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Theta-burst stimulation (TBS) is a form of repetitive transcranial magnetic stimulation (TMS) developed to induce neuroplasticity. TBS usually consists of 50 Hz bursts at 5 Hz intervals. When applied intermittently, it can lead to facilitation of motor evoked potentials (MEPs), although these effects can be variable between individuals. Here, we aimed to determine whether a version of intermittent TBS (iTBS) consisting of 30 Hz bursts at 6 Hz intervals would produce less variable modulation. Nineteen healthy adults underwent single-pulse TMS to assess corticomotor excitability at baseline as reflected in MEP amplitude. 30 Hz iTBS was then administered and MEP amplitude was reassessed at 5-, 20- and 45-mins after the iTBS protocol. Compared to baseline, MEPs were significantly facilitated up to 45-min post-iTBS and most participants exhibited the expected facilitation. These observations suggest that 30 Hz/6 Hz iTBS may provide a sound alternative to induce consistent neuromodulatory effects over the commonly used 50 Hz/5 Hz protocol.

INTRODUÇÃO: O Transtorno do Espectro Autista tem incidência precoce e causas genéticas e ambientais multifatoriais. Gera disfunção no desenvolvimento da linguagem e da sociabilidade e um padrão de comportamento restrito e repetitivo. A formação e o desenvolvimento do sistema nervoso são afetados provocando impacto na arquitetura tecidual, desequilíbrio funcional entre os sistemas excitatórios e inibitórios, além de problemas na conectividade e consistência das redes neurais. O tratamento baseia-se em estimulação multiprofissional precoce e no uso de medicamentos que interferem na sintomatologia impactante do cotidiano. Os comportamentos restritos e repetitivos marcam o perfil funcional do paciente com Transtorno do Espectro Autista e podem interferir diretamente no desenvolvimento da linguagem e na sociabilidade. A mudança do espectro comportamental em razão do amadurecimento cognitivo não impede o desequilíbrio funcional nas atividades da vida diária. Existem indícios de que a função da flexibilidade cognitiva somada à capacidade para gerar novos conceitos e à velocidade de processamento das informações estão afetadas nesses pacientes e podem representar a base fisiopatológica dos Comportamentos Restritos e Repetitivos e suas repercussões no desenvolvimento desses indivíduos. O presente estudo visa avaliar os efeitos da facilitação da transmissão dos impulsos nervosos na função da flexibilidade cognitiva e no comportamento restrito e repetitivo dos pacientes com o diagnóstico de Transtorno do Espectro Autista de alto funcionamento através da Estimulação Magnética Transcraniana de pulsos pareados no Córtex Pré Frontal Ventro Lateral (CPFVL) direito em sua porção antero inferior. MÉTODOS: Trata-se de um estudo experimental com procedimento sistematizado e intervencional realizado com 11 pacientes de 9 a 17 anos, pareados por um perfil cognitivo dentro dos limites da normalidade, que foram submetidos ao protocolo de estimulação com a técnica de \"Theta Burst\" em CPFVL antero inferior à direita em 15 sessões divididas em três semanas. Os pacientes foram testados antes e depois do procedimento. A avaliação da flexibilidade cognitiva, da capacidade de formação de novos conceitos e do tempo cognitivo foram realizada através dos testes Wisconsin Sort Card Test (WSCT) e STROOP, aplicados aos pacientes. Os Comportamentos Restritos e Repetitivos foram avaliados pelos instrumentos Repetitive Behavior Scale - Revised (RBS-r) e Escala de Pensamentos Obsessivos e Comportamentos Compulsivos de Yale Brown (YBOCS) por meio de questionários aplicados aos pais e cuidadores desses pacientes. RESULTADOS: Encontraram-se evidências de mudanças no padrão de inflexibilidade cognitiva, representada pelo WSCT, nos itens Erros Perserverativos (p=0,028) e na Formação de Nível Conceitual (p=0,022). A alteração demonstrada pela Formação de Nível Conceitual pelo WSCT e pelo Total de Tempo para realizar o STROOP test (p=0,001) representam mudança na velocidade de processamento de informações. Constatou-se melhora do Comportamento Restrito e Repetitivo tanto pelo RBS-r (p=0,002) quanto no YBOCS Total de Compulsões (p=0,02). Todas as classes mostraram mudanças significativas: Ordem Inferior (p=0,05), Ordem superior (p=0,028) e Insistência na Mesmice (p=0,014). Houve correlação entre as curvas que representam as mudanças ocorridas no RBS-r e na flexibilidade cognitiva, representada pelo item Respostas Perseverativas (r=0,049). Por se tratar de um piloto, o presente estudo permite o aprofundamento das pesquisas que relacionam esta forma de intervenção descrita ao tratamento do Comportamento Restrito e Repetitivo em pacientes com Transtorno do Espectro Autista / INTRODUTION: The Autism Spectrum Disorder has an early incidence. It has genetic and environment multifactorial causes. Patients present language and social development disability and restricted and repetitive behavior. The maturation and development of the nervous system are damaged. Hence there is a disruption on the tissue architecture, functional imbalance between excitatory and inhibitory systems and connectivity and consistency of neural networks issues. The treatment is grounded on premature multiprofessional stimulation to improve cognition and the medication for mood instability, sleep problems, anxiety, hyperactivity and attention problems. The Restricted and Repetitive Behavior marks the functional profile of the Autism Spectrum Disorder and can hinder the communication and sociability development. The behavior changes with the cognitive maturation but does not prevent from the functional imbalance in daily activities. Evidence revel that the cognitive inflexibility added to the impairment to form new concepts and cognitive tempo can reflect the pathophysiology of these behaviors and its impact on development. The current study aims to valuate changes on cognitive flexibility and restricted and repetitive behavior after the facilitation of impulses through paired pulse Trascranial Magnetic Stimulation (EMT) on right anterior inferior Ventro Lateral Pre Frontal Cortex (VLPFC) in high function Autism Spectrum Disorder individuals. METHODS: It is an experimental study with systemic interventional procedure. Eleven subjects with nine to seventeen years old paired by normal cognitive profile were submitted to the protocol of Theta Burst stimulation on right anterior inferior VLPFC with fifteen sessions divided into three weeks. Subjects were tested before and after the procedure. They were tested for cognitive inflexibility, the ability to form new concepts and the cognitive tempo by the Wisconsin Sort Card (WSCT) test and STROOP test. The restricted and repetitive behaviors were evaluated by Restricted and Repetitive Behavior Scale revised (RBS-r) and Yale Brown Obsessive and Compulsive Scale applied for parents. RESULTS: Evidence of changes on cognitive inflexibility pattern were found items Perseverative Errors (p=0,028) and Conceptual level Response (p=0,022) of the WSCT test. Information processing speed changes were established by the Conceptual level Response of the WSCT and the Total Time to Finish the STROOP test (p=0,001). Improvement on restricted and repetitive behavior were found by changes on total score of RBS-r (p=0,002) and by YBOCS Total of Compulsions (p=0,02). There were changes on all aspects of the repetitive behaviors: Low-Order behavior (p=0,05), High-Order behavior (p=0,028) and Sameness behavior (0,014). Correlation were found between changing curves of cognitive inflexibility represented by Perseverative Response and total score of RBS-r (r=0,049). Since this is a pilot study, our data allows us to suggest that EMT-pp can be efficient for treating restricted and repetitive behavior on Autism Spectrum Disorder. Further controlled studies will be conducted to confirm this hypothesis

INTRODUÇÃO: O Transtorno do Espectro Autista tem incidência precoce e causas genéticas e ambientais multifatoriais. Gera disfunção no desenvolvimento da linguagem e da sociabilidade e um padrão de comportamento restrito e repetitivo. A formação e o desenvolvimento do sistema nervoso são afetados provocando impacto na arquitetura tecidual, desequilíbrio funcional entre os sistemas excitatórios e inibitórios, além de problemas na conectividade e consistência das redes neurais. O tratamento baseia-se em estimulação multiprofissional precoce e no uso de medicamentos que interferem na sintomatologia impactante do cotidiano. Os comportamentos restritos e repetitivos marcam o perfil funcional do paciente com Transtorno do Espectro Autista e podem interferir diretamente no desenvolvimento da linguagem e na sociabilidade. A mudança do espectro comportamental em razão do amadurecimento cognitivo não impede o desequilíbrio funcional nas atividades da vida diária. Existem indícios de que a função da flexibilidade cognitiva somada à capacidade para gerar novos conceitos e à velocidade de processamento das informações estão afetadas nesses pacientes e podem representar a base fisiopatológica dos Comportamentos Restritos e Repetitivos e suas repercussões no desenvolvimento desses indivíduos. O presente estudo visa avaliar os efeitos da facilitação da transmissão dos impulsos nervosos na função da flexibilidade cognitiva e no comportamento restrito e repetitivo dos pacientes com o diagnóstico de Transtorno do Espectro Autista de alto funcionamento através da Estimulação Magnética Transcraniana de pulsos pareados no Córtex Pré Frontal Ventro Lateral (CPFVL) direito em sua porção antero inferior. MÉTODOS: Trata-se de um estudo experimental com procedimento sistematizado e intervencional realizado com 11 pacientes de 9 a 17 anos, pareados por um perfil cognitivo dentro dos limites da normalidade, que foram submetidos ao protocolo de estimulação com a técnica de \"Theta Burst\" em CPFVL antero inferior à direita em 15 sessões divididas em três semanas. Os pacientes foram testados antes e depois do procedimento. A avaliação da flexibilidade cognitiva, da capacidade de formação de novos conceitos e do tempo cognitivo foram realizada através dos testes Wisconsin Sort Card Test (WSCT) e STROOP, aplicados aos pacientes. Os Comportamentos Restritos e Repetitivos foram avaliados pelos instrumentos Repetitive Behavior Scale - Revised (RBS-r) e Escala de Pensamentos Obsessivos e Comportamentos Compulsivos de Yale Brown (YBOCS) por meio de questionários aplicados aos pais e cuidadores desses pacientes. RESULTADOS: Encontraram-se evidências de mudanças no padrão de inflexibilidade cognitiva, representada pelo WSCT, nos itens Erros Perserverativos (p=0,028) e na Formação de Nível Conceitual (p=0,022). A alteração demonstrada pela Formação de Nível Conceitual pelo WSCT e pelo Total de Tempo para realizar o STROOP test (p=0,001) representam mudança na velocidade de processamento de informações. Constatou-se melhora do Comportamento Restrito e Repetitivo tanto pelo RBS-r (p=0,002) quanto no YBOCS Total de Compulsões (p=0,02). Todas as classes mostraram mudanças significativas: Ordem Inferior (p=0,05), Ordem superior (p=0,028) e Insistência na Mesmice (p=0,014). Houve correlação entre as curvas que representam as mudanças ocorridas no RBS-r e na flexibilidade cognitiva, representada pelo item Respostas Perseverativas (r=0,049). Por se tratar de um piloto, o presente estudo permite o aprofundamento das pesquisas que relacionam esta forma de intervenção descrita ao tratamento do Comportamento Restrito e Repetitivo em pacientes com Transtorno do Espectro Autista / INTRODUTION: The Autism Spectrum Disorder has an early incidence. It has genetic and environment multifactorial causes. Patients present language and social development disability and restricted and repetitive behavior. The maturation and development of the nervous system are damaged. Hence there is a disruption on the tissue architecture, functional imbalance between excitatory and inhibitory systems and connectivity and consistency of neural networks issues. The treatment is grounded on premature multiprofessional stimulation to improve cognition and the medication for mood instability, sleep problems, anxiety, hyperactivity and attention problems. The Restricted and Repetitive Behavior marks the functional profile of the Autism Spectrum Disorder and can hinder the communication and sociability development. The behavior changes with the cognitive maturation but does not prevent from the functional imbalance in daily activities. Evidence revel that the cognitive inflexibility added to the impairment to form new concepts and cognitive tempo can reflect the pathophysiology of these behaviors and its impact on development. The current study aims to valuate changes on cognitive flexibility and restricted and repetitive behavior after the facilitation of impulses through paired pulse Trascranial Magnetic Stimulation (EMT) on right anterior inferior Ventro Lateral Pre Frontal Cortex (VLPFC) in high function Autism Spectrum Disorder individuals. METHODS: It is an experimental study with systemic interventional procedure. Eleven subjects with nine to seventeen years old paired by normal cognitive profile were submitted to the protocol of Theta Burst stimulation on right anterior inferior VLPFC with fifteen sessions divided into three weeks. Subjects were tested before and after the procedure. They were tested for cognitive inflexibility, the ability to form new concepts and the cognitive tempo by the Wisconsin Sort Card (WSCT) test and STROOP test. The restricted and repetitive behaviors were evaluated by Restricted and Repetitive Behavior Scale revised (RBS-r) and Yale Brown Obsessive and Compulsive Scale applied for parents. RESULTS: Evidence of changes on cognitive inflexibility pattern were found items Perseverative Errors (p=0,028) and Conceptual level Response (p=0,022) of the WSCT test. Information processing speed changes were established by the Conceptual level Response of the WSCT and the Total Time to Finish the STROOP test (p=0,001). Improvement on restricted and repetitive behavior were found by changes on total score of RBS-r (p=0,002) and by YBOCS Total of Compulsions (p=0,02). There were changes on all aspects of the repetitive behaviors: Low-Order behavior (p=0,05), High-Order behavior (p=0,028) and Sameness behavior (0,014). Correlation were found between changing curves of cognitive inflexibility represented by Perseverative Response and total score of RBS-r (r=0,049). Since this is a pilot study, our data allows us to suggest that EMT-pp can be efficient for treating restricted and repetitive behavior on Autism Spectrum Disorder. Further controlled studies will be conducted to confirm this hypothesis

Post-traumatic stress disorder (PTSD) is a highly debilitating mental illness that is incited by various types of trauma and causes core symptoms of re-experiencing, hyperarousal, avoidance of trauma-related stimuli, and negative cognition and mood. It is accompanied by functional, social, and occupational impairment, as well as higher risks of medical comorbidities and mortality. Estimates indicate that PTSD affects 3.9% of the global population, and 7-9% of the US population, with only 50% of those with persistent PTSD treatment-seeking. The gold standard of PTSD treatment is prolonged exposure therapy and cognitive processing theory, with the addition of antidepressants; however, dropout rates are high likely due to the adverse effects of worsening re-experiencing of trauma and exacerbating behaviors of avoidance. As a result, alternative therapies such as transcranial magnetic stimulation (TMS) represent more tolerable treatment options. Historically, literature on TMS is promising for its low risk of side effects and efficacy, but there is no general consensus on treatment-specific targets, frequency of treatment delivery, or long-term efficacy. This proposed study will evaluate the use of neuroimaging guided intermittent theta burst stimulation, a form of TMS, for core PTSD symptom reduction and its efficacy up to one year in duration to potentially reduce the morbidity and mortality sequelae of PTSD.

Movement training modulates the excitability in several cortical and subcortical areas. Compared to training with a single arm, movement training with both arms yields a greater increase in motor related cortical regions. A short-term session of bimanual training (BMT) enhances cortical activity of motor preparation and execution areas in both hemispheres. The underlying neural mechanisms for this increased activation with BMT are unclear, but may involve interhemispheric connections between homologous primary motor cortex (M1) representations and input from motor preparatory areas (i.e. dorsal premotor cortex (PMd)). Also, it is unclear how selective up-regulation or down-regulation of specific motor-related areas may contribute to changes in M1 excitability when combined with BMT. The work in this thesis investigated modulation of M1 excitability in terms of in-phase versus anti-phase BMT (Study #1), potentially up-regulating the left dorsal premotor cortex (lPMd) via iTBS before BMT (Study #2), theoretically down-regulating contralateral (right) M1 homologous representation before BMT (Study #3), and finally the potential intracortical and interhemispheric cortical adaptations in M1 bilaterally due to the same interventions as Study #2 (Study #4). For Study #1, it was hypothesized that in-phase BMT would lead to an increased excitability in M1. For Studies #2-4, it was hypothesized that modulation of motor-related areas would cause an increase in the excitability of left M1, and this modulation would be greater when combined with BMT. Study #1 found that in-phase, and not anti-phase BMT, lead to increase M1 excitability. Study #2 found that iTBS to lPMd followed by BMT caused a unique increase in M1 excitability, in terms of increased spatial extent and global MEP amplitude. Study #3 found that the combination of cTBS to right M1 with BMT caused greater excitability enhancements than either intervention alone. Finally, Study #4 found distinct modulations of cortical excitability within and across M1 bilaterally due to BMT, iTBS to lPMd and the combination of these interventions that involved long-interval inhibitory circuitry asymmetrically. Overall, this current work found that the modulation of remote cortical areas to M1 (i.e. lPMd and contralateral M1) in combination with movement training led to unique, and at times greater, excitability enhancements of M1 which could be advantageous in enhancing short-term plasticity in damaged M1.

Introduction: Memory is a complex cognitive process formerly linked to mechanisms of brain plasticity that can be estimated in the left dorsolateral prefrontal cortex (DLPFC) using transcranial magnetic stimulation and electroencephalography (TMS-EEG). Also, cortical thickness in the DLPFC may be a potential proxy measure of brain plasticity as previous literature reports a link between better memory and thicker cortex. However, the link between brain plasticity and memory performance as well as DLPFC thickness remains to be clarified. Methods: Intermittent theta burst stimulation (iTBS) probed plasticity-like mechanisms in the left DLPFC in 17 cognitively healthy participants. TMS-EEG recordings were performed before and after sham and active iTBS to quantify plasticity via transcranial magnetic stimulation-evoked potentials (TEPs). Composite memory scores for each domain (verbal episodic, visual episodic and working memory) were obtained using the Cambridge Neuropsychological Test Automated Battery. Anatomical T1 images were acquired by magnetic resonance imaging and processed by open-source software (CIVET) and the Automated Anatomical Labeling atlas to extract cortical thickness of the DLPFC. All statistical analyses (linear mixed model, Tukey's post hoc test and Pearson's correlations) were completed in R Studio. Results: iTBS resulted in increased TEP amplitude P30 (F= 5.239, p = 0.029), as shown by a significant interaction between condition (iTBS, sham) and time (pre- and post-condition). Specifically, Tukey's post hoc test revealed that the P30 increase was near trending significant post-iTBS compared to pre-iTBS for the active condition (p = 0.166) but not for the sham condition (p = 0.294). A trending significant relationship was observed between the magnitude of P30 change post-iTBS and thicker left DLPFC (r = 0.488; p = 0.108). Lastly, no significant relationships between P30 change and memory performance were observed. Conclusion: These preliminary findings suggest there could be a relationship between increased capacity for brain plasticity and a thicker left DLPFC. To further investigate these relationships, we plan to recruit additional cognitively healthy participants. Our preliminary findings support the foundation for future clinical studies in which DLPFC thickness could be explored as a predictive factor for response to plasticity-targeting iTBS treatment.

<p>The primary somatosensory cortex (SI) is important for hand function and influences motor circuitry in the primary motor cortex (M1). Areas 3a, 1 and 2 of SI have direct connectivity with M1. Much of our present knowledge of this connectivity and its relevance to hand function is based on animal research. However, less is known about the neural mechanisms that underpin hand function in humans. The present study investigated the influence of SI on corticospinal excitability as well as inhibitory and excitatory neural circuitry within M1 before and after continuous theta-burst stimulation (cTBS). Additionally, stimulation parameters influence the direction and magnitude of cTBS after-effects. Thus, current direction and frequency of cTBS were manipulated. Two experiments were performed. In Experiment 1, motor-evoked potentials (MEPs) were recorded from the first-dorsal interosseous (FDI) muscle bilaterally before and after 50 Hz cTBS over left SI. In a second condition, the orientation of cTBS was reversed. Experiment 2 measured MEPs, short-latency intracortical inhibition (SICI) and intracortical facilitation (ICF) from the right FDI following a modified 30 Hz cTBS over left SI or M1. The results of Experiment 1 and 2 demonstrate that SI influences M1 circuitry such that MEPs are facilitated following cTBS over SI. However, MEPs are suppressed when the current direction is reversed. CTBS at 30 Hz delivered over M1 suppressed excitatory circuitry that generates MEPs and ICF. The findings from the thesis suggest that SI influences hand motor circuitry and is likely a mechanism by which somatosensory information modulates hand motor function.</p> / Bachelor of Science (BSc)

Chez l’humain, différents protocoles de stimulation magnétique transcrânienne répétée (SMTr) peuvent être utilisés afin de manipuler expérimentalement la plasticité cérébrale au niveau du cortex moteur primaire (M1). Ces techniques ont permis de mieux comprendre le rôle du sommeil dans la régulation de la plasticité cérébrale. Récemment, une étude a montré que lorsqu’une première session de stimulation SMTr au niveau de M1 est suivie d’une nuit de sommeil, l’induction subséquente de la plasticité par une deuxième session SMTr est augmentée. La présente étude a investigué si ce type de métaplasticité pouvait également bénéficier d’une sieste diurne. Quatorze sujets en santé ont reçu deux sessions de intermittent theta burst stimulation (iTBS) connue pour son effet facilitateur sur l’excitabilité corticale. Les sessions de stimulation étaient séparées par une sieste de 90 minutes ou par une période équivalente d’éveil. L’excitabilité corticale était quantifiée en terme d’amplitude des potentiels évoqués moteurs (PEM) mesurés avant et après chaque session de iTBS. Les résultats montrent que la iTBS n’est pas parvenue à augmenter de manière robuste l’amplitude des PEMs lors de la première session de stimulation. Lors de la deuxième session de stimulation, la iTBS a produit des changements plastiques variables et ce peu importe si les sujets ont dormi ou pas. Les effets de la iTBS sur l’excitabilité corticale étaient marqués par une importante variabilité inter et intra-individuelle dont les possibles causes sont discutées. / In humans, various repetitive transcranial magnetic stimulation (rTMS) protocols can be used to modulate motor cortical plasticity. These techniques have shed light on the role of sleep in neural plasticity regulation. Recent work has demonstrated that when a night of sleep follows one session of rTMS over the hand motor cortex (M1), the capacity to induce subsequent plasticity by another rTMS session in M1 is enhanced. The present study investigated whether such metaplasticity could also benefit from a day nap. Fourteen healthy participants received two sessions of intermittent theta burst stimulation (iTBS) known for its excitatory effects on cortical excitability over M1 spaced by either a 90-minute nap or an equivalent amount of wake. Motor cortical excitability was measured in terms of amplitude of motor evoked potentials (MEP), which were assessed before iTBS and after the stimulation. Results show that the first iTBS session did not induce significant change in MEP amplitude. The second iTBS session induced variable plastic changes regardless of whether participants slept or stayed awake. The effects of iTBS on motor cortical excitability were highly variable within and between individuals. The possible causes of such variability are discussed.

Chez l’humain, différents protocoles de stimulation magnétique transcrânienne répétée (SMTr) peuvent être utilisés afin de manipuler expérimentalement la plasticité cérébrale au niveau du cortex moteur primaire (M1). Ces techniques ont permis de mieux comprendre le rôle du sommeil dans la régulation de la plasticité cérébrale. Récemment, une étude a montré que lorsqu’une première session de stimulation SMTr au niveau de M1 est suivie d’une nuit de sommeil, l’induction subséquente de la plasticité par une deuxième session SMTr est augmentée. La présente étude a investigué si ce type de métaplasticité pouvait également bénéficier d’une sieste diurne. Quatorze sujets en santé ont reçu deux sessions de intermittent theta burst stimulation (iTBS) connue pour son effet facilitateur sur l’excitabilité corticale. Les sessions de stimulation étaient séparées par une sieste de 90 minutes ou par une période équivalente d’éveil. L’excitabilité corticale était quantifiée en terme d’amplitude des potentiels évoqués moteurs (PEM) mesurés avant et après chaque session de iTBS. Les résultats montrent que la iTBS n’est pas parvenue à augmenter de manière robuste l’amplitude des PEMs lors de la première session de stimulation. Lors de la deuxième session de stimulation, la iTBS a produit des changements plastiques variables et ce peu importe si les sujets ont dormi ou pas. Les effets de la iTBS sur l’excitabilité corticale étaient marqués par une importante variabilité inter et intra-individuelle dont les possibles causes sont discutées. / In humans, various repetitive transcranial magnetic stimulation (rTMS) protocols can be used to modulate motor cortical plasticity. These techniques have shed light on the role of sleep in neural plasticity regulation. Recent work has demonstrated that when a night of sleep follows one session of rTMS over the hand motor cortex (M1), the capacity to induce subsequent plasticity by another rTMS session in M1 is enhanced. The present study investigated whether such metaplasticity could also benefit from a day nap. Fourteen healthy participants received two sessions of intermittent theta burst stimulation (iTBS) known for its excitatory effects on cortical excitability over M1 spaced by either a 90-minute nap or an equivalent amount of wake. Motor cortical excitability was measured in terms of amplitude of motor evoked potentials (MEP), which were assessed before iTBS and after the stimulation. Results show that the first iTBS session did not induce significant change in MEP amplitude. The second iTBS session induced variable plastic changes regardless of whether participants slept or stayed awake. The effects of iTBS on motor cortical excitability were highly variable within and between individuals. The possible causes of such variability are discussed.