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Stress. 2017 Mar;20(2):212-216. doi: 10.1080/10253890.2017.1301424. Epub 2017 Mar 20.

Academic stress disrupts cortical plasticity in graduate students.

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a Department of Interprofessional Health Sciences & Health Administration , School of Health and Medical Sciences, Seton Hall University , NJ , USA.
b Department of Clinical and Experimental Medicine , Psychiatry Unit, University of Catania.
c Division of Pre-clinical sciences , New York College of Podiatric Medicine , New York, NY , USA.
d Department of Biomedical and Dental Sciences and Morphofunctional Imaging , Psychiatry Unit, University of Messina , Messina , Italy.


Medical education is a time of high stress and anxiety for many graduate students in medical professions. In this study, we sought to investigate the effect of academic stress on cortical excitability and plasticity by using transcranial magnetic stimulation (TMS). We tested two groups (n = 13 each) of healthy graduate medical students (mean age 33.7 ± 3.8 SE). One group was tested during a final exam week (High-stress group) while the other group was tested after a break, during a week without exams (Low-stress group). Students were required to fill the Perceived Stress Scale-10 (PSS) questionnaire. We investigated resting motor threshold (RMT), motor evoked potential (MEP) amplitude and cortical silent period (CSP). The paired-pulse stimulation paradigm was used to assess short interval intracortical inhibition (SICI) and intracortical facilitation (ICF). Long-term potentiation (LTP)-like plasticity was evaluated with paired associative stimulation (PAS-25). There was no between-group difference in cortical excitability. On the contrary, during examination period, levels of perceived stress were significantly higher (p= .036) and the amount of cortical plasticity (60 min after PAS) was significantly lower (p = .029). LTP-like plasticity (60 min after PAS) was inversely correlated with perceived stress in the High-stress group. The present study showed LTP-like plasticity was reduced by examining stress in graduate students. Our results provide a new opportunity to objectively quantify the negative effect of academic and examination stress on brain plasticity.


Academic stress; LTP; TMS; cortical plasticity; graduate medical education; stress

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