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Alvaro Pascualleone - One of the best experts on this subject based on the ideXlab platform.
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transcranial Magnetic Stimulation of the brain guidelines for pain treatment research
Pain, 2015Co-Authors: Max Klein, Alvaro Pascualleone, Roi Treister, Tommi Raij, Lawrence T Park, Turo Nurmikko, Frederick Lenz, J P Lefaucheur, Magdalena LangAbstract:Recognizing that electrically stimulating the motor cortex could relieve chronic pain sparked development of noninvasive technologies. In transcranial Magnetic Stimulation (TMS), electroMagnetic coils held against the scalp influence underlying cortical firing. Multiday repetitive transcranial Magnetic Stimulation (rTMS) can induce long-lasting, potentially therapeutic brain plasticity. Nearby ferroMagnetic or electronic implants are contraindications. Adverse effects are minimal, primarily headaches. Single provoked seizures are very rare. Transcranial Magnetic Stimulation devices are marketed for depression and migraine in the United States and for various indications elsewhere. Although multiple studies report that high-frequency rTMS of the motor cortex reduces neuropathic pain, their quality has been insufficient to support Food and Drug Administration application. Harvard's Radcliffe Institute therefore sponsored a workshop to solicit advice from experts in TMS, pain research, and clinical trials. They recommended that researchers standardize and document all TMS parameters and improve strategies for sham and double blinding. Subjects should have common well-characterized pain conditions amenable to motor cortex rTMS and studies should be adequately powered. They recommended standardized assessment tools (eg, NIH's PROMIS) plus validated condition-specific instruments and consensus-recommended metrics (eg, IMMPACT). Outcomes should include pain intensity and qualities, patient and clinician impression of change, and proportions achieving 30% and 50% pain relief. Secondary outcomes could include function, mood, sleep, and/or quality of life. Minimum required elements include sample sources, sizes, and demographics, recruitment methods, inclusion and exclusion criteria, baseline and posttreatment means and SD, adverse effects, safety concerns, discontinuations, and medication-usage records. Outcomes should be monitored for at least 3 months after initiation with prespecified statistical analyses. Multigroup collaborations or registry studies may be needed for pivotal trials.
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use of transcranial Magnetic Stimulation in autism spectrum disorders
Journal of Autism and Developmental Disorders, 2015Co-Authors: Lindsay M Oberman, Alexander Rotenberg, Alvaro PascualleoneAbstract:The clinical, social and financial burden of autism spectrum disorder (ASD) is staggering. We urgently need valid and reliable biomarkers for diagnosis and effective treatments targeting the often debilitating symptoms. Transcranial Magnetic Stimulation (TMS) is beginning to be used by a number of centers worldwide and may represent a novel technique with both diagnostic and therapeutic potential. Here we critically review the current scientific evidence for the use of TMS in ASD. Though preliminary data suggests promise, there is simply not enough evidence yet to conclusively support the clinical widespread use of TMS in ASD, neither diagnostically nor therapeutically. Carefully designed and properly controlled clinical trials are warranted to evaluate the true potential of TMS in ASD.
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lateralization of forelimb motor evoked potentials by transcranial Magnetic Stimulation in rats
Clinical Neurophysiology, 2010Co-Authors: Alvaro Pascualleone, Alexander Rotenberg, Paul A Muller, Andrew M Vahabzadehhagh, Xavier Navarro, Ruben Lopezvales, Frances E JensenAbstract:Objectives To approximate methods for human transcranial Magnetic Stimulation (TMS) in rats, we tested whether lateralized cortical Stimulation resulting in selective activation of one forelimb contralateral to the site of Stimulation could be achieved by TMS in the rat.
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handbook of transcranial Magnetic Stimulation
2002Co-Authors: Alvaro PascualleoneAbstract:Transcranial Magnetic Stimulation (TMS) is a method for stimulating the cerebral cortex through the intact skull by use of a coil delivering a rapidly changing Magnetic field. It has applications in neuropsychiatric diagnosis, and in psychiatric therapy, using around one million times less energy than is required for traditional electroconvulsive therapy. Bringing together the basic science, fundamental principles, and essential practicalities of TMS, this book should prove useful to all users whether they are using the technique clinically or in research. The final two sections then bring together current up to date knowledge of applications of the technique. This handbook offers a companion to users of TMS in all departments of neurology, neurophysiology, neuropsychology, and psychiatry.
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transcranial Magnetic Stimulation in cognitive neuroscience virtual lesion chronometry and functional connectivity
Current Opinion in Neurobiology, 2000Co-Authors: Alvaro Pascualleone, Vincent Walsh, J C RothwellAbstract:Fifteen years after its introduction by Anthony Barker, transcranial Magnetic Stimulation (TMS) appears to be 'coming of age' in cognitive neuroscience and promises to reshape the way we investigate brain-behavior relations. Among the many methods now available for imaging the activity of the human brain, Magnetic Stimulation is the only technique that allows us to interfere actively with brain function. As illustrated by several experiments over the past couple of years, this property of TMS allows us to investigate the relationship between focal cortical activity and behavior, to trace the timing at which activity in a particular cortical region contributes to a given task, and to map the functional connectivity between brain regions.
John H Krystal - One of the best experts on this subject based on the ideXlab platform.
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transcranial Magnetic Stimulation of left temporoparietal cortex and medication resistant auditory hallucinations
Archives of General Psychiatry, 2003Co-Authors: Ralph E Hoffman, Nashaat N Boutros, Keith A Hawkins, Ralitza Gueorguieva, Fady Rachid, Kathleen M Carroll, John H KrystalAbstract:Background Neuroimaging studies suggest that auditory hallucinations (AHs) of speech arise, at least in part, from activation of brain areas underlying speech perception. One-hertz repetitive transcranial Magnetic Stimulation (rTMS) produces sustained reductions in cortical activation. Recent results of 4-day administration of 1-Hz rTMS to left temporoparietal cortex were superior to those of sham Stimulation in reducing AHs. We sought to determine if a more extended trial of rTMS could significantly reduce AHs that were resistant to antipsychotic medication. Methods Twenty-four patients with schizophrenia or schizoaffective disorder and medication-resistant AHs were randomly allocated to receive rTMS or sham Stimulation for 9 days at 90% of motor threshold. Patients receiving sham Stimulation were subsequently offered an open-label trial of rTMS. Neuropsychological assessments were administered at baseline and during and following each arm of the trial. Results Auditory hallucinations were robustly improved with rTMS relative to sham Stimulation. Frequency and attentional salience were the 2 aspects of hallucinatory experience that showed greatest improvement. Duration of putative treatment effects ranged widely, with 52% of patients maintaining improvement for at least 15 weeks. Repetitive transcranial Magnetic Stimulation was well tolerated, without evidence of neuropsychological impairment. Conclusions These data suggest that the mechanism of AHs involves activation of the left temporoparietal cortex. One-hertz rTMS deserves additional study as a possible treatment for this syndrome.
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transcranial Magnetic Stimulation of left temporoparietal cortex and medication resistant auditory hallucinations
Archives of General Psychiatry, 2003Co-Authors: Ralph E Hoffman, Nashaat N Boutros, Keith A Hawkins, Ralitza Gueorguieva, Fady Rachid, Kathleen M Carroll, John H KrystalAbstract:Background: Neuroimaging studies suggest that auditory hallucinations (AHs) of speech arise, at least in part, from activation of brain areas underlying speech perception. One-hertz repetitive transcranial Magnetic Stimulation (rTMS) produces sustained reductions in cortical activation. Recent results of 4-day administration of 1-Hz rTMS to left temporoparietal cortex were superior to those of sham Stimulation in reducing AHs. We sought to determine if a more extended trial of rTMS could significantly reduce AHs that were resistant to antipsychotic medication. Methods: Twenty-four patients with schizophrenia or schizoaffective disorder and medication-resistant AHs were randomly allocated to receive rTMS or sham Stimulation for 9 days at 90% of motor threshold. Patients receiving sham Stimulation were subsequently offered an open-label trial of rTMS. Neuropsychological assessments were administered at baseline and during and following each arm of the trial. Results: Auditory hallucinations were robustly improved with rTMS relative to sham Stimulation. Frequency and attentional salience were the 2 aspects of hallucinatory experience that showed greatest improvement. Duration of putative treatment effects ranged widely, with 52% of patients maintaining improvement for at least 15 weeks. Repetitive transcranial Magnetic Stimulation was well tolerated, without evidence of neuropsychological impairment. Conclusions: These data suggest that the mechanism of AHs involves activation of the left temporoparietal cortex. One-hertz rTMS deserves additional study as a possible treatment for this syndrome. Arch Gen Psychiatry. 2003;60:49-56
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transcranial Magnetic Stimulation and auditory hallucinations in schizophrenia
The Lancet, 2000Co-Authors: Ralph E Hoffman, Nashaat N Boutros, Sylvia Hu, Robert M Berman, John H Krystal, Dennis S CharneyAbstract:Summary 12 patients with schizophrenia and auditory hallucinations received 1 Hz transcranial Magnetic Stimulation of left temporoparietlal cortex. In a double-blind crossover trial, active Stimulation significantly reduced hallucinations relative to sham Stimulation.
Mark Hallett - One of the best experts on this subject based on the ideXlab platform.
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transcranial Magnetic Stimulation a primer
Neuron, 2007Co-Authors: Mark HallettAbstract:Transcranial Magnetic Stimulation (TMS) is a technique for noninvasive Stimulation of the human brain. Stimulation is produced by generating a brief, high-intensity Magnetic field by passing a brief electric current through a Magnetic coil. The field can excite or inhibit a small area of brain below the coil. All parts of the brain just beneath the skull can be influenced, but most studies have been of the motor cortex where a focal muscle twitch can be produced, called the motor-evoked potential. The technique can be used to map brain function and explore the excitability of different regions. Brief interference has allowed mapping of many sensory, motor, and cognitive functions. TMS has some clinical utility, and, because it can influence brain function if delivered repetitively, it is being developed for various therapeutic purposes.
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a coil design for transcranial Magnetic Stimulation of deep brain regions
Journal of Clinical Neurophysiology, 2002Co-Authors: Yiftach Roth, Abraham Zangen, Mark HallettAbstract:Summary Noninvasive Magnetic Stimulation of the human central nervous system has been used in research and the clinic for several years. However, the coils used previously stimulated mainly the cortical brain regions but could not stimulate deeper brain regions directly. The purpose of the current s
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mood improvement following daily left prefrontal repetitive transcranial Magnetic Stimulation in patients with depression a placebo controlled crossover trial
American Journal of Psychiatry, 1997Co-Authors: Mark S George, Mark Hallett, Eric M Wassermann, Tim A Kimbrell, John T Little, Wendol E Williams, Aimee L Danielson, Benjamin D Greenberg, Robert M PostAbstract:Objective: Preliminary studies have indicated that daily left prefrontal repetitive transcranial Magnetic Stimulation might have antidepressant activity. The authors sought to confirm this finding by using a double-blind crossover design. Method: Twelve depressed adults received in random order 2 weeks of active treatment (repetitive transcranial Magnetic Stimulation, 20 Hz at 80% motor threshold) and 2 weeks of sham treatment. Results: Changes from the relevant phase baseline in scores on the 21-item Hamilton depression scale showed that repetitive transcranial Magnetic Stimulation significantly improved mood over sham treatment. During the active-treatment phase, Hamilton depression scale scores decreased 5 points, while during sham treatment the scores increased or worsened by 3 points. No adverse effects were noted. Conclusions: These placebo-controlled results suggest that daily left prefrontal repetitive transcranial Magnetic Stimulation has antidepressant activity when administered at these parameters. Further controlled studies are indicated to explore optimal Stimulation characteristics and location, potential clinical applications, and possible mechanisms of action. (Am J Psychiatry 1997; 154:1752‐1756)
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focal transcranial Magnetic Stimulation and response bias in a forced choice task
Journal of Neurology Neurosurgery and Psychiatry, 1992Co-Authors: J P Brasilneto, Alvaro Pascualleone, Josep Vallssole, Leonardo G Cohen, Mark HallettAbstract:The effects of transcranial Magnetic Stimulation were studied on the performance of a warned, forced-choice response time task by normal adults. The task consisted of extension of the index finger in response to the click produced by the discharge of the Magnetic coil (go-signal). The subjects were asked to choose the right or left finger only after the go-signal was delivered. Single Magnetic stimuli were delivered to the prefrontal or motor area, and in the control situation, away from the head. Magnetic Stimulation affected hand preference only when it was delivered to the motor area. With Stimulation of this area, subjects more often chose the hand contralateral to the site stimulated with response times that were mainly less than 200 ms. With longer response times (between 200 and 1100 ms), Magnetic Stimulation had no effect on hand preference regardless of the site stimulated. Stimulation of prefrontal areas yielded results similar to the control situation. These results suggest that response bias in this paradigm is caused by an effect of Magnetic Stimulation on neural structures within, or closely related to, the motor areas of the brain. Although the response bias was clear and predictable, the subjects were unaware of its existence. It is possible to influence endogenous processes of movement preparation externally without disrupting the conscious perception of volition.
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effects of focal transcranial Magnetic Stimulation on simple reaction time to acoustic visual and somatosensory stimuli
Brain, 1992Co-Authors: Alvaro Pascualleone, Josep Vallssole, Eric M Wassermann, J P Brasilneto, Leonardo G Cohen, Mark HallettAbstract:In a simple reaction time (RT) paradigm, Magnetic Stimulation of different intensities was delivered over different scalp positions and at variable delays before (negative) or after (positive) the go-signal. Magnetic Stimulation shortened RT to different go-signals (auditory, visual and somatosensory stimuli) by approximately 30 ms when delivered over the motor cortex contralateral to the responding arm at intensities below motor threshold. This effect was maximal at a delay of approximately + 10 ms. A similar effect was found with suprathreshold Stimulation to the ipsilateral motor cortex. Magnetic Stimulation over other scalp areas did not affect RT regardless of the delay. No differences were found between the effects on elbow flexion and thumb abduction. The shortening of RT was not associated with changes in the timing development of premovement excitability increase in the motor cortex. We conclude that Magnetic Stimulation shortens RT by inducing an earlier initiation of this excitability increase
John Moxham - One of the best experts on this subject based on the ideXlab platform.
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Magnetic Stimulation for the measurement of respiratory and skeletal muscle function
European Respiratory Journal, 2004Co-Authors: Dc W Man, John Moxham, Michael I PolkeyAbstract:Respiratory and skeletal muscle function is of interest in many areas of pulmonary and critical care medicine. The capacity of the respiratory muscle pump to respond to the load imposed by disease is the basis of an understanding of ventilatory failure. Over the last four decades, considerable progress has been made in quantifying the capacity of the respiratory muscles, in terms of strength, endurance and fatigue. With the development of Magnetic Stimulation, it has recently become possible to nonvolitionally assess the respiratory muscles in a clinically acceptable way. This is of particular interest in the investigation of patients receiving critical care, those with neuromuscular disease, and in children where volitional efforts are either not possible or likely to be sub-maximal. Furthermore, the adaptation of these techniques to quantify the strength of peripheral muscles, such as the quadriceps, has allowed the effects of muscle training or rehabilitation, uninfluenced by learning effect, to be assessed. This article focuses on the physiological basis of Magnetic nerve Stimulation, and reviews how the technique has been applied to measure muscle strength and fatigue, with particular emphasis upon the diaphragm. The translation of Magnetic Stimulation into a clinical tool is described, and how it may be of diagnostic, prognostic and therapeutic value in several areas of pulmonary medicine. In particular, the use of Magnetic Stimulation in neuromuscular disease, the intensive care setting, chronic obstructive pulmonary disease and paediatrics will be discussed.
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clinical assessment of diaphragm strength by cervical Magnetic Stimulation of the phrenic nerves
Thorax, 1996Co-Authors: C. H. Hamnegard, D Kyroussis, S Wragg, G. H. Mills, John Moxham, Michael I Polkey, B Bake, M. GreenAbstract:BACKGROUND: Accurate assessment of diaphragm strength can be difficult. Transdiaphragmatic pressure (PDI) measurements during volitional manoeuvres are useful but it may be difficult to ensure maximum patient effort. Magnetic Stimulation of the phrenic nerves is easy to perform and the results are reproducible in normal subjects. The purpose of the present study was to evaluate the usefulness of Magnetic Stimulation of the phrenic nerves in the assessment of diaphragm weakness in patients. METHODS: Sixty-six patients referred for assessment of respiratory muscle strength and 23 normal subjects were studied. Twitch PDI (TwPDI) following Magnetic Stimulation of the phrenic nerves and sniffPDI were obtained in all individuals. TWPDI following bilateral electrical Stimulation of the phrenic nerves was also obtained in eight patients. RESULTS: Mean (SD) TwPdi for the normal subjects was 31 (6) cm H2O and 18 (11) cm H2O for the patients. TwPDI and sniffPDI were correlated (r = 0.77). Seven of the 37 patients (19%) with a reduced sniffPDI had a TwPDI within the normal range whereas two of the 32 patients (6%) with a reduced TwPDI had a normal sniffPDI. TwPDI was similar with Magnetic and electrical Stimulation. CONCLUSIONS: TwPDI following Magnetic Stimulation of the phrenic nerves is a clinically useful measurement when assessing diaphragm weakness.
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unilateral Magnetic Stimulation of the phrenic nerve
Thorax, 1995Co-Authors: G. H. Mills, D Kyroussis, S Wragg, C. H. Hamnegard, John Moxham, M. GreenAbstract:BACKGROUND--Electrical Stimulation of the phrenic nerve is a useful non-volitional method of assessing diaphragm contractility. During the assessment of hemidiaphragm contractility with electrical Stimulation, low twitch transdiaphragmatic pressures may result from difficulty in locating and stimulating the phrenic nerve. Cervical Magnetic Stimulation overcomes some of these problems, but this technique may not be absolutely specific and does not allow the contractility of one hemidiaphragm to be assessed. This study assesses both the best means of producing supramaximal unilateral Magnetic phrenic Stimulation and its reproducibility. This technique is then applied to patients. METHODS--The ability of four different Magnetic coils to produce unilateral phrenic Stimulation in five normal subjects was assessed from twitch transdiaphragmatic pressure (TwPDI) measurements and diaphragmatic electromyogram (EMG) recordings. The results from Magnetic Stimulation were compared with those from electrical Stimulation. To determine whether the Magnetic field affects the contralateral phrenic nerve as well as the intended phrenic nerve, EMG recordings from each hemidiaphragm were compared during Stimulation on the same side and the opposite side relative to the recording electrodes. The EMG recordings were made from skin surface electrodes in five normal subjects and from needle electrodes placed in the diaphragm during cardiac surgery in six patients. Similarly, the direction of hemidiaphragm movement was evaluated by ultrasonography. To determine the usefulness of the technique in patients the 43 mm mean diameter double coil was used in 54 patients referred for assessment of possible respiratory muscle weakness. These results were compared with unilateral electrical phrenic Stimulation, maximum sniff PDI, and TwPDI during cervical Magnetic Stimulation. RESULTS--In the five normal subjects supramaximal Stimulation was established for eight out of 10 phrenic nerves with the 43 mm double coil. Supramaximal unilateral Magnetic Stimulation produced a higher TwPDI than electrical Stimulation (mean (SD) 13.4 (2.5) cm H2O with 35 mm coil; 14.1 (3.8) cm H2O with 43 mm coil; 10.0 (1.7) cm H2O with electrical Stimulation). Spread of the Magnetic field to the opposite phrenic nerve produced a small amplitude contralateral diaphragm EMG measured from skin surface electrodes which reached a mean of 15% of the maximum EMG amplitude produced by ipsilateral Stimulation. Similarly, in six patients with EMG activity recorded directly from needle electrodes, the contralateral spread of the Magnetic field produced EMG activity up to a mean of 3% and a maximum of 6% of that seen with ipsilateral Stimulation. Unilateral Magnetic Stimulation of the phrenic nerve was rapidly achieved and well tolerated. In the 54 patients unilateral Magnetic TwPDI was more closely related than unilateral electrical TwPDI to transdiaphragmatic pressure produced during maximum sniffs and cervical Magnetic Stimulation. Unilateral Magnetic Stimulation eliminated the problem of producing a falsely low TwPDI because of technical difficulties in locating and adequately stimulating the nerve. Eight patients with unilateral phrenic nerve paresis, as indicated by a unilaterally elevated hemidiaphragm on a chest radiograph and maximum sniff PDI consistent with hemidiaphragm weakness, were all accurately identified by unilateral Magnetic Stimulation. CONCLUSIONS--Unilateral Magnetic phrenic nerve Stimulation is easy to apply and is a reproducible technique in the assessment of hemidiaphragm contractility. It is well tolerated and allows hemidiaphragm contractility to be rapidly and reliably assessed because precise positioning of the coils is not necessary. This may be particularly useful in patients. In addition, the anterolateral positioning of the coil allows the use of the magnet in the supine patient such as in the operating theatre or intensive care unit.
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comparison of cervical Magnetic Stimulation and bilateral percutaneous electrical Stimulation of the phrenic nerves in normal subjects
European Respiratory Journal, 1994Co-Authors: S Wragg, C. H. Hamnegard, M. Green, R Aquilina, J Moran, Michael C Ridding, Tom Fearn, John MoxhamAbstract:Cervical Magnetic Stimulation is a new technique for stimulating the phrenic nerves, and may offer an alternative to percutaneous electrical Stimulation for assessing diaphragmatic strength in normal subjects and patients in whom electrical Stimulation is technically difficult or poorly tolerated. We compared cervical Magnetic Stimulation with conventional supramaximal bilateral percutaneous electrical Stimulation in nine normal subjects. We measured oesophageal pressure (Poes), gastric pressure (Pgas) and transdiaphragmatic pressure (Pdi). The maximal relaxation rate (MRR) was also measured. The mean Magnetic twitch Pdi was 36.5 cmH2O (range 27-48 cmH2O), significantly larger than electrical twitch Pdi, mean 29.7 cmH2O (range 22-40 cmH2O). The difference in twitch Pdi was explained entirely by twitch Poes, and it is possible that the Magnetic technique stimulates some of the nerves to the upper chest wall muscles as well as the phrenic nerves. We compared bilateral, rectified, integrated, diaphragm surface electromyographic (EMG) responses in three subjects and found results within 10% in each subject, indicating similar diaphragmatic activation. The within occasion coefficient of variation, i.e. same subject/same session, was 6.7% both for Magnetic and electrical twitch Pdi. The between occasion coefficient of variation, i.e. same subject/different days, was 6.6% for Magnetic Stimulation and 8.8% for electrical. There was no difference between relaxation rates measured with either technique. We conclude that Magnetic Stimulation is a reproducible and acceptable technique for stimulating the phrenic nerves, and that it provides a potentially useful alternative to conventional electrical Stimulation as a nonvolitional test of diaphragm strength.
Angel V Peterchev - One of the best experts on this subject based on the ideXlab platform.
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redesigning existing transcranial Magnetic Stimulation coils to reduce energy application to low field Magnetic Stimulation
Journal of Neural Engineering, 2018Co-Authors: Boshuo Wang, Michael R Shen, Zhide Deng, Evan J Smith, Joseph J Tharayil, Clement J Gurrey, Luis J Gomez, Angel V PeterchevAbstract:Objective. To present a systematic framework and exemplar for the development of a compact and energy-efficient coil that replicates the electric field (E-field) distribution induced by an existing transcranial Magnetic Stimulation coil. Approach. The E-field generated by a conventional low field Magnetic Stimulation (LFMS) coil was measured for a spherical head model and simulated in both spherical and realistic head models. Then, using a spherical head model and spatial harmonic decomposition, a spherical-shaped cap coil was synthesized such that its windings conformed to a spherical surface and replicated the E-field on the cortical surface while requiring less energy. A prototype coil was built and electrically characterized. The effect of constraining the windings to the upper half of the head was also explored via an alternative coil design. Main results. The LFMS E-field distribution resembled that of a large double-cone coil, with a peak field strength around 350 mV m−1 in the cortex. The E-field distributions of the cap coil designs were validated against the original coil, with mean errors of 1%–3%. The cap coil required as little as 2% of the original coil energy and was significantly smaller in size. Significance. The redesigned LFMS coil is substantially smaller and more energy-efficient than the original, improving cost, power consumption, and portability. These improvements could facilitate deployment of LFMS in the clinic and potentially at home. This coil redesign approach can also be applied to other Magnetic Stimulation paradigms. Finally, the anatomically-accurate E-field simulation of LFMS can be used to interpret clinical LFMS data.
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coil design considerations for deep transcranial Magnetic Stimulation
Clinical Neurophysiology, 2014Co-Authors: Zhide Deng, Sarah H Lisanby, Angel V PeterchevAbstract:Objectives To explore the field characteristics and design tradeoffs of coils for deep transcranial Magnetic Stimulation (dTMS).