Nonlinear interaction between stimulation intensity and initial brain state: Evidence for the facilitatory/suppressive range model of online TMS effects

The effects of online Transcranial Magnetic Stimulation (TMS) can qualitatively vary as a function of brain state. For example, TMS intensities which normally impair performance can have a facilitatory effect if the targeted neuronal representations are in a suppressed state. These phenomena have been explained in terms of the existence of distinct facilitatory and suppressive ranges as a function of TMS intensity which are shifted by changes in neural excitability. We tested this model by applying TMS at a low (60% of phosphene threshold) or high (120% of phosphene threshold) intensity during a priming paradigm. Our results show that state-dependent TMS effects vary qualitatively as a function of TMS intensity. Whereas the application of TMS at 120% of participants' phosphene threshold impaired performance on fully congruent trials (in effect, reducing the benefit of priming), TMS applied at a lower intensity (60% of phosphene threshold), facilitated performance on congruent trials. These results demonstrate that behavioral effects of TMS reflect a nonlinear interaction between initial activation state and TMS intensity. They also provide support for the existence of facilitatory/suppressive ranges of TMS effects which shift when neural excitability changes.