Abstract
Objective Intermittent theta burst stimulation (iTBS) is a widely used noninvasive brain stimulation for the facilitation of corticospinal excitability (CSE). Previous studies have shown that acupuncture applied to acupoints associated with motor function in healthy people can reduce the amplitude of the motor-evoked potentials (MEPs), which reflects the inhibition of CSE. In our work, we wanted to test whether the combination of iTBS and electroacupuncture (EA) would have different effects on CSE in humans. Methods A single-blind sham-controlled crossover design study was conducted on 20 healthy subjects. Subjects received 20 minutes' sham or real EA stimulation immediately after sham or real iTBS. MEPs, short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), cortical silent period (CSP), and central motor conduction time (CMCT) were recorded before each trial, and immediately, 20 minutes, and 40 minutes after the end of stimulation. Results In the sham iTBS group, EA produced a reduction in MEPs amplitude, lasting approximately 40 minutes, while in the real iTBS group, EA significantly increased MEPs amplitude beyond 40 minutes after the end of stimulation. In sham EA group, the recorded MEPs amplitude showed no significant trend over time compared to baseline. Among all experiments, there were no significant changes in SICI, ICF, CSP, CMCT, etc. Conclusion These data indicate that immediate application of EA after iTBS significantly increased corticospinal excitability. This trial was registered in the Chinese Clinical Trial Registry (registration no. ChiCTR1900025348).
Highlights
In 2005, Huang et al proposed theta burst stimulation (TBS) as a special paradigm of repetitive transcranial magnetic stimulation which mimics endogenous theta oscillation and is able to modulate human brain excitability beyond the time of stimulation [1]
We used single TMS to measure resting motor threshold (RMT), active motor threshold (AMT), motor-evoked potentials (MEPs), cortical silent period (CSP), central motor conduction time (CMCT), and paired pulse TMS to measure shortinterval intracortical inhibition (SICI) and intracortical facilitation (ICF) to determine whether combination of Intermittent theta burst stimulation (iTBS) and EA could modulate the neural excitability of the M1 in healthy adults when compared with only iTBS, electroacupuncture, or none
We applied EA immediately after the end of iTBS on Hegu (LI4), Quchi (LI11), Zusanli (ST36), and Yanglingquan (GB34), which are four acupuncture points that are most commonly used in the rehabilitation of stroke exercise in the clinic. e results indicated that iTBS combined with EA can significantly increase the excitability of the motor cortex for 40 minutes after the end of the intervention, while applying EA alone will inhibit the excitability of the motor cortex
Summary
Intermittent theta burst stimulation (iTBS) is a widely used noninvasive brain stimulation for the facilitation of corticospinal excitability (CSE). Subjects received 20 minutes’ sham or real EA stimulation immediately after sham or real iTBS. MEPs, shortinterval intracortical inhibition (SICI), intracortical facilitation (ICF), cortical silent period (CSP), and central motor conduction time (CMCT) were recorded before each trial, and immediately, 20 minutes, and 40 minutes after the end of stimulation. In the sham iTBS group, EA produced a reduction in MEPs amplitude, lasting approximately 40 minutes, while in the real iTBS group, EA significantly increased MEPs amplitude beyond 40 minutes after the end of stimulation. In sham EA group, the recorded MEPs amplitude showed no significant trend over time compared to baseline. Ese data indicate that immediate application of EA after iTBS significantly increased corticospinal excitability.
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