(as measured with simultaneous EEG) notes that both low-frequency and high-frequency rTMS produce an approximately 30% change in TMS-evoked response (depression with low-frequency rTMS, and facilitation with high-frequency rTMS), with the excitability changes persisting for a mean of about 30 minutes (Thut & Pascual-Leone, 2010). Significantly however, one study demonstrated that if an identical rTMS protocol was repeated on consecutive days, the evoked change in cortical excitability was larger on day 2, implying a carryover effect (Maeda et al., 2000). More recently, Huang et al. developed a patterned repetitive stimulation protocol to rapidly induce changes in cortical plasticity (Huang et al., 2005). The “theta-burst” rTMS stimulation paradigm consists of 3 pulses at 50 Hz and intensity of 80% active motor threshold, repeated every 200 ms (ie. at 5 Hz). In the continuous protocol, a 40-second train of uninterrupted theta-burst stimulation was applied for a total of 600 pulses, resulting in a decrease in MEP amplitude of over 40%, with suppression persisting for as long as 60 minutes. In the intermittent theta burst protocol, a two-second train of theta burst stimulation was repeated every 10 seconds, also for a total of 600 pulses; the MEP amplitude was increased by up to
