Can we manipulate brain connectivity? A systematic review of cortico-cortical paired associative stimulation effects

Hernandez-Pavon, Julio C.; San Agustín, Arantzazu; Wang, Max C.; Veniero, Domenica; Pons, Jose L.

Abstract

Objective
Cortico-cortical paired associative stimulation (ccPAS) is a form of dual-site transcranial magnetic stimulation (TMS) entailing a series of single-TMS pulses paired at specific interstimulus intervals (ISI) delivered to distant cortical areas. The goal of this article is to systematically review its efficacy in inducing plasticity in humans focusing on stimulation parameters and hypotheses of underlying neurophysiology.

Methods
A systematic review of the literature from 2009–2023 was undertaken to identify all articles utilizing ccPAS to study brain plasticity and connectivity. Six electronic databases were searched and included.

Results
32 studies were identified. The studies targeted connections within the same hemisphere or between hemispheres. 28 ccPAS studies were in healthy participants, 1 study in schizophrenia, and 1 in Alzheimer’s disease (AD) patients. 2 additional studies used cortico-cortical repetitive paired associative stimulation (cc-rPAS) in generalized anxiety disorder (GAD) patients. Outcome measures include electromyography (EMG), behavioral measures, electroencephalography (EEG), and functional magnetic resonance imaging (fMRI). ccPAS seems to be able to modulate brain connectivity depending on the ISI.

Conclusions
ccPAS can be used to modulate corticospinal excitability, brain activity, and behavior. Although the stimulation parameters used across studies reviewed in this paper are varied, ccPAS is a promising approach for basic research and potential clinical applications.

Significance
Recent advances in neuroscience have caused a shift of interest from the study of single areas to a more complex approach focusing on networks of areas that orchestrate brain activity. Consequently, the TMS community is also witnessing a change, with a growing interest in targeting multiple brain areas rather than a single locus, as evidenced by an increasing number of papers using ccPAS. In light of this new enthusiasm for brain connectivity, this review summarizes existing literature and stimulation parameters that have proven effective in changing electrophysiological, behavioral, or neuroimaging-derived measures.

Citation

Hernandez-Pavon, J. C., San Agustín, A., Wang, M. C., Veniero, D., & Pons, J. L. (2023). Can we manipulate brain connectivity? A systematic review of cortico-cortical paired associative stimulation effects. Clinical Neurophysiology, 154, 169-193. https://doi.org/10.1016/j.clinph.2023.06.016

• Journal Article Type: Article
• Acceptance Date: Jun 16, 2023
• Online Publication Date: Aug 25, 2023
• Publication Date: 2023-10
• Deposit Date: Apr 3, 2025
• Publicly Available Date: Apr 9, 2025
• Journal: Clinical Neurophysiology
• Print ISSN: 1388-2457
• Electronic ISSN: 1388-2457
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 154
• Pages: 169-193
• DOI: https://doi.org/10.1016/j.clinph.2023.06.016
• Keywords: Connectivity, Cortico-cortical paired associative stimulation, Hebbian plasticity, Systematic review, Transcranial magnetic stimulation
• Public URL: https://nottingham-repository.worktribe.com/output/24870093
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1388245723006569?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: Can we manipulate brain connectivity? A systematic review of cortico-cortical paired associative stimulation effects; Journal Title: Clinical Neurophysiology; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.clinph.2023.06.016; Content Type: article; Copyright: © 2023 International Federation of Clinical Neurophysiology. Published by Elsevier B.V.