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Specifically, we assessed lower\u2010limb corticospinal excitability when voluntary ipsilateral upper\u2010limb muscle contraction (UMC) was integrated into lower\u2010limb PAS in 19 able\u2010bodied young adults. PAS targeted the right soleus muscle (i.e., a lower\u2010limb muscle), pairing peripheral nerve stimulation (PNS) with transcranial magnetic stimulation (TMS) to modulate cortical excitability. Experiment 1 evaluated motor\u2010evoked potentials (MEPs) and Hoffmann reflex (H\u2010reflex) after PAS\u2009+\u2009UMC, PAS, and UMC interventions. Experiment 2 investigated the modulation of MEP and short\u2010interval intracortical inhibition (SICI) following PAS\u2009+\u2009UMC and PAS interventions, with focused attention on PNS. During PAS\u2009+\u2009UMC intervention, participants performed right wrist flexion at 30% maximum voluntary contraction coinciding with stimulation. Results showed a significant increase in MEPs 30\u2009min after PAS\u2009+\u2009UMC intervention, with enhanced increase under controlled attention. The H\u2010reflex slightly increased 15 and 30\u2009min after PAS\u2009+\u2009UMC intervention. SICI increased 30\u2009min after PAS\u2009+\u2009UMC intervention, though the correlation between MEP and SICI observed in PAS intervention was absent in PAS\u2009+\u2009UMC intervention. Our findings suggest that combining lower\u2010limb PAS with UMC can facilitate lower\u2010limb corticospinal excitability more effectively than conventional PAS, despite the complex neural mechanism underlying PAS.<\/jats:p>","DOI":"10.1111\/ejn.70072","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T11:33:46Z","timestamp":1744112026000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Stable Enhancement of Corticospinal Excitability by the Combination of Paired Associative Stimulation and Interlimb Cortical Network"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4493-2200","authenticated-orcid":false,"given":"Tatsuya","family":"Kato","sequence":"first","affiliation":[{"name":"Sony Computer Science Laboratories. Inc.  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