Cortico-cortical paired associative stimulation highlights asymmetrical communication between rostral premotor cortices and primary motor cortex

Cortico-cortical paired associative stimulation (ccPAS) is a transcranial magnetic stimulation (TMS) protocol designed to mimic neurostimulation patterns capable of inducing spike-timing-dependent plasticity (STDP). This protocol, based on the Hebbian principle, entails coupling of pre- and post-synaptic activity through TMS, targeting two interconnected brain areas. By tailoring stimulation parameters to the characteristics of the target pathway, ccPAS can modulate its connectivity strength [[1], [2], [3]] and induce functional changes [4,5]. Understanding the behavioral and physiological impact of ccPAS manipulation over different networks is key to developing clinical interventions.