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Theta burst stimulation (TBS) can modulate cortical excitability but suffers from high inter-subject variability. Modified TBS frequency patterns (30 Hz) showed consistent inhibitory aftereffects, but further research into the time course of these effects is needed. This study aimed to investigate the efficacy of a 30 Hz continuous TBS (cTBS) protocol. Participants (n = 20) underwent an experimental session (real cTBS) and a control session (sham cTBS). To assess cortical excitability, Transcranial Magnetic Stimulation was applied over the primary motor cortex before cTBS, and at five timepoints after cTBS. Percentage change (PC) to baseline was analysed using a Linear Mixed Model. No difference in PC was found between real and sham cTBS (p = 0.696). Our results demonstrate a significant increase in PC over time (p = 0.006) at 30, (p = 0.01), 45 (p = 0.027), and 55 min (p = 0.024) post cTBS, irrespective of condition. Secondary analysis dividing the sample into responders and paradox-responders showed no significant predictors for cTBS responsiveness. We could not replicate previously reported suppressive effects of 30 Hz cTBS. Increases in MEP amplitudes over a 60-minute time window were independent of stimulation condition and marked by high inter-subject variability. Validations of modified TBS protocols are further needed to replicate findings and understand mechanisms underlying individuals' responsiveness. [ABSTRACT FROM AUTHOR]

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Background and Purpose: Transcranial magnetic stimulation is a non-invasive procedure that uses robust magnetic fields to create an electrical current in the cerebral cortex. Dual stimulation consists of administering subthre-shold conditioning stimulation (CS), then suprathreshold test stimulation (TS). When the interstimulus interval (ISI) is 1-6 msec, the motor evoked potential (MEP) decreases in amplitude; this decrease is termed "short interval intracortical inhibition" (SICI); when the ISI is 7-30 msec, an increase in MEP amplitude occurs, termed "short interval intracortical facilitation" (SICF). Continuous theta burst stimulation (cTBS), often applied at a frequency of 50 Hz, has been shown to decrease cortical excitability. The primary objective is to determine which duration of cTBS achieves better inhibition or excitation. The secondary objective is to compare 50 Hz cTBS to 30 Hz and 100 Hz cTBS., Methods: The resting motor threshold (rMT), MEP, SICI, and SICF were studied in 30 healthy volunteers. CS and TS were administered at 80%-120% and 70%-140% of rMT at 2 and 3-millisecond (msec) intervals for SICI, and 10- and 12-msec intervals for SICF. Ten individuals in each group received 30, 50, or 100 Hz, followed by administration of rMT, MT-MEP, SICI, SICF immediately and at 30 minutes., Results: Greater inhibition was achieved with 3 msec than 2 msec in SICI, whereas better facilitation occurred at 12 msec than 10 msec in SICF. At 30 Hz, cTBS augmented inhibition and suppressed facilitation, while 50 Hz yielded less inhibition and greater inter-individual variability. At 100 Hz, cTBS provided slight facilitation in MEP amplitudes with less interindividual variability. SICI and SICF did not differ significantly between 50 Hz and 100 Hz cTBS., Conclusion: Our results suggest that performing SICI and SICF for 3 and 12 msec, respectively, and CS and TS at 80%-120% of rMT, demonstrate safer inhibition and facilitation. Recently, TBS has been used in the treatment of various neurological diseases, and we recommend preferentially 30 Hz over 50 Hz cTBS for better inhibition with greater safety and less inter-individual variability.