High visual demand following theta burst stimulation modulates the effect on visual cortex excitability

Modulatory effects of repetitive transcranial magnetic stimulation (TMS) depend on the activity of the stimulated cortical area before, during, and even after application. In the present study, we investigated the effects of theta burst stimulation (TBS) on visual cortex excitability using phosphene threshold (PTs). In a between-group design either continuous or intermittent TBS was applied with 100% of individual PT intensity. We varied visual demand following stimulation in form of high demand (acuity task) or low demand (looking at the wall). No change of PTs was observed directly after TBS. We found increased PTs only if subjects had high visual demand following continuous TBS. With low visual demand following stimulation no change of PT was observed. Intermittent TBS had no effect on visual cortex excitability at all. Since other studies showed increased PTs following continuous TBS using subthreshold intensities, our results highlight the importance of stimulation intensity applying TBS to the visual cortex. Furthermore, the state of the neurons in the stimulated cortex area not only before but also following TBS has an important influence on the effects of stimulation, making it necessary to scrupulously control for activity during the whole experimental session in a study.