iTBS induces a suppression-rebound pattern in human cortical excitability
- 1Stanford University
Abstract
Intermittent theta burst stimulation (iTBS) is a widely used form of brain stimulation, developed on the premise that it promotes long-term potentiation (LTP) and neural excitation. However, this is not validated in higher-order neocortex, and evidence suggests its excitatory properties may have been overstated. To address this, we recruited 20 neurosurgical patients to undergo sessions of intracranial iTBS to varied targets. We probed changes in cortical reactivity with single pulse electrical stimulation, finding that iTBS resulted in approximately 1 minute of decreased cortical reactivity in the theta and high-frequency ranges in regions strongly connected to the stimulation site. However, we observed a subsequent rise in reactivity leading up to the next iTBS session with parallel changes in resting state excitation/inhibition balance. Finally, we generalized these findings to 3 neurosurgical patients who underwent iTBS delivered by transcranial magnetic stimulation, demonstrating a similar suppression-rebound pattern. Our results suggest iTBS promotes a dynamic process of cortical suppression followed by rebound increases in excitability.
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BibTeX
@misc{solomon2026itbs,
title = {{iTBS induces a suppression-rebound pattern in human cortical excitability}},
author = {E. A. Solomon and U. Hassan and C. W. Dickey and C. C. Cline and S. Pantis and R. Garg and A. Ramayya and V. P. Buch and M. A. Howard and J. R. Tatz and N. T. Trapp and A. D. Boes and C. J. Keller},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.15.26363149},
url = {https://www.medrxiv.org/content/10.64898/2026.09.15.26363149v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - iTBS induces a suppression-rebound pattern in human cortical excitability
AU - E. A. Solomon
AU - U. Hassan
AU - C. W. Dickey
AU - C. C. Cline
AU - S. Pantis
AU - R. Garg
AU - A. Ramayya
AU - V. P. Buch
AU - M. A. Howard
AU - J. R. Tatz
AU - N. T. Trapp
AU - A. D. Boes
AU - C. J. Keller
PY - 2026
DA - 2026/09/15
PB - medRxiv
DO - 10.64898/2026.09.15.26363149
UR - https://www.medrxiv.org/content/10.64898/2026.09.15.26363149v1
AB - Intermittent theta burst stimulation (iTBS) is a widely used form of brain stimulation, developed on the premise that it promotes long-term potentiation (LTP) and neural excitation. However, this is not validated in higher-order neocortex, and evidence suggests its excitatory properties may have been overstated. To address this, we recruited 20 neurosurgical patients to undergo sessions of intracranial iTBS to varied targets. We probed changes in cortical reactivity with single pulse electrical stimulation, finding that iTBS resulted in approximately 1 minute of decreased cortical reactivity in the theta and high-frequency ranges in regions strongly connected to the stimulation site. However, we observed a subsequent rise in reactivity leading up to the next iTBS session with parallel changes in resting state excitation/inhibition balance. Finally, we generalized these findings to 3 neurosurgical patients who underwent iTBS delivered by transcranial magnetic stimulation, demonstrating a similar suppression-rebound pattern. Our results suggest iTBS promotes a dynamic process of cortical suppression followed by rebound increases in excitability.
ER -