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Brain Stimulation Study Shows Cannabis Users Have Heightened Cortical Excitability

Case Control StudyLow evidence
The takeaway

Using transcranial magnetic stimulation, cannabis users showed increased cortical excitability and reduced intracortical inhibition compared to controls, with lower resting motor thresholds correlating with addiction severity.

Neuroscience researchers, neurologists, addiction specialists

Motor threshold correlated with addiction severity (p = 0.026)

What the researchers found

Cannabis users (n = 16) showed significantly higher motor evoked potential amplitude at 130% of resting motor threshold (p = 0.012), delayed cortical silent period onset at multiple intensities, and reduced short-latency intracortical inhibition at 4 ms interstimulus interval (p = 0.028). Resting motor threshold correlated negatively with addiction severity (p = 0.026).

Why it matters

This is direct neurophysiological evidence that cannabis use alters the balance between excitation and inhibition in the brain. The correlation between motor threshold and addiction severity suggests these changes track with heavier use.

The numbers in context

16 cannabis users vs. 20 controls; MEP amplitude increased (p = 0.012); CSP onset delayed (p = 0.018-0.036); SICI reduced at ISI 4 ms (p = 0.028); RMT correlated with addiction severity (p = 0.026).

How the study worked

Case-control study comparing 16 cannabis users and 20 controls using transcranial magnetic stimulation (TMS) measures of cortical excitability and inhibition, alongside clinical assessments including SCL-90-R, MoCA, and Hamilton anxiety/depression scales.

What this study cannot tell us

Very small sample (16 vs. 20). Cross-sectional design cannot determine whether cannabis caused the changes or whether people with different baseline excitability are more drawn to cannabis. No information on duration or amount of use.

How to read the evidence

Small case-control study with objective neurophysiological measures but very limited sample size.

When this study was published

2025 publication

The bigger picture

Altered cortical excitability could help explain cognitive and motor effects reported by cannabis users. If cannabis shifts the brain toward greater excitability with less inhibition, this may have implications for seizure threshold, impulsivity, and other neurological outcomes.

Questions still open

  • Do cortical excitability changes reverse after cannabis cessation?
  • Are these TMS changes related to functional cognitive or behavioral outcomes?

Common questions

Does cannabis change brain excitability?
Yes, this TMS study found cannabis users had significantly higher cortical excitability and reduced inhibition compared to non-users. These changes correlated with addiction severity, suggesting heavier use produces larger effects.
What does increased cortical excitability mean?
It means the brain responds more strongly to stimulation and has less inhibitory control. In cannabis users, this showed up as larger motor responses and reduced intracortical inhibition on TMS testing.

Read the original research

The impact of cannabis use on cortical excitability and inhibitory mechanisms: A case-control study.

Psychiatry research, 351, 116617

Citation

Khedr, Eman M; Elserogy, Yasser; Ahmed, Gellan K. (2025). The impact of cannabis use on cortical excitability and inhibitory mechanisms: A case-control study.. Psychiatry research, 351, 116617. https://doi.org/10.1016/j.psychres.2025.116617

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