Hemodynamic changes in response to excitatory and inhibitory modulations by transcranial magnetic stimulation at the human sensorimotor cortex

Transcranial magnetic stimulation (TMS) can non-invasively induce both excitatory and inhibitory neuronal activity. However, the neurophysiological basis for both kinds of modulation remains elusive. In this study, with a controlled dosage over the 30-s interval, we elicited excitatory and inhibitory TMS modulations over the human primary motor cortex (M1) with TMS bursts of high (10-Hz and 30-Hz) and low frequency (0.5-Hz), respectively, and took functional magnetic resonance images (fMRI). Excitatory and inhibitory modulations were evidenced by changes in motor evoked potentials (MEP). Significantly increased fMRI signal at M1 was only detected under excitatory high-frequency TMS but not during inhibitory low-frequency TMS. The supplementary motor area (SMA) had significant fMRI signal changes after both excitatory and inhibitory TMS. The topology of the activated M1 and SMA matched the activated sensorimotor network during voluntary movement. The precuneus was selectively activated with bursts of five TMS pulses. These findings demonstrated the asymmetric hemodynamic responses to excitatory and inhibitory TMS modulations with region-dependent relationships between the local fMRI signal changes and TMS dosage over different time scales.