**Brain Response Induced with Paired Associative Stimulation Is Related to Repetition Suppression of Motor Evoked Potential**

**Shohreh Kariminezhad 1,2, \*, Jari Karhu 3 , Laura Säisänen 2 , Jusa Reijonen 1,2 , Mervi Könönen 2,4 and Petro Julkunen 1,2**


Received: 21 August 2020; Accepted: 25 September 2020; Published: 26 September 2020

**Abstract:** Repetition suppression (RS), i.e., the reduction of neuronal activity upon repetition of an external stimulus, can be demonstrated in the motor system using transcranial magnetic stimulation (TMS). We evaluated the RS in relation to the neuroplastic changes induced by paired associative stimulation (PAS). An RS paradigm, consisting of 20 trains of four identical suprathreshold TMS pulses 1 s apart, was assessed for motor-evoked potentials (MEPs) in 16 healthy subjects, before and following (at 0, 10, and 20 min) a common PAS protocol. For analysis, we divided RS into two components: (1) the ratio of the second MEP amplitude to the first one in RS trains, i.e., the "dynamic" component, and (2) the mean of the second to fourth MEP amplitudes, i.e., the "stable" component. Following PAS, five subjects showed change in the dynamic RS component. However, nearly all the individuals (*n* = 14) exhibited change in the stable component (*p* < 0.05). The stable component was similar between subjects showing increased MEPs and those showing decreased MEPs at this level (*p* = 0.254). The results suggest the tendency of the brain towards a stable state, probably free from the ongoing dynamics, following PAS.

**Keywords:** repetition suppression; neuroplasticity; transcranial magnetic stimulation; paired associative stimulation
