Current models of motor cortical plasticity, developed in studies on experimental animals, emphasize the importance of the conjoint activity of somatosensory afferents and intrinsic motor cortical circuits. The hypothesis that an enduring change in excitability in the cortical output circuitry can be induced in the human motor cortex by a paired-stimulation protocol was tested. Low-frequency median nerve stimulation was paired with transcranial magnetic stimulation (TMS) over the optimal cranial site for stimulating the abductor pollicis brevis muscle (APB). This protocol induced an increase in the amplitudes of the motor evoked potentials (MEPs) in the resting APB as well as a prolongation of the silent period measured in the precontracted APB following TMS; amplitudes of MEPs measured in voluntary contraction remained unchanged. Experiments testing the excitability of spinal motoneurons using F-wave studies and electrical stimulation of the brainstem suggested that the site of the plastic changes was within the motor cortex. The increases in resting amplitudes and silent period duration were conditionally dependent on the timing between the afferent and the magnetic stimulation in that they were present when events elicited by afferent and magnetic stimulation were synchronous at the level of the motor cortex. Plasticity induced by paired stimulation evolved rapidly (within 30 min), was persistent (minimum duration 30-60 min) yet reversible, and was topographically specific. This combination of features and the similarity to properties of induced enduring changes in synaptic efficacy, as elucidated in animal studies, leads us to propose that the induced plasticity may represent a signature of associative long-term potentiation of cortical synapses or closely related neuronal mechanisms in the human cortex.

Bilateral pallidal neurostimulation for 3 months was more effective than sham stimulation in patients with primary generalized or segmental dystonia. (ClinicalTrials.gov number, NCT00142259 [ClinicalTrials.gov].).

Classen. A temporally asymmetric Hebbian rule governing plasticity in the human motor cortex. J Neurophysiol 89: 2339 -2345, 2003. First published January 22, 2003 10.1152/jn.00900.2002 Synaptic plasticity is conspicuously dependent on the temporal order of the pre-and postsynaptic activity. Human motor cortical excitability can be increased by a paired associative stimulation (PAS) protocol. Here we show that it can also be decreased by minimally changing the interval between the two associative stimuli. Corticomotor excitability of the abductor pollicis brevis (APB) representation was tested before and after repetitively pairing of single right median nerve simulation with single pulse transcranial magnetic stimulation (TMS) delivered over the optimal site for activation of the contralateral APB. Following PAS, depression of TMS-evoked motor-evoked potentials (MEPs) was induced only when the median nerve stimulation preceded the TMS pulse by 10 ms, while enhancement of cortical excitability was induced using an interstimulus interval of 25 ms, suggesting an important role of the sequence of cortical events triggered by the two stimulation modalities. Experiments using F-wave studies and electrical brain stem stimulation indicated that the site of the plastic changes underlying the decrease of MEP amplitudes following PAS (10 ms) was within the motor cortex. MEP amplitudes remained depressed for approximately 90 min. The decrease of MEP amplitudes was blocked when PAS(10 ms) was performed under the influence of dextromethorphan, an N-methyl-D-aspartate-receptor antagonist, or nimodipine, an L-type voltage-gated calcium-channel antagonist. The physiological profile of the depression of human motor cortical excitability following PAS(10 ms) suggests long-term depression of synaptic efficacy to be involved. Together with earlier findings, this study suggests that strict temporal Hebbian rules govern the induction of long-term potentiation/long-term depression-like phenomena in vivo in the human primary motor cortex. I N T R O D U C T I O NActivity-dependent long-term modification of synaptic efficacy has been proposed to underlie information storage in neuronal populations. Hebb (1949) postulated that the strength of a synapse may be modulated by correlated activity of a (weak) input to a postsynaptic cell with activation of that cell, as a consequence of activity of another (strong) input to it. This principle, termed associativity, has been confirmed experimentally in numerous studies. Additionally, a stringent and surprisingly simple asymmetric temporal rule governing the direction of synaptic change has been revealed in many brain regions. With few notable exceptions (e.g., Bell et al. 1997; Egger et al. 1999; Holmgren and Zilberter 2001), it was found that associative long-term potentiation (LTP) was induced when an action potential of the postsynaptic neuron (induced by a strong input to the cell) followed the postsynaptic potential induced by a weak input. If the order of stimulation was reversed (i.e., ...

Synaptic inhibition in the brain is mainly mediated by ã_aminobutyric acid (GABA) (Biggio, 1992). The effects of GABA are modulated by a powerful uptake system (Dingledine & Korn, 1985) that limits spatial diffusion of GABA and the duration of inhibitory postsynaptic potentials (IPSPs) (Isaacson et al. 1993). If GABA uptake is blocked pharmacologically, profound changes in the shape and duration of stimulus-induced IPSPs can be observed in cortical slices of experimental animals (Dingledine & Korn, 1985;Thompson & G ahwiler, 1992). Tiagabine (TGB), a lipophilic derivative of nipecotic acid, is a novel antiepileptic drug effective in controlling partial seizures (Ben-Menachem, 1995). In in vitro experiments, TGB has been shown to inhibit the uptake of GABA from the synaptic cleft into glial cells and neurons (Suzdak & Jansen, 1995). Because so much is known concerning the mechanism of action of TGB as elucidated in experiments in animals and cortical slice preparations, it may serve as a suitable substance for enabling us to learn more about the organizational principles of cortical inhibition in humans. We used transcranial magnetic stimulation (TMS) to study non-invasively the effects of blocking GABA uptake in the human motor cortex. Although the exact neuronal mechanisms leading to inhibitory or facilitatory phenomena are not known, TMS techniques are now widely used to assess intracortical excitability in certain neurological disorders and under experimental conditions (Rothwell, 1997) including neuropharmacological manipulation (Ziemann et al. 1996b). Our

Associative stimulation has been shown to enhance excitability in the human motor cortex (Stefan et al. 2000); however, little is known about the underlying mechanisms. An interventional paired associative stimulation (IPAS) was employed consisting of repetitive application of single afferent electric stimuli, delivered to the right median nerve, paired with single pulse transcranial magnetic stimulation (TMS) over the optimal site for activation of the abductor pollicis brevis muscle (APB) to generate approximately synchronous events in the primary motor cortex. Compared to baseline, motor evoked potentials (MEPs) induced by unconditioned, single TMS pulses increased after IPAS. By contrast, intracortical inhibition, assessed using (i) a suprathreshold test TMS pulse conditioned by a subthreshold TMS pulse delivered 3 ms before the test pulse, and (ii) a suprathreshold test TMS pulse conditioned by afferent median nerve stimulation delivered 25 ms before the TMS pulse, remained unchanged when assessed with appropriately matching test stimulus intensities. The increase of single‐pulse TMS‐evoked MEP amplitudes was blocked when IPAS was performed under the influence of dextromethorphan, an N‐methyl‐d‐aspartate (NMDA) receptor antagonist known to block long‐term potentiation (LTP). Further experiments employing the double‐shock TMS protocol suggested that the afferent pulse, as one component of the IPAS protocol, induced disinhibition of the primary motor cortex at the time when the TMS pulse, as the other component of IPAS, was delivered. Together, these findings support the view that LTP‐like mechanisms may underlie the cortical plasticity induced by IPAS.