Improvement of tactile perception and enhancement of cortical excitability through intermittent theta burst rTMS over human primary somatosensory cortex

Adopting the patterns of theta burst stimulation (TBS) used in brain-slice preparations, a novel and rapid method of conditioning the human brain has recently been introduced. Using short bursts of high-frequency (50 Hz) repetitive transcranial magnetic stimulation (rTMS) has been shown to induce lasting changes in brain physiology of the motor cortex. In the present study, we tested whether a few minutes of intermittent theta burst stimulation (iTBS) over left primary somatosensory cortex (SI) evokes excitability changes within the stimulated brain area and whether such changes are accompanied by changes in tactile discrimination behavior. As a measure of altered perception we assessed tactile discrimination thresholds on the right and left index fingers (d2) before and after iTBS. We found an improved discrimination performance on the right d2 that was present for at least 30 min after termination of iTBS. Similar improvements were found for the ring finger, while left d2 remained unaffected in all cases. As a control, iTBS over the tibialis anterior muscle representation within primary motor cortex had no effects on tactile discrimination. Recording somatosensory evoked potentials over left SI after median nerve stimulation revealed a reduction in paired-pulse inhibition after iTBS that was associated but not correlated with improved discrimination performance. No excitability changes could be found for SI contralateral to iTBS. Testing the performance of simple motor tasks revealed no alterations after iTBS was applied over left SI. Our results demonstrate that iTBS protocols resembling those used in slice preparations for the induction of long-term potentiation are also effective in driving lasting improvements of the perception of touch in human subjects together with an enhancement of cortical excitability.