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Radwa A.b. Badawy - One of the best experts on this subject based on the ideXlab platform.
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does the region of epileptogenicity influence the pattern of change in Cortical Excitability
Clinical Neurophysiology, 2015Co-Authors: Radwa A.b. Badawy, Simon J. Vogrin, Mark J. CookAbstract:Abstract Objective To investigate whether Cortical Excitability measures on transcranial magnetic stimulation (TMS) differed between groups of patients with different focal epilepsy syndromes. Methods 85 Patients with focal epilepsy syndromes divided into temporal and extra-temporal lobe epilepsy were studied. The cohorts were further divided into drug naive-new onset, refractory and seizure free groups. Motor threshold (MT) and paired pulse TMS at short (2, 5, 10, 15 ms) and long (100–300 ms) interstimulus intervals (ISIs) were measured. Results were compared to those of 20 controls. Results Cortical Excitability was higher at 2 & 5 ms and 250, 300 ms ISIs ( p Conclusion Disturbances in Cortical Excitability are more confined to the affected hemisphere in temporal lobe epilepsy but only early at onset in the drug naive state. Significance Group TMS studies show that Cortical Excitability measures are different in temporal lobe epilepsy and can be distinguished from other focal epilepsies early at onset in the drug naive state. Further studies are needed to determine whether these results can be applied clinically as the utility of TMS in distinguishing between epilepsy syndromes at an individual level remains to be determined.
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On the midway to epilepsy: is Cortical Excitability normal in patients with isolated seizures?
International journal of neural systems, 2014Co-Authors: Radwa A.b. Badawy, Simon J. Vogrin, Alan Lai, Mark J. CookAbstract:Paired pulse transcranial magnetic stimulation was used to investigate differences in Cortical Excitability between patients with isolated (unrecurrent, unprovoked) seizures and those with epilepsy. Compared to controls, Cortical Excitability was higher in the isolated seizure group at 250–300 ms. Compared to epilepsy, Cortical Excitability was lower in patients with isolated seizures also at 250 and 300 ms. Lowered seizure threshold caused by disturbances within inhibitory circuits is present in patients who experience a seizure even if no further seizures occur.
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TMS, Cortical Excitability and epilepsy: The clinical impact
Epilepsy research, 2013Co-Authors: Radwa A.b. Badawy, Gionata Strigaro, Roberto CantelloAbstract:Paired-pulse transcranial magnetic stimulation (ppTMS) is a well-established method for non-invasive measurement of Cortical Excitability, alterations of which are the core background of epilepsy. For the past 20 years this technique has been extensively used to assess patients with epilepsy. We present here a critical overview of these studies, with emphasis on their translation to the clinical practice.
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The Cortical Excitability profile of temporal lobe epilepsy
Epilepsia, 2013Co-Authors: Radwa A.b. Badawy, Simon J. Vogrin, Alan Lai, Mark J. CookAbstract:Summary Purpose Transcranial magnetic stimulation (TMS) was used to characterize measurable changes of Cortical Excitability in patients who were undergoing medical and surgical management of temporal lobe epilepsy (TLE) to investigate whether these alterations depended on timing of achieving seizure control throughout the course of illness and method of management. Methods Eighty-five patients with TLE divided into (1) drug naive–new onset, (2) early medically refractor, and (3) late medically refractory, (4) early seizure-free on antiepileptic drugs, and (5) late seizure-free on antiepileptic drugs, (6) postoperative refractory, and (7) postoperative seizure-free groups were studied. Motor threshold (MT) and paired-pulse TMS at short (2, 5, 10, and 15 msec) and long (100–300 msec) interstimulus intervals (ISIs) were measured. Results were compared to those of 20 controls. Key Findings A significant interhemispheric difference was observed early at onset prior to starting medication, with higher Cortical Excitability in the hemisphere ipsilateral to the seizure focus, whereas the unaffected hemisphere was normal. After that, Cortical Excitability was higher in both hemispheres in the refractory groups (medical and postoperative) compared to the seizure-free and drug-naive groups (p
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Capturing the epileptic trait: Cortical Excitability measures in patients and their unaffected siblings.
Brain : a journal of neurology, 2013Co-Authors: Radwa A.b. Badawy, Simon J. Vogrin, Alan Lai, Mark J. CookAbstract:We used transcranial magnetic stimulation to investigate whether the Cortical Excitability changes observed amongst the different generalized and focal epilepsy syndromes are reflected in their asymptomatic siblings and if these changes depended on the clinical phenotype. We studied 157 patients with epilepsy (95 generalized and 62 focal) and their asymptomatic siblings (138 and 82, respectively). Motor threshold and paired pulse transcranial magnetic stimulation at short (2, 5, 10 and 15 ms) and long (100-300 ms) interstimulus intervals were measured. Results were compared to those of 12 control subjects and 20 of their siblings. There were no differences in Cortical Excitability between healthy control subjects and their siblings. Compared with control subjects, Cortical Excitability was higher in siblings of patients whether generalized (P < 0.05; short and long interstimulus intervals) or focal (P < 0.05; long interstimulus intervals). Compared with epilepsy, motor threshold was lower (P < 0.05) in patients with juvenile myoclonic epilepsy compared with their siblings only early at onset in the drug naïve state. In all groups (generalized and focal) Cortical Excitability was lower in siblings only at the long interstimulus intervals (250 and 300; P < 0.05). Cortical Excitability is higher in asymptomatic siblings of patients with generalized and focal epilepsy in a similar manner. The disturbance seems to involve intraCortical inhibitory circuits even in the siblings of patients with a structural abnormality (acquired epilepsy). This implies there are certain genetic factors that predispose to both generalized and focal epilepsies and a complex genetic/environmental interaction then determines the clinical phenotype.
Mark J. Cook - One of the best experts on this subject based on the ideXlab platform.
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does the region of epileptogenicity influence the pattern of change in Cortical Excitability
Clinical Neurophysiology, 2015Co-Authors: Radwa A.b. Badawy, Simon J. Vogrin, Mark J. CookAbstract:Abstract Objective To investigate whether Cortical Excitability measures on transcranial magnetic stimulation (TMS) differed between groups of patients with different focal epilepsy syndromes. Methods 85 Patients with focal epilepsy syndromes divided into temporal and extra-temporal lobe epilepsy were studied. The cohorts were further divided into drug naive-new onset, refractory and seizure free groups. Motor threshold (MT) and paired pulse TMS at short (2, 5, 10, 15 ms) and long (100–300 ms) interstimulus intervals (ISIs) were measured. Results were compared to those of 20 controls. Results Cortical Excitability was higher at 2 & 5 ms and 250, 300 ms ISIs ( p Conclusion Disturbances in Cortical Excitability are more confined to the affected hemisphere in temporal lobe epilepsy but only early at onset in the drug naive state. Significance Group TMS studies show that Cortical Excitability measures are different in temporal lobe epilepsy and can be distinguished from other focal epilepsies early at onset in the drug naive state. Further studies are needed to determine whether these results can be applied clinically as the utility of TMS in distinguishing between epilepsy syndromes at an individual level remains to be determined.
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On the midway to epilepsy: is Cortical Excitability normal in patients with isolated seizures?
International journal of neural systems, 2014Co-Authors: Radwa A.b. Badawy, Simon J. Vogrin, Alan Lai, Mark J. CookAbstract:Paired pulse transcranial magnetic stimulation was used to investigate differences in Cortical Excitability between patients with isolated (unrecurrent, unprovoked) seizures and those with epilepsy. Compared to controls, Cortical Excitability was higher in the isolated seizure group at 250–300 ms. Compared to epilepsy, Cortical Excitability was lower in patients with isolated seizures also at 250 and 300 ms. Lowered seizure threshold caused by disturbances within inhibitory circuits is present in patients who experience a seizure even if no further seizures occur.
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The Cortical Excitability profile of temporal lobe epilepsy
Epilepsia, 2013Co-Authors: Radwa A.b. Badawy, Simon J. Vogrin, Alan Lai, Mark J. CookAbstract:Summary Purpose Transcranial magnetic stimulation (TMS) was used to characterize measurable changes of Cortical Excitability in patients who were undergoing medical and surgical management of temporal lobe epilepsy (TLE) to investigate whether these alterations depended on timing of achieving seizure control throughout the course of illness and method of management. Methods Eighty-five patients with TLE divided into (1) drug naive–new onset, (2) early medically refractor, and (3) late medically refractory, (4) early seizure-free on antiepileptic drugs, and (5) late seizure-free on antiepileptic drugs, (6) postoperative refractory, and (7) postoperative seizure-free groups were studied. Motor threshold (MT) and paired-pulse TMS at short (2, 5, 10, and 15 msec) and long (100–300 msec) interstimulus intervals (ISIs) were measured. Results were compared to those of 20 controls. Key Findings A significant interhemispheric difference was observed early at onset prior to starting medication, with higher Cortical Excitability in the hemisphere ipsilateral to the seizure focus, whereas the unaffected hemisphere was normal. After that, Cortical Excitability was higher in both hemispheres in the refractory groups (medical and postoperative) compared to the seizure-free and drug-naive groups (p
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Capturing the epileptic trait: Cortical Excitability measures in patients and their unaffected siblings.
Brain : a journal of neurology, 2013Co-Authors: Radwa A.b. Badawy, Simon J. Vogrin, Alan Lai, Mark J. CookAbstract:We used transcranial magnetic stimulation to investigate whether the Cortical Excitability changes observed amongst the different generalized and focal epilepsy syndromes are reflected in their asymptomatic siblings and if these changes depended on the clinical phenotype. We studied 157 patients with epilepsy (95 generalized and 62 focal) and their asymptomatic siblings (138 and 82, respectively). Motor threshold and paired pulse transcranial magnetic stimulation at short (2, 5, 10 and 15 ms) and long (100-300 ms) interstimulus intervals were measured. Results were compared to those of 12 control subjects and 20 of their siblings. There were no differences in Cortical Excitability between healthy control subjects and their siblings. Compared with control subjects, Cortical Excitability was higher in siblings of patients whether generalized (P < 0.05; short and long interstimulus intervals) or focal (P < 0.05; long interstimulus intervals). Compared with epilepsy, motor threshold was lower (P < 0.05) in patients with juvenile myoclonic epilepsy compared with their siblings only early at onset in the drug naïve state. In all groups (generalized and focal) Cortical Excitability was lower in siblings only at the long interstimulus intervals (250 and 300; P < 0.05). Cortical Excitability is higher in asymptomatic siblings of patients with generalized and focal epilepsy in a similar manner. The disturbance seems to involve intraCortical inhibitory circuits even in the siblings of patients with a structural abnormality (acquired epilepsy). This implies there are certain genetic factors that predispose to both generalized and focal epilepsies and a complex genetic/environmental interaction then determines the clinical phenotype.
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Capturing the epileptic trait: Cortical Excitability measures in patients and their unaffected siblings
Brain, 2013Co-Authors: Radwa A.b. Badawy, Simon J. Vogrin, Alan Lai, Mark J. CookAbstract:We used transcranial magnetic stimulation to investigate whether the Cortical Excitability changes observed amongst the different generalized and focal epilepsy syndromes are reflected in their asymptomatic siblings and if these changes depended on the clinical phenotype. We studied 157 patients with epilepsy (95 generalized and 62 focal) and their asymptomatic siblings (138 and 82, respectively). Motor threshold and paired pulse transcranial magnetic stimulation at short (2, 5, 10 and 15 ms) and long (100–300 ms) interstimulus intervals were measured. Results were compared to those of 12 control subjects and 20 of their siblings. There were no differences in Cortical Excitability between healthy control subjects and their siblings. Compared with control subjects, Cortical Excitability was higher in siblings of patients whether generalized ( P < 0.05; short and long interstimulus intervals) or focal ( P < 0.05; long interstimulus intervals). Compared with epilepsy, motor threshold was lower ( P < 0.05) in patients with juvenile myoclonic epilepsy compared with their siblings only early at onset in the drug naive state. In all groups (generalized and focal) Cortical Excitability was lower in siblings only at the long interstimulus intervals (250 and 300; P < 0.05). Cortical Excitability is higher in asymptomatic siblings of patients with generalized and focal epilepsy in a similar manner. The disturbance seems to involve intraCortical inhibitory circuits even in the siblings of patients with a structural abnormality (acquired epilepsy). This implies there are certain genetic factors that predispose to both generalized and focal epilepsies and a complex genetic/environmental interaction then determines the clinical phenotype. * Abbreviation : TMS : transcranial magnetic stimulation
Paul B Fitzgerald - One of the best experts on this subject based on the ideXlab platform.
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Commentary regarding: TDCS increases Cortical Excitability: Direct evidence from TMS-EEG
Cerebral Cortex, 2014Co-Authors: Neil W. Bailey, Richard Hilton Siddall Thomson, Kate Elizabeth Hoy, Julio C. Hernandez-pavon, Paul B FitzgeraldAbstract:Recently Romero Lauro et al. (2014) published the results of a study (‘TDCS increases Cortical Excitability: Direct evidence from TMS-EEG’) demonstrating altered Cortical Excitability following tDCS, using a combination of TMS and EEG to assess Excitability before, during, and after tDCS. One of their goals was to assess not just whether Cortical Excitability was altered by tDCS, but whether brain areas that were not directly stimulated by tDCS also exhibited altered Excitability. This speaks to the question of whether indirect effects of tDCS occur in regions connected to the directly stimulated region. In other words, Romero Lauro et al.'s research attempts to answer whether tDCS at one location affects activity across diverse regions in the brain, through spreading activation via connected regions. Their results indicated that activity recorded from the scalp over nonstimulated clusters differed following tDCS, so they concluded that tDCS shows spreading activation changes to non-stimulated brain regions. This study is the first to explore the effect of tDCS on Cortical Excitability with TMS-EEG outside the motor system, and as such we agree that this is a novel and interesting study with excellent experimental design. However, we are concerned that a potentially significant confound was not addressed with enough clarity for readers without significant technical expertise in EEG to understand the limitation. Specifically, the manner in which changes in Excitability were assessed in non-stimulated regions from pre to post and be-
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Motor Cortical Excitability and inhibition in acquired mirror pain.
Neuroscience letters, 2012Co-Authors: Bernadette M. Fitzgibbon, John L. Bradshaw, Peter G. Enticott, Melita J. Giummarra, Nellie Georgiou-karistianis, Michael Chou, Paul B FitzgeraldAbstract:Abstract ‘Mirror pain’ describes when the observation of another's pain experience induces a personal experience of pain. It has been suggested that mirror pain could result from changes in neural Excitability or inhibition. In this study we used transcranial magnetic stimulation (TMS) to investigate motor Cortical Excitability in lower-limb amputees who experience mirror pain. Using paired-pulse TMS to assess motor Cortical inhibition (CI) and Cortical facilitation (CF), recordings were taken from the right first dorsal interosseus in lower-limb amputees who experience mirror pain (MP+), lower-limb amputees who do not experience mirror pain (MP−), and non-amputee controls. No differences in CI or CF were observed between the MP+ and both control groups. Thus, when not paired with a pain-related stimulus, changes in motor Cortical Excitability do not appear to contribute to the experience of mirror pain in lower-limb amputees.
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a comprehensive review of the effects of rtms on motor Cortical Excitability and inhibition
Clinical Neurophysiology, 2006Co-Authors: Paul B Fitzgerald, Sarah Fountain, Zafiris J DaskalakisAbstract:Repetitive transcranial magnetic stimulation (rTMS) procedures are being widely applied in therapeutic and investigative studies. Numerous studies have investigated the effects of rTMS on Cortical Excitability and inhibition, yielding somewhat contradictory results. The purpose of this study was to comprehensively review this literature to guide the selection of methodology in therapeutic studies. We conducted a comprehensive review of all identified studies that investigated effects of low and/or high frequency rTMS on motor Cortical Excitability or inhibition. Low frequency rTMS appears to produce a transient reduction in Cortical Excitability as assessed by motor evoked potential (MEP) size and produces no substantial effect on Cortical inhibition. High frequency rTMS appears to produce a persistent increase in MEP size and a reduction in Cortical inhibition measured with paired pulse methods although few studies have investigated frequencies greater than 5 Hz. A number of novel stimulation paradigms have significant potential for altering Cortical Excitability but require further investigation. Although commonly applied forms of rTMS have effects on Cortical Excitability, more substantial effects may be obtained through the use of novel stimulation paradigms or innovative approaches to the stimulation of areas connected to a potential target site. Further research is required, however, before these paradigms can be more widely adopted.
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Motor Cortical Excitability and clinical response to rTMS in depression.
Journal of Affective Disorders, 2004Co-Authors: Paul B Fitzgerald, Timothy L. Brown, Natasha Ausa Upton Marston, Anthony De Castella, John L. Bradshaw, Zafiris J Daskalakis, Jayashri KulkarniAbstract:Abstract Background: The relationship between frontal lobe activity in the left and right hemispheres and the pathophysiology of depression remains unclear. In addition, it is uncertain whether levels of frontal or motor Cortical Excitability relate to clinical response to treatment modalities. We aimed to explore whether motor Cortical Excitability as assessed with single and paired pulse transcranial magnetic stimulation (TMS) could be used to predict the response to treatment with repetitive TMS (rTMS) applied to the left or right prefrontal cortex. Methods: Motor thresholds, Cortical Excitability and Cortical inhibition (CI) were assessed prior to a trial of rTMS in patients with treatment resistant depression. Results: There was no consistent pattern of differences in hemispheric activity, although there was a relationship between the degree of psychopathology and Cortical Excitability (right hemisphere) and an inverse relationship between inhibitory activity and clinical response (left hemisphere). Conclusions: The study does not support a simple model of laterality in motor Cortical Excitability in depression. The TMS measures used in this study appear to be of limited use in the prediction of clinical response to rTMS.
Richard A L Macdonell - One of the best experts on this subject based on the ideXlab platform.
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Cortical Excitability and refractory epilepsy: a three-year longitudinal transcranial magnetic stimulation study.
International journal of neural systems, 2012Co-Authors: Radwa A.b. Badawy, Samuel F. Berkovic, Graeme D. Jackson, Richard A L MacdonellAbstract:Transcranial magnetic stimulation was used to study the effect of recurrent seizures on Cortical Excitability over time in epilepsy. 77 patients with firm diagnoses of idiopathic generalized epilepsy (IGE) or focal epilepsy were repeatedly evaluated over three years. At onset, all groups had increased Cortical Excitability. At the end of follow-up the refractory group was associated with a broad increase in Cortical Excitability. Conversely, Cortical Excitability decreased in all seizure free groups after introduction of an effective medication.
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Cortical Excitability decreases in Lennox‐Gastaut syndrome
Epilepsia, 2012Co-Authors: Radwa A.b. Badawy, Richard A L Macdonell, Simon J. Vogrin, Alan Lai, Mark J. CookAbstract:SUMMARY Purpose: We used transcranial magnetic stimulation (TMS) to investigate Cortical Excitability changes in Lennox-Gastaut syndrome (LGS), anticipating we would find a marked increase in Excitability compared to other patients with refractory epilepsies. Methods: Eighteen patients with LGS were studied. Motor threshold (MT), short intraCortical inhibition (paired pulse TMS at 2 and 5 msec interstimulus intervals [ISIs]), intraCortical facilitation (10 and 15 msec ISIs), and long intraCortical inhibition (100‐300 msec ISIs) were measured. Results were compared to those of 20 patients with chronic refractory idiopathic generalized epilepsy (IGE), 20 patients with chronic refractory focal epilepsy, and 20 healthy nonepilepsy controls. Key Findings: A significant decrease in Cortical Excitability was observed in LGS compared to the other two groups with refractory epilepsy as evidenced by increased MT and intraCortical inhibition at both short (2, 5 msec ISIs), and long (100‐300 msec ISIs) as well as decreased intraCortical facilitation (10, 15 msec ISIs), (p < 0.01; effect sizes ranging from 0.3 to 1.8). Cortical Excitability was also lower in LGS compared to nonepilepsy controls (increased MT and decreased intraCortical facilitation; p < 0.05; effect sizes ranging from 0.5 to 0.9). Significance: Interictal Cortical Excitability is decreased in LGS; a feature that distinguishes it from other refractory epilepsy syndromes. This decrease may be an important mechanism for the neurobehavioral comorbidities associ
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Cortical Excitability and neurology: insights into the pathophysiology.
Functional neurology, 2012Co-Authors: Radwa A.b. Badawy, Richard A L Macdonell, Tobias Loetscher, Amy BrodtmannAbstract:Transcranial magnetic stimulation (TMS) is a technique developed to non-invasively investigate the integrity of human motor corticospinal tracts. Over the last three decades, the use of stimulation paradigms including single-pulse TMS, paired-pulse TMS, repetitive TMS, and integration with EEG and functional imaging have been developed to facilitate measurement of Cortical Excitability.Through the use of these protocols, TMS has evolved in-to an excellent tool for measuring Cortical Excitability.TMS has high sensitivity in detecting subtle changes in Cortical Excitability, and therefore it is also a good measure of disturbances associated with brain disorders. In this review, we appraise the current literature on Cortical Excitability studies using TMS in neurological disorders.We begin with a brief overview of current TMS measures and then show how these have added to our understand-ing of the underlying mechanisms of brain disorders.
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Predicting seizure control: Cortical Excitability and antiepileptic medication
Annals of neurology, 2010Co-Authors: Radwa A.b. Badawy, Richard A L Macdonell, Samuel F. Berkovic, Mark R Newton, Graeme D. JacksonAbstract:Objective Approximately 30% of patients with newly diagnosed epilepsy do not respond to antiepileptic drugs (AEDs), but this is not predictable. We used transcranial magnetic stimulation to determine the effect of AEDs on Cortical Excitability in patients with epilepsy and correlated this with a successful response to treatment. Methods Ninety-nine drug-naive patients with newly diagnosed epilepsy (55 idiopathic generalized epilepsy, 44 focal epilepsy) were evaluated. Motor threshold and Cortical Excitability on recovery curve analysis were measured before and 4 to 16 weeks after starting medication. After 1 year of treatment, 43 of 55 idiopathic generalized epilepsy and 26 of 44 focal epilepsy patients were seizure free. Results A decrease in Cortical Excitability occurred in the seizure-free group as indicated by an increase in motor threshold (p < 0.05) and intraCortical inhibition on recovery curve analysis, maximum at the 250-millisecond interstimulus interval (p < 0.01) compared with pretreatment values. These changes were not present in the group with ongoing seizures. Interpretation Seizure freedom is marked by a reduction in transcranial magnetic stimulation measures of Cortical Excitability, evident shortly after beginning therapy. This virtual normalization of Cortical Excitability occurred regardless of the seizure characteristics or AED used. Failure to show this response to AED treatment may be valuable as an early predictor of pharmacoresistance in individual patients. ANN NEUROL 2010;67:64–73
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Sleep deprivation increases Cortical Excitability in epilepsy Syndrome-specific effects
Neurology, 2006Co-Authors: Radwa A.b. Badawy, Samuel F. Berkovic, Mark R Newton, J M Curatolo, Richard A L MacdonellAbstract:Objective: To use transcranial magnetic stimulation (TMS) to investigate the hypothesis that sleep deprivation increases Cortical Excitability in people with epilepsy. Methods: We performed paired pulse TMS stimulation, using a number of interstimulus intervals (ISIs) on each hemisphere of 30 patients with untreated newly diagnosed epilepsy (15 idiopathic generalized epilepsy [IGE] and 15 focal epilepsy) and on the dominant hemisphere of 13 healthy control subjects, before and after sleep deprivation. Results: Both hemispheres in patients with IGE and the hemisphere ipsilateral to the EEG seizure focus in those with focal epilepsy showed an increase in Cortical Excitability following sleep deprivation at a number of ISIs. This change in Excitability was most prominent in the patients with IGE. Although there were minor changes after sleep deprivation in control subjects and the contralateral hemisphere in the focal epilepsy group seen at the 250-millisecond ISI, it was less than in the other groups. Conclusions: Sleep deprivation increases Cortical Excitability in epilepsy; the pattern of change is syndrome dependent.
Peter Eichhammer - One of the best experts on this subject based on the ideXlab platform.
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Transcranial magnetic stimulation for the treatment of tinnitus: effects on Cortical Excitability.
BMC neuroscience, 2007Co-Authors: Berthold Langguth, Tobias Kleinjung, J. Marienhagen, Harald Binder, Philipp G. Sand, Göran Hajak, Peter EichhammerAbstract:Background Low frequency repetitive transcranial magnetic stimulation (rTMS) has been proposed as an innovative treatment for chronic tinnitus. The aim of the present study was to elucidate the underlying mechanism and to evaluate the relationship between clinical outcome and changes in Cortical Excitability. We investigated ten patients with chronic tinnitus who participated in a sham-controlled crossover treatment trial. Magnetic-resonance-imaging and positron-emission-tomography guided 1 Hz rTMS were performed over the auditory cortex on 5 consecutive days. Active and sham treatments were separated by one week. Parameters of Cortical Excitability (motor thresholds, intraCortical inhibition, intraCortical facilitation, Cortical silent period) were measured serially before and after rTMS treatment by using single- and paired-pulse transcranial magnetic stimulation. Clinical improvement was assessed with a standardized tinnitus-questionnaire.
