Paired associative stimulation (PAS) merges transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS) to promote plastic changes in the motor system, showing promise as a therapy for spinal cord injury patients.
A new PAS protocol with a third TMS pulse (20-Hz rTMS) boosted motor-evoked potentials (MEPs) more effectively than traditional PAS methods, particularly at the 60-minute mark post-stimulation.
Despite promising results, three subjects experienced strong involuntary twitches, indicating the need for further testing before clinical application.