A New Paired Associative Stimulation Protocol with High-Frequency Peripheral Component and High-Intensity 20 Hz Repetitive Transcranial Magnetic Stimulation-A Pilot Study.

Sabin Sathyan, Aleksandra Tolmacheva, Sergei Tugin, Jyrki P Mäkelä, Anastasia Shulga, Pantelis Lioumis

Open access · goldAbstract read

In one paragraph

Article in International journal of environmental research and public health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it

0cells of the map it votes in

2citing papers in PubMed

0.3field-weighted citation impact, top 43% of its field

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 6 citations in OpenAlex.

Clinical development and guiding theory of transcranial magnetic stimulation: a literature review.Annals of medicine · 2025
Review
Spinally targeted paired associated stimulation with high-frequency peripheral component induces spinal level plasticity in healthy subjects.Scientific reports · 2024
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 1 institution in 1 country.

Sabin SathyanResearch Group of Computational Electromechanics, Department of Electrical Engineering and Automation, Aalto University, 02150 Espoo, Finland.ORCID 0000-0003-2018-5340

Aleksandra TolmachevaBioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, 00280 Helsinki, Finland.

Sergei TuginBioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, 00280 Helsinki, Finland.

Jyrki P MäkeläBioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, 00280 Helsinki, Finland.

Anastasia ShulgaBioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, 00280 Helsinki, Finland.

Pantelis LioumisBioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, 00280 Helsinki, Finland.ORCID 0000-0003-2016-9199

University of Helsinki · FI

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Paired associative stimulation (PAS) is a stimulation technique combining transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS) that can induce plastic changes in the human motor system. A PAS protocol consisting of a high-intensity single TMS pulse given at 100% of stimulator output (SO) and high-frequency 100-Hz PNS train, or "the high-PAS" was designed to promote corticomotoneuronal synapses. Such PAS, applied as a long-term intervention, has demonstrated therapeutic efficacy in spinal cord injury (SCI) patients. Adding a second TMS pulse, however, rendered this protocol inhibitory. The current study sought for more effective PAS parameters. Here, we added a third TMS pulse, i.e., a 20-Hz rTMS (three pulses at 96% SO) combined with high-frequency PNS (six pulses at 100 Hz). We examined the ability of the proposed stimulation paradigm to induce the potentiation of motor-evoked potentials (MEPs) in five human subjects and described the safety and tolerability of the new protocol in these subjects. In this study, rTMS alone was used as a control. In addition, we compared the efficacy of the new protocol in five subjects with two PAS protocols consisting of PNS trains of six pulses at 100 Hz combined with (a) single 100% SO TMS pulses (high-PAS) and (b) a 20-Hz rTMS at a lower intensity (three pulses at 120% RMT). The MEPs were measured immediately after, and 30 and 60 min after the stimulation. Although at 0 and 30 min there was no significant difference in the induced MEP potentiation between the new PAS protocol and the rTMS control, the MEP potentiation remained significantly higher at 60 min after the new PAS than after rTMS alone. At 60 min, the new protocol was also more effective than the two other PAS protocols. The new protocol caused strong involuntary twitches in three subjects and, therefore, its further characterization is needed before introducing it for clinical research. Additionally, its mechanism plausibly differs from PAS with high-frequency PNS that has been used in SCI patients.

Indexed as

Motor CortexTranscutaneous Electric Nerve StimulationEvoked Potentials, MotorHumansPilot ProjectsTranscranial Magnetic Stimulationcorticospinal tractlong interval cortical inhibitionneuroplasticitypaired associative stimulationperipheral nerve stimulationprimary motor cortexspinal cord injurytranscranial magnetic stimulation

Identifiers

PMID34769744

DOI10.3390/ijerph182111224

PMCPMC8583447

OpenAlexW3209412598

What OpenQuestion holds

Textmetadata

LicenceCC BY

Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.