Good test-retest reliability of a paired-pulse transcranial magnetic stimulation protocol to measure short-interval intracortical facilitation

Transcranial magnetic stimulation (TMS) is used frequently to study human physiology, including the indirect-wave (I-wave) circuits generating short-interval intracortical facilitation (SICF). Growing evidence implicates SICF in plasticity and motor learning, suggesting that SICF is likely of functional relevance in both health and disease. To date, test-retest reliability has not been established for measures of SICF: given the clear potential of SICF to be used as a diagnostic tool, it is critical to establish the reliability of the paired-pulse TMS protocol to measure SICF. We investigated the test-retest reliability of SICF measured using paired-pulse TMS.SICF was measured in two sessions in 20 young adults using single- and paired-pulse TMS. Single-pulse TMS was set at an intensity that elicited MEPs of 1 mV (SI1mV) and paired-pulse TMS was set with the first stimulus at SI1mV, the second stimulus (S2) 90% of resting motor threshold (RMT), and a total of 20 interstimulus intervals (ISI; 1.1-4.9 ms with a 0.2 ms step). Large intraclass correlation coefficients (ICC) indicate good test-retest reliability between sessions for all SICF peaks (ICCs ranging from 0.73 to 0.79). The ISI at which SICF was maximal within individuals was consistent at all three peaks across both experimental sessions. Results showed good test-retest reliability of SICF at all three peaks when using a standard paired-pulse protocol to measure SICF. This finding suggests that paired-pulse TMS can be used to reliably probe the excitability of the interneuronal circuits that generate SICF. This provides a strong platform for future research to investigate the functional role of I-wave circuitry, including the role of I-wave circuitry in motor control decline in healthy older adults and individuals with movement disorders.