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Here, we investigated the plasticity mechanisms underlying combined stimulation effects using paired-pulse TMS paradigms. rPPS was applied to the peak phase of \u03b2 tACS (rPPS-tACS-peak) or sham tACS (rPPS alone), or tACS was delivered without rPPS (tACS alone). Resting motor threshold (RMT) and motor evoked potentials (MEPs) elicited by single-pulse TMS, short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), short-latency afferent inhibition (SAI), and short-interval intracortical facilitation (SICF) were measured before and after intervention. rPPS-tACS-peak stimulation significantly increased MEPs compared with other conditions after intervention. Although I-wave interaction was expected to be produced by the facilitation effect of rPPS, rPPS-tACS-peak did not change SICF. In contrast, SAI was decreased in rPPS-tACS-peak compared with baseline. In the control experiment, rPPS-tACS-trough did not change MEPs, SAI, and SICF. Therefore, the after-effects of rPPS-tACS-peak on M1 may be caused by a partial reduction in the inhibitory circuit mediated by cholinergic interneurons, rather than an enhancement of the facilitatory effects of rPPS.<\/jats:p>","DOI":"10.1038\/s41598-025-92444-4","type":"journal-article","created":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T04:23:25Z","timestamp":1740803005000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Neural mechanisms underlying the after-effects of repetitive paired-pulse TMS with \u03b2 tACS on the human primary motor cortex"],"prefix":"10.1038","volume":"15","author":[{"given":"Hisato","family":"Nakazono","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuya","family":"Ogata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsubasa","family":"Mitsutake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akinori","family":"Takeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emi","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shozo","family":"Tobimatsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,1]]},"reference":[{"key":"92444_CR1","doi-asserted-by":"publisher","first-page":"1926","DOI":"10.1126\/science.1099745","volume":"304","author":"G Buzs\u00e1ki","year":"2004","unstructured":"Buzs\u00e1ki, G. & Draguhn, A. 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