Longitudinal changes in intracortical excitability during Ramadan diurnal intermittent fasting: A paired-pulse transcranial magnetic stimulation study.
Overview
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Laboratory of Health Science & Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University, Yongin, Republic of Korea
- Neuromusculoskeletal Rehabilitation Research Group, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
- Department of Rehabilitation Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
Abstract
Ramadan diurnal intermittent fasting (RDIF) represents a natural model of prolonged daily intermittent fasting associated with metabolic and circadian alterations. This study investigated longitudinal changes in intracortical excitability across pre-, mid-, and post-Ramadan timepoints in healthy adults observing RDIF. Thirty fasting participants in this prospective observational cohort study underwent paired-pulse transcranial magnetic stimulation at three timepoints (pre-, mid-, and post-Ramadan). A non-fasting control group (n = 11) was assessed at pre- and mid-Ramadan. Conditioned motor-evoked potentials were recorded at interstimulus intervals of 2–10 ms and normalized to unconditioned responses. A linear mixed-effects model assessed effects of Timepoint and interstimulus interval (ISI). Secondary outcomes included blood glucose, cognitive performance, sleep duration, and reaction time. A significant main effect of Timepoint (p < 0.001) indicated longitudinal modulation of intracortical excitability, with increased MEP ratios at mid-Ramadan and partial persistence post-Ramadan. The ISI effect confirmed the inhibition–facilitation gradient (p < 0.001). The Timepoint × ISI interaction was not significant (p = 0.566), indicating a global shift in excitability without ISI-specific modulation. Blood glucose and sleep duration decreased significantly at mid-Ramadan. RDIF is associated with a time-dependent increase in intracortical excitability, most appropriately interpreted as a generalized shift rather than selective modulation of inhibitory or facilitatory circuits. These changes occur in the context of concurrent metabolic, sleep, and circadian alterations and may reflect combined physiological influences of these factors; however, their individual contributions cannot be disentangled within the present naturalistic observational design. Because the non-fasting comparison group was not evaluated after Ramadan, the persistence of elevated intracortical excitability beyond Ramadan requires confirmation in adequately controlled longitudinal studies.
Reproduced under the paper's license (CC BY), from the paper cited above.
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Data
Datasets cited
- zenodo:20018903, at Zenodo; found in “Data Availability”
Data Availability
All relevant data underlying the findings of this study are publicly available in the Zenodo repository at https://
Reproduced under the paper's license (CC BY), from the paper cited above.
Versions
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Version 1, 27 September 2026: the first record
Recorded: type, language, journal, volume, issue, pages, dates, 6 authors, 17 MeSH terms, 34 references.
Cite
This paper
Kim, M., Mostafa, I. M., Al-Sharman, A., Saad, N., Khalil, H., & Hadoush, H. (2026). Longitudinal changes in intracortical excitability during Ramadan diurnal intermittent fasting: A paired-pulse transcranial magnetic stimulation study. PloS one, 21(8), e0349740. https://
BibTeX
@article{kim2026longitud
author = {Kim, Meeyoung and Mostafa, Ibrahim M. and Al-Sharman, Alham and Saad, Nabil and Khalil, Hanan and Hadoush, Hikmat},
title = {{Longitudinal changes in intracortical excitability during Ramadan diurnal intermittent fasting: A paired-pulse transcranial magnetic stimulation study}},
journal = {PloS one},
year = {2026},
month = aug,
volume = {21},
number = {8},
pages = {e0349740},
publisher = {PLOS},
issn = {1932-6203},
doi = {10.1371/
url = {https://
pmid = {42672002},
pmcid = {PMC13529010}
}
RIS
TY - JOUR
AU - Kim, Meeyoung
AU - Mostafa, Ibrahim M.
AU - Al-Sharman, Alham
AU - Saad, Nabil
AU - Khalil, Hanan
AU - Hadoush, Hikmat
TI - Longitudinal changes in intracortical excitability during Ramadan diurnal intermittent fasting: A paired-pulse transcranial magnetic stimulation study
T2 - PloS one
J2 - PLoS One
PY - 2026
DA - 2026/
VL - 21
IS - 8
SP - e0349740
SN - 1932-6203
PB - PLOS
DO - 10.1371/
UR - https://
LA - en
ER -
CSL-JSON
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"URL": "https://
"language": "en",
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