Response to Letter by Hotermans et al
We thank Hotermans and colleagues for their insightful comments. In general, we concur with their comments. Despite robust and meticulous experimental procedure, clinical rTMS trials on both individuals with normal and/or pathological conditions show a large inter-/intrasubject variability in cortical excitability and associated motor behaviors. Such variability may result from issues related to subjects’ inherent brain morphology, lesion, precise stimulation site and parameters of stimulation including the frequency, intensity, intervals, number of repetitions, and duration.1–3
As Dr Hotermans et al pointed out, the patient safety guideline for the use of high-frequency rTMS and intervention customization are important issues that need to be continuously addressed. Because we have strictly adhered to the established rTMS guideline4 and used robust inclusion criteria for safety reasons, no undesirable effect was seen in our patients during or after rTMS. Currently, a very large number of rTMS techniques and experimental paradigms have been implemented and are under investigation. It is only through scrupulous experimental studies, such as the one we have done, that we will be able to determine the best safe and effective intervention methods to help patients.