzo,1,4 Michael A. Nitsche,3 Walter Paulus,3 Roger N. Lemon,1 and John C. Rothwell1

1Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College of London, London WC1N 3BG, United Kingdom, 2Department of Neurology, Christian-Albrechts University, 24105 Kiel, Germany, 3Department of Clinical Neurophysiology, Georg-August University, 37075 Göttingen, Germany, and 4Department of Neurosciences and Psychiatric and Anaesthesiological Sciences, University of Messina, 98125 Messina, Italy

Recent experimental work in animals has emphasized the importance of homeostatic plasticity as a means of stabilizing the properties of neuronal circuits. Here, we report a phenomenon that indicates a homeostatic pattern of cortical plasticity in healthy human subjects. The experiments combined two techniques that can produce long-term effects on the excitability of corticospinal output neurons: transcranial direct current stimulation (TDCS) and repetitive transcranial magnetic stimulation (rTMS) of the left primary motor cortex. "Facilitatory preconditioning" with anodal TDCS caused a subsequent period of 1 Hz rTMS to reduce corticospinal excitability to below baseline levels for >20 min. Conversely, "inhibitory preconditioning" with cathodal TDCS resulted in 1 Hz rTMS increasing corticospinal excitability for at least 20 min. No changes in excitability occurred when 1 Hz rTMS was preceded by sham TDCS. Thus, changing the initial state of the motor cortex by a period of DC polarization reversed the conditioning effects of 1 Hz rTMS. These preconditioning effects of TDCS suggest the existence of a homeostatic mechanism in the human motor cortex that stabilizes corticospinal excitability within a physiologically useful range.

Key words: corticospinal excitability; homeostatic plasticity; human motor cortex; transcranial magnetic stimulation; transcranial direct current stimulation; metaplasticity


Received Nov 13, 2003; revised February 23, 2004; accepted February 23, 2004.




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