Test–retest reliability of single and paired pulse transcranial magnetic stimulation parameters in healthy subjects

• Re-test reliability is high for resting motor threshold and test stimulus.
• Visually and automatically analyzed cortical silent period is similar in reliability.
• Reliable Change indices are calculated for all TMS-parameters.

ObjectiveTo determine the influence of different factors on test–retest reliability of frequently used transcranial magnetic stimulation (TMS) parameters while controlling for potential confounders in healthy subjects.MethodsTMS was applied in 93 healthy volunteers (61% male) twice (mean retest interval of 34.0 ± 25.6 (SD) days) between 7 am and 2 pm by four investigators (sessions n investigator A = 47, investigator B = 95, investigator C = 28, investigator D = 16). Women were assessed in their follicular phase. Test stimulus (TS), resting motor threshold (RMT), short latency intracortical inhibition (SICI), intracortical facilitation (ICF) and cortical silent period (SCP) were analyzed.ResultsGood test–retest reliabilities were observed for TS (r = .880) and RMT (r = .826), moderate for visual and automated analyzed CSP durations (resp. r = .466, r = .486), and poor for ICF (r = −.159). Reliable change indexes are reported. Gender (e.g. automated CSP women: r = .538 vs. men: r = .422), re-test interval and method of CSP-analysis did not influence reliabilities.ConclusionsIn a large sample of healthy volunteers we found good to moderate test–retest reliabilities in all but one TMS-parameter. Automated analysis of the CSP did not prove to be more reliable than visual determination.SignificanceThis study contains analyses of re-test reliability in TMS considering several confounding factors. For the first time it presents reliable change indices for all frequently used TMS parameters.