Time-dependent changes in motor cortical excitability by electrical stimulation combined with voluntary drive.

Prolonged changes in primary motor cortex excitability in response to combined neuromuscular electrical stimulation (NMES) and voluntary contraction with motor evoked potentials (MEPs) were investigated by transcranial magnetic stimulation and recorded by mechanomyography. Participants included 22 healthy individuals. NMES was applied to the extensor carpi radialis (ECR) by voluntary ECR contraction with 20% maximum voluntary contraction (MVC) of wrist extension. MEPs were recorded from the flexor carpi radialis (FCR) and ECR at rest with NMES, at 20% MVC with NMES (combined), and at 20% MVC alone. Significant conditional effects were revealed in ECR and FCR. In the combined condition, MEPs showed gradual enhancement, and those in FCR were more inhibited than those in the control condition. Voluntary contraction with NMES increased primary motor cortex excitability in the agonist muscle, whereas the antagonist muscle might affect reciprocal modulation in the combined condition.