Central fatigue and transcranial magnetic stimulation: effect of caffeine and the confound of peripheral transmission failure

In this experiment, we attempt to replicate the fatigue-induced decline in voluntary surface electromyography (EMG) and motor evoked potentials (MEPs) observed in previous studies and determine: (1) if this decline can be attributed to central failure, and (2) whether this failure is offset by caffeine. Seven subjects each attended two sessions (caffeine and placebo). Central excitability was estimated using transcranial magnetic stimulation (TMS), and surface EMG and twitch interpolation were used to estimate voluntary activation before, during and after fatigue of the first dorsal interosseous (FDI). Mass action potentials (M waves) were evoked to assess peripheral transmission throughout the experiment. We observed an increase in post-activation potentiation of the motor evoked potential in the caffeine trial and a fatigue-induced decline in the MEP and maximal EMG in both the placebo and caffeine trials. However, there was also a fatigue-induced decline in peripheral transmission, and estimates of central failure were considerably reduced when normalized to the M wave. A review of central fatigue literature revealed many studies that attribute the decline in voluntary EMG or MEP's wholly to central failure and fail to consider peripheral transmission. Thus, we conclude by stressing the importance of reporting peripheral transmission when surface recordings are used to estimate central mechanisms. (C) 2004 Elsevier B.V. All rights reserved.