TMS with fast and accurate electronic control: measuring the orientation sensitivity of corticomotor pathways
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Abstract Background Transcranial magnetic stimulation (TMS) coils allow only a slow, mechanical adjustment of the stimulating electric field (E-field) orientation in the cerebral tissue. Fast E-field control is needed to synchronize the stimulation with the ongoing brain activity. Also, empirical models that fully describe the relationship between evoked responses and the stimulus orientation and intensity are still missing. Objective We aimed to (1) develop a TMS transducer for manipulating the E-field orientation electronically with high accuracy at the neuronally meaningful millisecond-level time scale and (2) devise and validate a physiologically based model describing the orientation selectivity of neuronal excitability. Methods We designed and manufactured a two-coil TMS transducer. The coil windings were computed with a minimum-energy optimization procedure, and the transducer was controlled with our custom-made electronics. The electronic E-field control was verified with a TMS characterizer. The motor evoked potential amplitude and latency of a hand muscle were mapped in 3° steps of the stimulus orientation in 16 healthy subjects for three stimulation intensities. We fitted a logistic model to the motor response amplitude. Results The two-coil TMS transducer allows one to manipulate the pulse orientation accurately without manual coil movement. The motor response amplitude followed a logistic function of the stimulus orientation; this dependency was strongly affected by the stimulus intensity. Conclusion The developed electronic control of the E-field orientation allows exploring new stimulation paradigms and probing neuronal mechanisms. The presented model helps to disentangle the neuronal mechanisms of brain function and guide future non-invasive stimulation protocols.Keywords:
Stimulus (psychology)
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We reviewed the literature on transcranial magnetic stimulation and its uses and efficacy in schizophrenia. Multiple sources were examined on transcranial magnetic stimulation efficacy in relieving positive and negative symptoms of schizophrenia. Literature review was conducted via Ovid Medline and PubMed databases. We found multiple published studies and metaanalyses that give evidence that repetitive transcranial magnetic stimulation can have benefit in relieving positive and negative symptoms of schizophrenia, particularly auditory hallucinations. These findings should encourage the psychiatric community to expand research into other applications for which transcranial magnetic stimulation may be used to treat patients with psychiatric disability.
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Transcranial magnetic stimulation (TMS) is a new tool for the study of the human brain and for neurological therapeutics. Magnetic coil design is very important in the TMS technique. Precise spatial localization of stimulation sites is the key of efficient functional magnetic stimulations. This paper develops circular coils, figure-of-8 coils and coil array elements in order to realize a transcranial magnetic stimulator, and analyses the coil properties. The results show that different coils have different focus.
Biomagnetism
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본 연구는 신경정신과, 신경재활 및 인지기능 회복에 적용되는 반복 경두개 자기 자극(repetitive transcranial magnetic stimulation, rTMS)의 특성과 효과를 알아보고자 하였다. 신경정신과에서 적용되는 rTMS는 우울증의 종류, 연령, 정도 등에서 다양한 결과를 보고하고 있으나 근거가 미약하여 차후 객관적 근거를 위한 연구가 필요하다. 신경재활에서는 뇌 손상의 위치, 크기, 나이, 성별등 환자의 개별적 특성에 따른 rTMS의 다양한 결과가 보고되었다. 특히 뇌졸중 환자의 상지기능, 인지기능 및 파킨슨병 환자의 운동기능 회복의 치료법으로 제시되어 차후 자기자극의 크기, 강도 및 빈도 등의 객관적 근거가 요구된다. 비침습적이고 안전한 rTMS는 선행연구를 통해 뇌 손상 환자의 감각, 운동, 정서, 인지 기능 및 신경 가역성에 긍정적인 영향을 줄 수 있다고 판단되며 약물, 정신치료 및 재활의 다른 치료법과 연계된 치료법으로써 활용될 수 있을 것으로 기대된다.
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Brain stimulation
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反復経頭蓋磁気刺激（repetitive transcranial magnetic stimulation，以下rTMS）は大きな変動磁場を頭皮上から引き起こすことで生じる渦電流が大脳皮質を刺激することを利用し，大脳皮質興奮性を変化させる特徴を有する．このrTMSの性質を利用し脳卒中，パーキンソン病，慢性疼痛などの中枢性疾患に対する治療報告が相次いでいる．リハビリテーション（以下，リハ）分野においては運動訓練だけでなく，強制使用，ボトックス治療，神経筋刺激を組み合わせることで脳卒中後運動麻痺を改善させる報告を認め，さらには言語訓練との併用が失語症に試みられつつある．大脳皮質興奮性を変化させることが可能なrTMSをリハ手法に併用することで，適切な可塑性を誘導し機能改善を引き出すことが期待されている．
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