Work

iTBS induces a suppression-rebound pattern in human cortical excitability

Year: 2026

Type: preprint

Study design: Clinical Trial

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.

Source: medRxiv

DOI: 10.64898/2026.09.15.26363149

Authors: Ethan A. Solomon, Umair Hassan, Charles W. Dickey, Christopher C. Cline, Sofia Pantis, Ritika Garg, Ashwin Ramayya, Vivek P. Buch, Matthew A. Howard, Joshua R. Tatz, Nicholas T. Trapp, Aaron D. Boes, Corey J. Keller

Institutions: Stanford Medicine, Stanford University, University of Iowa, University of Iowa Health Care, VA Palo Alto Health Care System, Mental Illness Research, Education and Clinical Centers

Language: English

Topic: Transcranial Magnetic Stimulation Studies

Subfield: Neurology

Field: Neuroscience

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: green

Funders: Brain and Behavior Research Foundation, Roy J. Carver Charitable Trust, Sleep Research Society, Sleep Research Society Foundation, National Institute of Mental Health, National Institute of Neurological Disorders and Stroke

Awards: Investigating the Effects of Transcranial Magnetic Stimulation with Intracranial EEG in Humans, G2905477430, G2936985921, G3170862141, G3570961274, G4459589948, G4725299874, Closing the loop: development of real-time, personalized brain stimulation, G6554066440, G7364806602, Predicting Cognitive Outcomes from Stroke Based on Lesion Location, The Iowa Neuroscience Specialty Program in Research Education (INSPIRE), Investigating the neural mechanisms of repetitive brain stimulation with invasive and noninvasive electrophysiology in humans, CRCNS US-France Research Proposal: Probing the Dorsolateral Prefrontal Cortex and Central Executive Network for Improving Neuromodulation in Depression, A Biobehavioral Research Training Grant

OpenAlex ID: W7213561614

Cites: 8

Cited by: 1

Related to: 10