Transcranial magnetic double stimulation: influence of the intensity of the conditioning stimulus.

The influence of stimulus parameters on compound muscle potentials evoked by transcranial magnetic double stimulation was systematically investigated. Two magnetic stimulators were discharged via a figure-of-eight-shaped magnetic coil (outer diameter of each circular coil, 7 cm) over the left hemisphere, 6 cm lateral to Cz, using a Bistim interface. Recordings were made from the right first dorsal interosseus muscle. In experiment I, in 12 healthy volunteers the intensity of the conditioning subthreshold stimulus was varied from 0 to 100% of the relaxed motor threshold at an interstimulus interval of 1 ms. In experiment II, interstimulus intervals of 1, 3 and 5 ms were used to investigate the effect of conditioning stimuli of 3 fixed intensities. Maximal reduction of the amplitude of motor evoked potentials was found at a conditioning stimulus intensity of 65% of the relaxed motor threshold (and at an interstimulus interval of 1 ms). Because intensities of the conditioning stimulus higher than 65% reduced amplitudes of motor evoked potentials less effectively than at this intensity, refractoriness of pyramidal neurons can be ruled out as the main mechanism contributing to the observed inhibition. Activation of inhibitory interneurons by intensities lower than is necessary to activate pyramidal neurons is discussed as a possible mechanism for the inhibitory effects evoked by transcranial magnetic stimulation.