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ObjectiveTo explore the therapeutic effect and mechanism of intermittent theta burst transcranial magnetic stimulation (iTBS) on non-fluent aphasia after stroke. MethodsFrom August, 2021 to August, 2022, 50 patients with non-fluent aphasia after stroke in the First People's Hospital of Lianyungang were randomly divided into sham stimulation group (n = 25) and iTBS group (n = 25). Both groups accepted speach training. iTBS group accepted iTBS, and the sham stimulation group received sham iTBS, for four weeks. The serum brain-derived neurotrophic factor (BDNF) was measured, and they were assessed by China Rehabilitation Research Center Standard Aphasia Examination (CRRCAE) and Boston Diagnostic Aphasia Examination before and after treatment. ResultsTwo cases in the sham stimulation group and three cases in iTBS group dropped down. The BDNF level, and listen and understand, repeat, name, read aloud, and total score of CRRCAE improved in two groups after treatment (|t| > 5.012, P < 0.001); and they were better in iTBS group than in the sham stimulation group (|t| > 3.968, P < 0.001). The total effective rate was more in iTBS group than in the sham stimulation group (χ2 = 8.835, P < 0.05). ConclusioniTBS can improve speech function in patients with non-fluent aphasia after stroke, which may associate with the promotion of BDNF.
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Objective:To observe any stimulatory effect of intermittent theta burst stimulation (iTBS) on the cerebral swallowing cortex and the cerebellar swallowing motor area and to explore the related mechanisms.Methods:Forty-four healthy right-handed subjects were divided at random into a dominant cerebellum group ( n=15), a non-dominant cerebellum group ( n=15) and a control group ( n=14). In the dominant cerebellum group, iTBS was administered to the cerebellum of the dominant hemisphere, and the other hemisphere was given sham stimulation. In the non-dominant cerebellum group, it was the opposite. The dominant cerebellum received the sham stimulation. In the control group both hemispheres received sham stimulation. Before and after the stimulation, single-pulse transcranial magnetic stimulation (TMS) was applied to the representative regions of suprahyoid muscles in bilateral brain and cerebellum to observe changes of the latency and amplitude of motor evoked potentials (MEPs). Results:After the intervention the MEP amplitude of the bilateral swallowing cortex and the stimulated cerebellum had increased in the non-dominant cerebellum group, with increased MEP amplitude only from the stimulated cerebellum of the dominant cerebellum group. Compared with the control group, the non-dominant cerebellum group showed the greatest improvement in MEP amplitude of the stimulated bilateral cerebral cortex and cerebellum. Improvement in the dominant cerebellum group was significantly smaller. However, there were no significant differences in MEP latency or the percentage change in MEP latency from baseline among the three groups.Conclusions:Applying iTBS to either the non-dominant or the dominant cerebellum excites the brain areas related to swallowing, but in different ways.
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Objective:To explore any effect of combining intermittent theta-burst stimulation (iTBS) of the cerebellum with physiotherapy on the balance function and gait of stroke survivors.Methods:Thirty-two hemiplegic stroke survivors were divided at random into a treatment group and a control group, each of 16. Both groups received conventional physical therapy. Before their physiotherapy sessions the treatment group received iTBS treatment of the cerebellar hemisphere contralateral to the affected cerebral hemisphere, while the control group was given pseudo-stimulation on the same site. The iTBS was given once a day for 200s each time, 6 times a week for 3 weeks consecutively. Before and after the treatment, as well as 3 weeks later, both groups′ balance was evaluated using the Berg Balance Scale (BBS). Their ability to shift their center of gravity, total length of their shaking trajectory, and maximum shaking diameter were also quantified. Walking ability was assessed using 10m walk test (10MWT) times and the Tinetti Gait Assessment Scale (POMA-G). Lower limb motor function was quantified using the relevant Fugl-Meyer assessment (FMA-LE) and the subjects′ ability in the activities of daily living was measured with the Barthel index (BI).Results:After the 3 weeks of treatment and at the follow-up the average BBS score of the treatment group had improved significantly more than the control group′s average, as had its total track length and maximum shake diameter. The average POMA-G, FMA-LE and BI scores of the treatment group were also significantly better.Conclusions:Combining iTBS with physiotherapy can improve the balance and gait of stroke survivors more effectively than physiotherapy alone.
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Objective:To investigate the effects of single intermittent theta-burst stimulation on functional connectivity in patients with mild cognitive impairment(MCI).Methods:From July to November 2020, forty MCI patients were selected and randomly divided into iTBS true stimulation group and iTBS sham-stimulation group, with 20 patients in each group.iTBS targeted the left dorsolateral prefrontal cortex (DLPFC). Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), activity of daily living scale(ADL), Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) were evaluated at baseline.The resting state electroencephalography (rsEEG) was collected for 5 minutes before and after iTBS in the two groups.The phase lag index(PLI) of EEG functional connectivity was calculated, and the functional connectivity matrix diagram was drawn.SPSS 26.0 software was used for statistical analysis.Data were statistically analyzed by χ2 test, Wilcoxon rank sum test and independent sample t-test. Results:There were no significant differences in scores of MoCA, ADL, HAMD and HAMA between the two groups(all P>0.05). In the iTBS true stimulation group, compared with that before iTBS treatment(0.140(0.133, 0.144)), the PLI of β band increased significantly after iTBS treatment(0.146(0.136, 0.167))( P<0.05). The region of increased PLI was mainly concentrated in the central region(C3/C4-T7/T8). Compared with that before iTBS treatment(0.251(0.232, 0.299)), the PLI of α band increased after iTBS treatment(0.286(0.241, 0.359)), but the difference was not statistically significant( P>0.05). Conclusion:Single iTBS treatment can significantly increase the EEG functional connectivity in patients with MCI, indicating that iTBS targeting the left DLPFC can effectively regulate the EEG functional connectivity in patients with MCI, which may reveal the mechanism of iTBS in improving cognitive function in patients with MCI.
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ObjectiveTo investigate the effect of intermittent theta burst stimulation (iTBS) of the multi-target cerebral cortex after stroke on functional recovery of the upper limb of the hemiplegic side. MethodsFrom November, 2019 to August, 2020, 40 stroke patients in Gansu Provine Hospital Rehabilitation Center were included and randomly divided into single-target stimulation group (n = 20) and multiple-target stimulation group (n = 20). Both groups underwent basic neurorehabilitation drug therapy and conventional rehabilitation exercises. The single-target stimulation group received repetitive transcranial magnetic stimulation (rTMS) (iTBS mode) only in the primary motor cortex (M1) of the affected side. The multi-target stimulation group received rTMS (iTBS mode) in the cerebellar cortex of the healthy brain and M1 of the affected side, once a day, six days a week, for four weeks. Before and after treatment, the scores of Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT) and modified Barthel Index (MBI), and the latency and amplitude of somatosensory-evoked potentials N20 were compared. ResultsNo serious adverse reaction occurred during treatment. After treatment, the scores of FMA-UE, MBI and ARAT, and the amplitude and latency of N20 improved in both groups (|t| > 3.478, |Z| > 2.243, P < 0.05); and the scores of FMA-UE and ARAT, and the amplitude of N20 were better in the multiple-target stimulation group than in the single-target stimulation group (t > 2.939, Z = -2.697, P < 0.01). ConclusionMulti-target stimulation is superior to single-target stimulation for improving upper limb motor function and N20 amplitude in the hemiplegics after stroke.
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Objective:To observe any effect of intermittent theta burst stimulation (iTBS) on the spatially-delayed responses of working memory using cynomolgus macaques.Methods:The working memory of six male cynomolgus macaques (8-9 years old) was trained using a spatially-delayed response task. They were then randomly divided into an iTBS group and a control group, each of 3. The iTBS group was given iTBS at an intensity of 35% of the maximum output, with 2 seconds of stimulation followed by 8 seconds of rest with trains of 50Hz bursts repeated at a frequency of 5Hz over a period of 192 seconds once daily for 5 days, while the control group was given sham iTBS. Before and after the 5 days, the body weight and working memory of each animal were evaluated. The total number of effective feeding episodes, and of effective feeding episodes with short and long delay periods were recorded.Results:There was no significant change in the average body weight of either group before and after the modeling and iTBS intervention. After the intervention the number of total effective feeding cases and those with a short delay period were both significantly higher in the iTBS group than in the control group. However, no significant inter-group differences in the effective feeding cases with a long delay period were observed.Conclusions:iTBS is effective in improving the spatially-delayed responses of working memory, at least in cynomolgus macaques.
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Objective:To investigate the effects of theta burst stimulation(TBS)mode repeated transcranial magnetic stimulation (r-TMS) in the left prefrontal on negative symptoms and cognitive function in the elderly chronic schizophrenic patients.Methods:Totally 48 patients with stable chronic senile schizophrenia (24 cases in r-TMS treatment group and 24 cases in r-TMS pseudo stimulation control group) were selected. The treatment group was given the TBS mode r-TMS performed in the left dorsolateral prefrontal cortex. The control group was given pseudo stimulation at the same site. Before and after treatment, the brief psychiatric rating scale(BPRS), scale for assessment of negative symptoms(SANS), and positive and negative syndrome scale(PANSS)were used to assess mental symptoms, while Mattis-dementia rating scale(MDRS-2)and social adaptation functioning evaluation(SAFE)were used to assess cognitive function and social function. SPSS 20.0 was used for statistical analysis.Comparisons of the differences between inter groups and intra groups were conducted by independent sample t test and paired t-test. Results:(1)There were significant differences in the total score of PANSS scale((60.17±3.73), (56.67±3.12)), the negative symptom subscale score of PANSS((20.88±2.94), (17.96±2.33)) and the score of SANS((30.67±1.66), (30.25±1.45)) before and after treatment in the treatment group (all P<0.05). The D-value before and after treatment in the scores of BPRS ( t=3.513, P=0.001), PANSS ( t=6.048, P<0.01), negative symptom subscale ( t=6.610, P<0.01) and SANS ( t=8.239, P<0.01) were significantly different between the two groups. (2)There were significant differences in the scores of MDRS-2 and its sub scales before and after treatment in the treatment group (all P<0.05). The D-value before and after treatment in the scores of MDRS-2 ( t=6.216, P<0.01), attention ( t=4.596, P<0.01), start/maintain ( t=6.424, P<0.01), concept formation ( t=3.974, P<0.01), construction( t=2.194, P=0.033) and memory ( t=3.162, P=0.003) were significantly different between the two groups.(3)There was no significant difference in the SAFE score between the treatment group and the control group before and after treatment ( t=0.138, 0.142, both P>0.05). Conclusion:TBS can improve the negative symptoms and cognitive function in patients with the elderly chronic schizophrenic, but the effect of social function is not clear.
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Objective:To observe any effect of intermittent theta burst stimulation (iTBS) of the cerebellum on swallowing dysfunction after cerebellar infarction, and to explore its mechanism.Methods:Sixty-two cerebellar stroke survivors with dysphagia were randomly divided into an observation group and a control group, each of 29. In addition to the routine swallowing rehabilitation training, the observation group was treated with iTBS, while the control group was given sham iTBS. The incubation and amplitude of the bilateral suprahyoid muscle motor evoked potential (MEP) were recorded before and after 4 weeks of treatment. The exponential approximate entropy (ApEn) of different brain regions was compared between the two groups during reflex and autonomous swallowing. Swallowing function was evaluated using the penetration-aspiration scale (PAS).Results:MEP incubation in the bilateral suprahyoid muscles had decreased significantly after 4 weeks of treatment in the observation group, and the MEP amplitude in the bilateral suprahyoid muscles of the two groups had increased significantly. The average improvement in the amplitude and incubation in the observation group was significantly greater than in the control group. The average ApEn at C3, C4, P3, P4, T5 and T6 had increased significantly in both groups during both reflex and spontaneous swallowing, with the improvement in the observation group significantly greater. Swallowing function had improved significantly in both groups, but the average PAS grade of the observation group was again significantly better.Conclusions:iTBS can improve the swallowing function of dysphagic cerebellar stroke survivors. This may be due to iTBS improving the excitability of the cerebral cortex and improving motor control of the swallowing muscles.
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Objective:To observe any effect of intermittent theta burst stimulation (iTBS) of the prefrontal lobe on dysphagia and impaired cognition, and to explore the neural mechanisms involved.Methods:Twenty-eight patients with dysphagia and mild cognitive impairment were randomly divided into an iTBS group of 16 and a control group of 11. The iTBS group received 20 minutes of iTBS (2 seconds on and 8 seconds off) of the right dorsal lateral prefrontal cortex (DLPFC) once daily for 2 weeks, with the intensity at 80% of the resting movement threshold of the right abductor pollicis brevis, while the control group was given sham iTBS. Before and after the treatment, both groups′ cognitive functioning was evaluated using the Montreal Cognitive Assessment Scale (MoCA), a trial marking test, a digit span test and a Stroop color word test. Video-fluoroscopy was used to record oral transmission times (OTTs), hyoid bone anterior displacement and hyoid bone upward displacement during swallowing. Resting-state functional magnetic resonance imaging measured the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo) and functional connectivity in the patients′ brains.Results:Before the treatment there was no significant difference in the average indices of cognition or swallowing function between the 2 groups. Afterward the average MoCA score had increased significantly in both groups, with the improvement in the iTBS group significantly greater than that of the controls. Average OTT had shortened significantly in both groups, with significantly greater improvement in the iTBS group. The magnetic resonance imaging showed that after iTBS treatment, local excitation indicators and functional connections in several brain regions had changed. ALFF and ReHo in the right anterior cuneus had increased, ReHo in the left middle temporal gyrus, the orbital region of the left inferior frontal gyrus and the left middle cingulate gyrus had decreased, and functional connectivity in the right DLPFC, the bilateral cuneus and the right middle cingulate gyrus had increased.Conclusions:Two weeks of intermittent TBS of the right DLPFC can improve the swallowing and cognition of persons with dysphagia. Functional reorganization of brain networks may be one of the neural mechanisms involved.
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Resumen Introducción: La estimulación magnética transcraneal (EMT) es una opción potencial de tratamiento para la sintomatología de trastorno del espectro autista. Objetivos: Determinar la eficacia de la EMT en modalidad theta-burst intermitente (ETBi) sobre la corteza pre frontal dorso lateral izquierda (CDLPF) en el manejo de comportamientos patológicos asociados con TEA. Pacientes y Métodos: Paciente masculino de 10 años de edad diagnosticado con TEA con (ADOS) Autistic Diagnostic Observation Schedule, presenta una historia familiar de una hermana menor con TEA. Tanto el estudio de Resonancia Magnética encéfalo (IRM) y IRM funcional (IRMf) con paradigma emocionales se efectuaron antes del tratamiento de ETBi, inmediatamente después de tratamiento ETBi, y después de 6 meses de tratamiento con ETBi. Resultados: La prueba de ATEC reporto mejoría en las escalas de comunicación, cognición, social y comportamiento, 83%,81%,72% y 52% respectivamente. La puntuación total mejoro un 66% inmediatamente después de tratamiento y 55% en un periodo de 6 meses. La IRMf revelo la activación de la corteza frontal, parietal y occipital antes del tratamiento con ETBi y persistiendo la mejoría por 6 meses. Conclusión: ETBi una técnica de neuromodulación no invasiva bien tolerado que requiere un tiempo de administración menor que el tratamiento estándar.
Abstract Background: Transcranial magnetic stimulation (TMS) is a potential treatment option for autism spectrum disorder (ASD) symptomatology. Objectives: To determine the efficacy of the TMS intermittent theta-burst stimulation (iTBS) protocol over the left dorsolateral prefrontal cortex (DLPFC) in the management of pathological behaviors associated with ASD. Patient/Methods: A 10-year-old male diagnosed with ASD by the Autism Diagnostic Observation Schedule (ADOS) presented with a family history of ASD with a younger sister diagnosed with the same disorder. Both magnetic resonance imaging (MRI) and functional MRI (fMRI) scans for emotional paradigms were performed before the iTBS treatment, immediately after the iTBS treatment, and after 6 months of iTBS treatment. Results: The ATEC reports revealed improvement in communication, cognition, sociability, and behavior scales by 83%, 81%, 72%, and 52%, respectively. The overall score improved by 66% immediately after the treatment and by 55% lasting over a 6-month period. The fMRI revealed the activation of the frontal, parietal, and occipital cortex before iTBS treatment, and a better integration and activation of the frontal, temporal, and occipital cortex after iTBS treatment and persisted after 6 months. Conclusions: iTBS is a well-tolerated, non-invasive neuromodulation technique that requires relatively less administration than the standard treatment.
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Objective • To explore the effect of cerebellar vermal repetitive transcranial magnetic stimulation (rTMS) with theta burst stimulation (TBS) paradigm on cognitive functions of patients with schizophrenia. Methods • Thirty-one schizophrenia patients were randomly assigned into study group (n=14) and control group (n=17). Patients in the study group received a combination of rTMS and drug therapy, and patients in the control group received a combination of sham rTMS and drug therapy. The intervention lasted for 2 weeks, a total of 10 times. To evaluate the effect of rTMS on cognitive functions, MATRICS consensus cognitive battery (MCCB) was used to assess at baseline, after the intervention, 12 weeks and 24 weeks after the end of the intervention. Results • At baseline, there were no significant differences between two groups in the scores of each factor and the overall composite scores (P>0.05). After the intervention, repeated measures analysis of variance showed that the main effect of time was statistically significant in the scores of social cognitive (F=3.901, P0.05). Moreover, in the scores of speed of processing, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving and the overall composite scores, the main effect of group/time and the interaction between time and group were not significant (P>0.05). Conclusion • Application of TBS rTMS to cerebellar vermal is not superior compared with sham rTMS in improving the above seven cognitive domains.
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Objective: Theta-burst stimulation (TBS) modulates synaptic plasticity more efficiently than standard repetitive transcranial magnetic stimulation delivery and may be a promising modality for neuropsychiatric disorders such as autism spectrum disorder (ASD). At present there are few effective interventions for prefrontal cortex dysfunction in ASD. We report on an open-label, pilot study of intermittent TBS (iTBS) to target executive function deficits and restricted, repetitive behaviors in male children and adolescents with ASD. Methods: Ten right-handed, male participants, aged 9-17 years with ASD were enrolled in an open-label trial of iTBS treatment. Fifteen sessions of neuronavigated iTBS at 100% motor threshold targeting the right dorsolateral prefrontal cortex were delivered over 3 weeks. Results: Parent report scores on the Repetitive Behavior Scale Revised and the Yale-Brown Obsessive Compulsive Scale demonstrated improvements with iTBS treatment. Participants demonstrated improvements in perseverative errors on the Wisconsin Card Sorting Test and total time for the Stroop test. The iTBS treatments were well tolerated with no serious adverse effects. Conclusion: These preliminary results suggest that further controlled interventional studies of iTBS for ASD are warranted.
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Humans , Male , Child , Adolescent , Theta Rhythm/physiology , Transcranial Magnetic Stimulation/methods , Autism Spectrum Disorder/therapy , Pilot Projects , Treatment Outcome , Prefrontal Cortex/physiopathology , Signal Detection, Psychological , Aftercare , Autism Spectrum Disorder/physiopathology , Autism Spectrum Disorder/psychology , Obsessive Behavior/psychology , Obsessive-Compulsive Disorder/psychologyABSTRACT
Objective To investigate the effects of continuous theta burst stimulation (cTBS) on the motor network in the motor area,in order to provide a new way for the basic treatment of motor function.Methods A total of 12 healthy subjects were recruited to stimulate the primary motor areas of the brain by continuous theta burst transcranialmagnetic stimulation,and finger movements were tested before and after stimulation,while the EEG was collected.Pearson correlation method was used to analyze the related characteristics of EEG signals,construct and analyze the functional network of brain,and study the characteristic parameters of brain function network.Results The correlation coefficient matrix,the topological map of the functional network and the parameters of the functional network of the brain were not changed before and after the intervention in the pseudo stimulus group (all P＞0.05);Before stimulation,as compared with after stimulation,cTBS stimulated the motor area,the key button exercise test mean reaction time increased,the degree of network node decreased,the cluster coefficient increased,the network of "small world" property reduced.After cTBS stimulation,there were significant differences (P＜0.05).Conclusion The cTBS mode of transcranial magnetic stimulation (TMS) can change the topological structure and network parameters of brain function network,and improve the motor function.
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Post-stroke aphasia recovery is affected by the hemispheric dominance of language lateralization and the dynamic changes after stroke. Theta burst stimulation is a novel model of repetitive transcranial magnetic stimulation, which has a shorter treatment time and a stronger treatment effect. It has been proven as a beneficial method to aphasia recovery after stroke. The mode, timing and location of the stimulation were introduced, and assessments and the follow-up timing were discussed, based on the potential mechanisms of aphasia recov-ery in the filed of hemispheric dominance.
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As a safe and noninvasive therapy, repetitive transcranial magnetic stimulation (rTMS) and theta burst stimulation (TBS) are used to change the cortical excitability, and induce or enhance neural plasticity, which can promote the recovery of motor function after stroke. This paper summarized the individual treatment of rTMS on motor function of stroke patients, the advantages of TBS compared with rTMS, and the mechanisms and clinical application of TBS.
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Objective To explore the effect of theta burst stimulation (TBS) paradigm of repetitive transcranial magnetic stimulation (rT-MS) on executive function in patients with chronic schizophrenia. Methods 60 patients meeting DSM-IV for chronic schizophrenia disor-ders criteria were enrolled. They were randomly divided into TBS group (n=30) and sham intervention group (n=30). They were assessed with digit span performance, space span performance and Wisconsin Card Sorting Test (WCST) before and 4 weeks after intervention. Re-sults After intervention, the forward score of digit span performance, the total score and forward score of space span performance increased (P0.05). There was significant difference in all the items be-tween 2 groups after intervention (P<0.05). Conclusion TBS paradigm of rTMS could improve the executive function in schizophrenic pa-tients.
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Objective To explore the effect of theta-burst stimulation (TBS) of the motor cortex on the suprahyoid muscles and the mechanism through which the bilateral motor cortex regulates the suprahyoid muscles.Methods Continuous TBS (cTBS) was applied to the left motor cortex followed by intermittent TBS (iTBS) applied to the right motor cortex of 24 healthy subjects.The motor-evoked potentials (MEPs) of the suprahyoid muscles on both sides were recorded before the stimulation and after 15 and 30 minutes.The MEP amplitudes of the left and right suprahyoid muscles were analyzed using repeated measures analysis of variance.Results Before stimulation, the average MEP amplitudes of the left and right suprahyoid muscles were (375.29 ± 176.09) μV and (368.17 ± 149.02) μV respectively, significantly lower than the values after the stimulation.Conclusion iTBS can distinctly enhance the excitability of the right motor cortex controlling the suprahyoid muscles and reverse the inhibition caused by cTBS applied to the left motor cortex.Clarifying the effect of TBS on the excitability of the bilateral motor cortex is important for the rehabilitation of dysphagic stroke survivors.
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Objective To evaluate the effect of theta burst stimulation( TBS) paradigm of repetitive tran?scranial magnetic stimulation ( rTMS ) on the treatment of schizophrenia through assessing executive function. Methods 60 patients met with DSM?4 and ICD?10 for schizophrenia disorders criteria were enrolled in this study. The group was divided into theta burst stimulation group(research group, n=30) and sham intervention group ( control group, n=30) . The research group and control group were assessed with the Wisconsin card sorting test (WCST) and the go/no?go task by event?related potential(ERPs) before and after 4 weeks treatment. Each test results of all groups before and after treatment were compared with each other respectively. Results Regarding the WCST test,compared with the baseline,the post?rTMS state of the TBS group showed a decrease in the error selec?tion percentage((59.8±14.7)%),the preservative error number(55.3±18.0) and the preservative error percentage (71.3±12.6)%,but the percentage of conceptual level(71.3±12.6)% increased in the TBS group(P0.05).Conclusions The?ta burst stimulation paradigm of rTMS can improve the executive function in schizophrenic patients.
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Repetitive transcranial magnetic stimulation (rTMS) has been applied in a variety of diseases due to the clinical effects through the plasticity of the brain. The effects of TMS appear differently depending on the methods of stimulation. Single pulse TMS depolarizes and discharges nerves temporally under the cortex areas stimulated, whereas rTMS induces long-lasting effects of nerves stimulated. According to the intensity of stimulation, the direction of coil and stimulation frequency, rTMS can increase or decrease the excitability of the corticospinal tract and has been verified as techniques to treat a variety of neuropsychiatric disorders. In rTMS studies using electroencephalogram (EEG), changes in brain waves have been measured before and after TMS or simultaneously during TMS. In these studies, low frequency (< or =1 Hz) rTMS, high-frequency (5-25 Hz) rTMS, theta burst stimulation, paired association stimulation have been studied and somatosensory, visual, cognitive, and motor potentials and oscillatory activities were measured and compared before and after TMS. Combined with neurophysiological and, neuroimaging methods, TMS techniques could be used to study cortical excitability, cortical inhibition and excitement, and the cortical plasticity of local areas and neural network. In particular, because simultaneous measurement during TMS as well as measurement before and after TMS is possible, EEG could be very useful to determine the effects of TMS compared to other brain imaging tools.