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Background Transcranial magnetic stimulation (TMS) allows non-invasive stimulation of the cortex. In multi-locus TMS (mTMS), the stimulating electric field (E-field) is controlled electronically without coil movement by adjusting currents in the coils of a transducer. Objective To develop an mTMS system that allows adjusting the location and orientation of the E-field maximum within a cortical region. Methods We designed and manufactured a planar 5-coil mTMS transducer to allow controlling the maximum of the induced E-field within a cortical region approximately 30 mm in diameter. We developed electronics with a design consisting of independently controlled H-bridge circuits to drive up to six TMS coils. To control the hardware, we programmed software that runs on a field-programmable gate array and a computer. To induce the desired E-field in the cortex, we developed an optimization method to calculate the currents needed in the coils. We characterized the mTMS system and conducted a proof-of-concept motor-mapping experiment on a healthy volunteer. In the motor mapping, we kept the transducer placement fixed while electronically shifting the E-field maximum on the precentral gyrus and measuring electromyography from the contralateral hand. Results The transducer consists of an oval coil, two figure-of-eight coils, and two four-leaf-clover coils stacked on top of each other. The technical characterization indicated that the mTMS system performs as designed. The measured motor evoked potential amplitudes varied consistently as a function of the location of the E-field maximum. Conclusion The developed mTMS system enables electronically targeted brain stimulation within a cortical region.

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A estimulação magnética transcraniana é um método não invasivo de estimulação do córtex humano. Conhecida pela sigla TMS, do inglês transcranial magnetic stimulation, a técnica foi introduzida por Barker et al. em 1985. Seu funcionamento baseia-se na Lei de Faraday, na qual um intenso campo magnético que varia rapidamente é capaz de induzir um campo elétrico na superfície do cérebro, despolarizando os neurônios no córtex cerebral. Devido à sua versatilidade, a TMS é utilizada atualmente tanto no âmbito da pesquisa quanto em aplicações clínicas. Entre as aplicações clínicas, a TMS é utilizada como ferramenta diagnóstica e também como técnica terapêutica de algumas doenças neurodegenerativas e distúrbios psiquiátricos como a depressão, a doença de Parkinson e o tinnitus. Quanto à ferramenta diagnóstica, destaca-se o mapeamento motor, uma técnica de delimitação da área de representação do músculo-alvo em sua superfície cortical, cuja aplicabilidade pode ser em estudos da fisiologia cerebral para avaliar danos ao córtex motor e trato corticoespinhal. Esta revisão teve como objetivo introduzir a física, os elementos básicos, os princípios biológicos e as principais aplicações da TMS.

BackgroundTraining in medical education depends on the availability of standardized materials that can reliably mimic the human anatomy and physiology. One alternative to using cadavers or animal bodies is to employ phantoms or mimicking devices. Styrene-ethylene/butylene-styrene (SEBS) gels are biologically inert and present tunable properties, including mechanical properties that resemble the soft tissue. Therefore, SEBS is an alternative to develop a patient-specific phantom, that provides real visual and morphological experience during simulation-based neurosurgical training.ResultsA 3D model was reconstructed and printed based on patient-specific magnetic resonance images. The fused deposition of polyactic acid (PLA) filament and selective laser sintering of polyamid were used for 3D printing. Silicone and SEBS materials were employed to mimic soft tissues. A neuronavigation protocol was performed on the 3D-printed models scaled to three different sizes, 100%, 50%, and 25% of the original dimensions. A neurosurgery team (17 individuals) evaluated the phantom realism as “very good” and “perfect” in 49% and 31% of the cases, respectively, and rated phantom utility as “very good” and “perfect” in 61% and 32% of the cases, respectively. Models in original size (100%) and scaled to 50% provided a quantitative and realistic visual analysis of the patient’s cortical anatomy without distortion. However, reduction to one quarter of the original size (25%) hindered visualization of surface details and identification of anatomical landmarks.ConclusionsA patient-specific phantom was developed with anatomically and spatially accurate shapes, that can be used as an alternative for surgical planning. Printed models scaled to sizes that avoided quality loss might save time and reduce medical training costs.

Background: Transcranial magnetic stimulation (TMS) is widely used in brain research and treatment of various brain dysfunctions. However, the optimal way to target stimulation and administer TMS therapies, for example, where and in which electric-field direction the stimuli should be given, is yet to be determined. Objective: To develop an automated closed-loop system for adjusting TMS parameters online based on TMS-evoked brain activity measured with electroencephalography (EEG). Methods: We developed an automated closed-loop TMS–EEG set-up. In this set-up, the stimulus parameters are electronically adjusted with multi-locus TMS. As a proof of concept, we developed an algorithm that automatically optimizes the stimulation parameters based on single-trial EEG responses. We applied the algorithm to determine the electric-field orientation that maximizes the amplitude of the TMS–EEG responses. The validation of the algorithm was performed with six healthy volunteers, repeating the search twenty times for each subject. Results: The validation demonstrated that the closed-loop control worked as desired despite the large variation in the single-trial EEG responses. We were often able to get close to the orientation that maximizes the EEG amplitude with only a few tens of pulses. Conclusion: Optimizing stimulation with EEG feedback in a closed-loop manner is feasible and enables effective coupling to brain activity.

Background: The electric field orientation is a crucial parameter for optimizing the excitation of neuronal tissue in transcranial magnetic stimulation (TMS). Yet, the effects of stimulus orientation on the short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) paradigms are poorly known, mainly due to significant technical challenges in manipulating the TMS-induced stimulus orientation within milliseconds. Objective: Our aim is to assess the effect of the TMS-induced stimulus orientation on the SICI and ICF paradigms and search for the optimal orientations to maximize the facilitation and suppression of the motor evoked potentials (MEP). Methods: We applied paired-pulse multi-channel TMS in healthy subjects to generate SICI and ICF with conditioning and test pulses in the same, opposite, and perpendicular orientations to each other. The conditioning- and test-stimulus intensities were 80% and 110% of the resting motor threshold, respectively. Results: Both SICI and ICF were significantly affected by the conditioning- and test-stimulus orientation. MEP suppression and facilitation were strongest with both pulses delivered in the same direction. SICI with a 2.5-ms and ICF with a 6.0-ms interstimulus interval (ISI) were more sensitive to changes in stimulus orientation compared with SICI at 0.5- and ICF at 8.0-ms ISIs, respectively. Conclusion: Our findings provide evidence that SICI and ICF at specific ISIs are mediated by distinct mechanisms. Such mechanisms exhibit a preferential orientation depending on the anatomical and morphological arrangement of inhibitory and excitatory neuronal populations. We also demonstrate that the SICI and ICF can be maximized by adjusting the TMS-induced electric field orientation.