Effects of attention on inhibitory and facilitatory phenomena elicited by paired-pulse transcranial magnetic stimulation in healthy subjects

We investigated whether human attentional processes influence the activity of intracortical inhibitory and excitatory circuits-short-interval intracortical inhibition (SICI), long-interval intracortical inhibition (LICI), and the intracortical facilitation (ICF)-elicited by paired-pulse transcranial magnetic stimulation (TMS) in healthy subjects. In eight healthy subjects we tested SICI, LICI and ICF under different attention-demanding conditions: "relaxed", "target hand" and "non-target hand". To compare the effects of attentional levels on SICI, LICI and ICF with those produced on the MEPs elicited by repetitive TMS (rTMS), in the same subjects we also delivered supra-threshold 5-Hz rTMS under the same three experimental conditions. To disclose whether attentional processes act selectively on circuits engaged by TMS delivered at 5 Hz frequency and at an interstimulus interval (ISI) of 200 ms, we also investigated the effects of different attention levels on paired-pulse TMS delivered at the 200 ms ISI and on the MEP size during 1-Hz rTMS. Attentional levels had no influence on SICI, ICF and LICI activated by paired-pulse TMS, but increased the MEP facilitation elicited by 5-Hz rTMS. Varying the attention level left the findings from 1-Hz rTMS unchanged. The finding that attention leaves the activity of intracortical inhibitory and excitatory circuits elicited by paired-pulse TMS unchanged but influences the MEP facilitation elicited by 5-Hz rTMS suggests that attention operates only when the stimulation entrains neural circuits made up of a large number of cortical cells with plasticity properties.