Hebbian associative plasticity in the visuo-tactile domain: A cross-modal paired associative stimulation protocol.

We developed and assessed the effects of a novel cross-modal protocol aimed at inducing associative (Hebbian-like) plasticity in the somatosensory cortical system through vision. Associative long-term potentiation can be induced in the primary somatosensory cortex (S1) by means of paired associative stimulation (PAS), in which a peripheral electrical stimulation of the median nerve is repeatedly paired with a transcranial magnetic stimulation (TMS) pulse over S1. Considering the mirror proprieties of S1, the cross-modal PAS (cm-PAS) consists of repetitive observation of bodily tactile stimulations, paired with TMS pulses over the contralateral S1. Through three experiments in healthy participants, we demonstrate that the cm-PAS is able to induce excitatory plastic effects with functional significance in S1, improving somatosensory processing at both behavioral (tactile acuity) and neurophysiological (somatosensory-evoked potentials) levels. The plastic effects induced by cm-PAS depend on the interval (20 ms) between the visual stimulus and the magnetic pulse, the targeted cortical site (S1), and the tactile content of the visual stimulus, which must represent a touch event. Such specificity implies the involvement of cross-modal, mirror-like, mechanisms in S1, which are able to visually promote associative synaptic plasticity in S1 likely through the recruitment of predictive coding processes.