这项研究是由来自韩国医疗技术的R＆D项目，卫生部和福利，韩国的赠款（A101901）的支持。我们感谢吉扬李医生在整个过程提供技术援助。

伦理学声明:本研究​​通过盲医院的机构审查委员会。 1.准备材料（表1） <ol><li>使用TMS设备具有3.0特斯拉的最大输出和在350微秒的脉冲宽度200-240伏交流50/60赫兹5A的电源。 </li><li>获得在由肌电图（EMG），每个受试者休息运动阈值（RMT）使用TMS系统和有源电极（参见步骤3.1细节）来确定运动诱发电位（MEP）。设置RMT作为实际TMS研究方案（ 图1）单独强度。 注:neuronavigational系统包括一个电脑屏幕，主观跟踪器，跟踪器线圈，指针校准模块，摄像头，TMS椅子座椅系统。 （ 图2 - 4） </li><li>使用Superlab程序来设置图片命名任务，并提出了刺激的科目，以测试诱导VIRTU程度人失语。 </li><li>记录反应时间用于使用语音录音系统，更详细地，在步骤4中描述的每个图片。 </li><li>分析由语音分析系统，更详细地，在步骤4中描述的图像命名响应的等待时间和持续时间。 </li></ol> 2.检查研究设计<ol><li>使用经颅磁刺激诱导到虚拟失语。 <ol><li>向受试者执行图片命名任务，更详细地，在步骤4图片命名任务说明。 </li><li>在图片命名任务中应用神经导航或者引导颅磁刺激（非关税措施）或传统的经颅磁刺激（CTMS）。 CTMS的细节在步骤5.3.2和5.5中描述。 </li></ol></li><li>测量反应时间和差错率为图片命名，结果这两个条件下，比较结果为在步骤4中更详细地描述。 </li></ol> 3. TMS协议的制备<ol><li>确定RMT <ol><li>放置活性电极上的左第一背terosseous（FDI）的肌肉。 </li><li>递送连续10刺激向右M1区域在一个4-6秒的刺激间隔，检查左侧FDI肌肉的收缩。 </li><li>利用在其中一个峰 - 峰值的MEP振幅大于50紫外更大产生至少五倍的最小TMS强度确定受验者的RMT。 </li></ol></li><li> TMS映射<ol><li>使用用于使用neuronavigational系统的对象的3-T MR扫描仪获得高分辨率T1加权磁共振（MR）解剖图像。对于MRI扫描的参数概括于表1中 。 注意:转移大脑MR图像的神经导航程序，该重建使用前连合（AC）和后连合（PC）的解剖指导每个人的大脑曲线和皮肤， 如图5。 <ol><li>重建皮肤结构<ol><li>获取对象的脑部MR的文件图像中的标准数字成像和通信医学（DICOM）。格式。通过选择"转换研究"转换的MR图像。设置从哪个文件传送到神经导航计算机的搜索目录。转换类型应该由DICOM类型来选择在神经导航程序中使用。 </li><li>的DICOM文件传输到在其中安装所述神经导航程序的计算机。实施导航程序。默认图标是"解剖"。对于新的病人记录，选择DICOM图像文件之一。 </li><li>点击"阿特拉斯空间"。这一步是设置参考点来重构各个图像。按下Dropbox的"新"，并通过单击设置参考解剖结构"手册（AC-PC盒）"。 </li><li>找到胼胝体的患者的交流，安置在穹窿的列的前两个半球的只是中线。马克AC在MR图像上，点击"设置AC"。 </li><li>发现患者的个人计算机，中脑导水管的上端的背侧两个半球的中线。马克PC的MR图像上，点击"设置PC"。 </li><li>点击"重建"，使皮肤结构。按"新"，在保管箱，选择"皮肤"。设置在MR图像重建的范围内。一定要包括与鼻尖和两个耳朵，整个头骨。 </li><li>在新的结构中，点击"计算皮"。等到该过程完成。皮肤施工完成后，应显示皮肤的形态。 </li></ol></li><li> "重构"一节中，选择"满脑曲线"重建大脑曲线以下3.2.1.1。类似于前面的步骤中，设置的范围为在含有鼻尖的MR图像重建。点击"计算曲线"。施工完毕后，应显示满脑的曲线。 </li></ol></li><li>马克鼻根，鼻尖，都耳屏注册解剖标志。这一步是匹配患者和用于对大脑皮质的靶的相对位置的结构的重建的皮肤结构（ 图6）之间的解剖点。 <ol><li>点击"地标"图标。要配置具有里程碑意义，标志着对计算皮肤结构鼻根（点额头鼻子之间，在鼻骨交界处）。通过点击"新"注册它并将其存储为"里程碑1" </li><li>标记鼻尖注册鼻根作为里程碑式1通过点击"新"注册鼻尖，并将其存储为"标2"之后</li><li>马克对皮肤结构中的每个耳屏。耳屏是外耳的小尖隆起，位于外耳的前面。标记，然后点击"新"地标注册后每耳屏。对于这个协议，右侧耳屏是章istered为"标3"和左侧被登记为"标4"。 </li></ol></li><li>把头带与参与者的头部主观跟踪。在每个学科每个会话校准与导航座椅系统的校准块线圈跟踪器。确保导航相机侦测并显示所有的主题，椅子，线圈，并在继续之前在电脑屏幕上的指针的跟踪系统。 <ol><li>校准用座椅系统的线圈。 <ol><li>每个非关税措施刺激前校准线圈跟踪器。在主计算机菜单，选择"窗口"。点击"TMS线圈校准"，在保管箱。点击"新校准"。在第二届会议上，选择线圈的名字第一次使用，并单击"重新校准"。 </li><li>广场上的校准块的标准点后的TMS线圈。确保线圈水平放置。检查摄像头检测两个校准模块和线圈跟踪器（显示为绿色）。然后，单击"开始倒计时校准"，和一个5秒倒计时开始。在倒计时过程中按住线圈依然。 </li></ol></li></ol></li></ol></li></ol> 4.图片命名任务<ol><li>将图片命名程序会自动移动到下一个画面之前提出每个刺激3000毫秒。 </li><li>请参与者尽可能准确和尽快命名呈现的画面。 </li><li>通过检测由通过耳机麦克风使用免费语音分析程序的主体发出的声音测量反应时间为每个图象（在屏幕上的刺激弹出到由参与者提出的第一声音延迟）。 <ol><li>从波士顿命名测试（K-BNT）韩版的图片数据库名的长度和两段匹配到3点40照片显示在屏幕上前后的刺激，如在研究由Kim 等人 ，（2014）。 </li></ol></li></ol> 5. TMS映射协议<ol><li> Deliver1赫兹刺激在10分钟的的RMT的90％的强度，以总共600的TMS脉冲。 </li><li>持8字形线圈沿切线与垂直定向到目标线圈颅骨。 </li><li> TMS映射（ 图7） <ol><li>确定基于归一化的脑的表面上的解剖额下回（IFG），为NTMS。 <ol><li>注册IFG作为非关税措施的目标。 <ol><li>点击"目标"，然后按"配置指标"。标记显示脑曲线的窗口上的IFG。详细的目标设定是针对每个横向和矢状MR图像实现的。保存点的"轨迹"。 </li></ol></li><li>注册与受试者头皮标志性建筑。 <ol><li>点击"会话"的映射。创建通过在新的Dropbox选择"联机会议"一个新的会话。创建一个"会话1"窗口，在其中默认的图标是"目标"。选择保存在步骤3.2.2.2目标名称。 （选择"轨迹1"）。点击"添加"按钮，并移动到下一个步骤。 </li><li>点击"注册"。这个步骤是，以配合该主题的重构脑曲线。注册的具有里程碑意义的步骤3.2.2.1。用于匹配与实际解剖结构的解剖点。 </li><li>确保相机识别指针和主题跟踪，在绿色显示两者。指向对象的用指针鼻根。点击"样品％跳转到下一个里程碑"。指向对象的鼻尖和品尝它。重复，直到所有四个标志性建筑相匹配。 </li></ol></li></ol></li><li>广场上的CTMS 10-20国际脑电系统7 F3线圈。 </li></ol></li><li>看屏幕，以确保线圈上所需的目标，并保持整个NTMS过程。作为线圈从由靶心（ 图8）所示的目标移开屏幕上应显示被检者的脑表面，预定的目标，和线圈，以及误差范围。参照画面，因为它被移开的操作者调节目标上的线圈。 <ol><li>在注册目标进行非关税措施<ol><li>点击按步骤5.3.1.1所述注册主体的地标后，屏幕上的"执行"。要改变摄像头检测到指针的默认设置中，选择一步3.2.3.1中保存的线圈名称。在"驱动程序"下拉框的底部。确保相机标识都受到跟踪和跟踪线圈。 </li><li>检查屏幕显示从注册的目标（IFG）的TMS线圈的相对距离和角度。如果线圈从目标移开，该距离被标记为红色，而它被标记为绿色，当线圈是预期的目标范围内。尝试获得线圈和目标为靶心之间的角度尽可能地。 </li></ol></li></ol></li><li>从操作员打开屏幕的距离以便获得CTMS程序盲目交付TMS。线圈保持，因为它是在会议的开始。 </li></ol> 6. Topograhic数据采集<ol><li>通过手动按下遥控器上的"录制"按钮，每刺激记录线圈位置。 </li><li>在记录每个刺激，获取Taliarach在X，Y，Z为指定的目标和实际的刺激区域坐标。 </li><li>说明使用免费的图像处理程序（MRIcro，http://www.mccauslandcenter.sc.edu/mricro/mricro/index.html）在一个标准化的大脑中的坐标。 </li><li>获得相应的解剖脑区，包括布罗德曼区的Gyrus，耳垂，半球区域标签的坐标塔莱拉什使用免费软件标签计划（Talairachclient，http://www.talairach.org/client.html）。 </li></ol>

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All authors declare no conflict of interest.

TMS无论是在临床实践和基础研究被广泛使用。10有价值的治疗作用是由磁刺激的生理影响，包括皮质兴奋与低频磁刺激治疗失语症的抑制神经调节作用所提供。神经处理或虚拟的11瞬态中断通过磁刺激诱 ​​导损毁可以改变行为表现。12然而，磁刺激的期望的效果，可以稀释或甚至不具有错位的目标上的线圈发生。误瞄准原本预定目标和实际的刺激皮层区域之间可以发生?...

重复经颅磁刺激（磁刺激）非侵入激活神经元回路中的中枢和外周神经系统。1磁刺激调制大脑兴奋2，并在几个精神病和神经性疾病的潜在治疗作用，如电机的弱点，失语，忽视，和疼痛3比运动皮层使用国际10-20脑电系统通常被确定的其他颅磁刺激，或通过测量特定外部的地标距离目标点。 然而，在尺寸，解剖学，和大脑皮质的形态学的个体间的差异不考虑，使得最佳目标定位有挑战性。3为磁刺激应用的另一个关键问题是在磁性线圈的位置和皮质区之间的偏差预期刺激。 光学跟踪导航神经外科有EXP相与它的应用程序涵盖包括rTMS治疗的电磁线圈的指导认知神经科学领域。该neuronavigational系统协助查明rTMS治疗的最佳目标结构。在对目标区域定位线圈4,5这样的分歧经常与采用脑电图10-20系统的传统方法时，这有望在神经导航克服。 这项研究办法表明诱导由neuronavigational的rTMS针对布罗卡区，采用个别解剖标测健康受试者虚拟失语的方法。虚拟失语在反应时间到图像命名变化方面的程度进行测量，并与从常规的刺激方法相比。神经导航引导方法具有用于递送磁脉冲到脑更高的精度，并且因此预计证明比传统方法更大的临床变化。此螺栓的目标y为引入刺激的更精确和有效的方法，患者的临床设置失语。

<table><tbody><tr><td>Medtronic MagPro X100</td><td>MagVenture</td><td>9016E0711</td><td></td></tr><tr><td>MCF-B65 Butterfly coil</td><td>MagVenture</td><td>9016E042</td><td></td></tr><tr><td>Brainsight TMS Navigation</td><td>Rogue Research</td><td>&lt;br/&gt; KITBSF1003&amp;nbsp;</td><td></td></tr></tbody></table>

neuronavigation-guided repetitive transcranial magnetic stimulation for aphasia

重复经颅磁刺激（磁刺激）被广泛用于多种神经系统疾病，因为它已经获得了确认其潜在的治疗效果。大脑兴奋是经颅磁刺激非侵入性调制，经颅磁刺激的语言领域已经证明了它的治疗失语的潜在影响。在我们的协议中，我们的目标是通过使用neuronavigational TMS（NTMS），以及国际10-20脑电图系统为常规的TMS（CTMS）的F3抑制布洛德曼区域44和45人工诱导健康受试者虚拟失语。为了测量失语的程度，在反应时间到画面命名任务前和刺激后的变化进行测量，并比较在NTMS和CTMS之间的反应时间的延迟。两个TMS刺激方法准确性通过平均目标和实际刺激塔莱拉什坐标进行比较。刺激的一致性是通过从目标的误差范围内表现出来。这STU的目的DY是展示使用NTMS的，并描述相比，这些CTMS的NTMS的优点和局限性。

Kim等人证实TMS的相比于非导航的传统方法neuronavigational系统引导的更优异的效果通过刺激多焦刺激向右M1区域8的更少分散， 如图9，进一步的证据支持掺入用TMS的neuronavigational系统由随机交叉实验表明通过靶向布洛德曼区域44和45对NTMS和国际10-20脑电图系统CTMS的F3诱导健康受试者虚拟失语症9 K...

Watch this Scientific Journal Video about Neuronavigation-guided Repetitive Transcranial Magnetic Stimulation for Aphasia at JoVE.com

Neuronavigation-guided Repetitive Transcranial Magnetic Stimulation for Aphasia

This study is designed to test the hypothesis that neuronavigational system-guided transcranial magnetic stimulation has higher accuracy for targeting the intended target as demonstrated by eliciting a greater degree of virtual aphasia in healthy subjects, measured by delay in reaction time to picture naming.

神经导航引导下重复经颅磁刺激的失语

Repetitive transcranial magnetic stimulation (rTMS) is widely used for several neurological conditions, as it has gained acknowledgement for its potential ...

neuronavigation-guided-repetitive-transcranial-magnetic-stimulation

Universidad de Cartagena UDEC

Research

JoVE Journal

Behavior

12.0K 次观看.  Inje University of Medicine, Haeundae Paik Hospital. This study is designed to test the hypothesis that neuronavigational system-guided transcranial magnetic stimulation has higher accuracy for targeting the intended target as demonstrated by eliciting a greater degree of virtual aphasia in healthy subjects, measured by delay in reaction time to picture naming.

视频: Neuronavigation-guided Repetitive Transcranial Magnetic Stimulation for Aphasia

Functional Magnetic Resonance Imaging (fMRI) with Auditory Stimulation in Songbirds

The neurobiology of birdsong, as a model for human speech, is a pronounced area of research in behavioral neuroscience. Whereas electrophysiology and molecular approaches allow the investigation of either different stimuli on few neurons, or one stimulus in large parts of the brain, blood oxygenation level dependent (BOLD) functional Magnetic Resonance Imaging (fMRI) allows combining both advantages, i.e. compare the neural activation induced by different stimuli in the entire brain at once. fMRI in songbirds is challenging because of the small size of their brains and because their bones and especially their skull comprise numerous air cavities, inducing important susceptibility artifacts. Gradient-echo (GE) BOLD fMRI has been successfully applied to songbirds 1-5 (for a review, see 6). These studies focused on the primary and secondary auditory brain areas, which are regions free of susceptibility artifacts. However, because processes of interest may occur beyond these regions, whole brain BOLD fMRI is required using an MRI sequence less susceptible to these artifacts. This can be achieved by using spin-echo (SE) BOLD fMRI 7,8 . In this article, we describe how to use this technique in zebra finches (Taeniopygia guttata), which are small songbirds with a bodyweight of 15-25 g extensively studied in behavioral neurosciences of birdsong. The main topic of fMRI studies on songbirds is song perception and song learning. The auditory nature of the stimuli combined with the weak BOLD sensitivity of SE (compared to GE) based fMRI sequences makes the implementation of this technique very challenging.

Functional Magnetic Resonance Imaging fMRI with Auditory Stimulation in Songbirds

This article shows an optimized procedure for imaging of the neural substrates of auditory stimulation in the songbird brain using functional Magnetic Resonance Imaging (fMRI). It describes the preparation of the sound stimuli, the positioning of the subject and the acquisition and subsequent analysis of the fMRI data.

功能磁共振成像（fMRI）技术与听觉刺激鸣禽

The neurobiology of birdsong, as a model for human speech, is a pronounced area of research in behavioral neuroscience. Whereas electrophysiology and ...

科研

行为学

Best Current Practice for Obtaining High Quality EEG Data During Simultaneous fMRI

Simultaneous EEG-fMRI allows the excellent temporal resolution of EEG to be combined with the high spatial accuracy of fMRI. The data from these two modalities can be combined in a number of ways, but all rely on the acquisition of high quality EEG and fMRI data. EEG data acquired during simultaneous fMRI are affected by several artifacts, including the gradient artefact (due to the changing magnetic field gradients required for fMRI), the pulse artefact (linked to the cardiac cycle) and movement artifacts (resulting from movements in the strong magnetic field of the scanner, and muscle activity). Post-processing methods for successfully correcting the gradient and pulse artifacts require a number of criteria to be satisfied during data acquisition. Minimizing head motion during EEG-fMRI is also imperative for limiting the generation of artifacts.
Interactions between the radio frequency (RF) pulses required for MRI and the EEG hardware may occur and can cause heating. This is only a significant risk if safety guidelines are not satisfied. Hardware design and set-up, as well as careful selection of which MR sequences are run with the EEG hardware present must therefore be considered.
The above issues highlight the importance of the choice of the experimental protocol employed when performing a simultaneous EEG-fMRI experiment. Based on previous research we describe an optimal experimental set-up. This provides high quality EEG data during simultaneous fMRI when using commercial EEG and fMRI systems, with safety risks to the subject minimized. We demonstrate this set-up in an EEG-fMRI experiment using a simple visual stimulus. However, much more complex stimuli can be used. Here we show the EEG-fMRI set-up using a Brain Products GmbH (Gilching, Germany) MRplus, 32 channel EEG system in conjunction with a Philips Achieva (Best, Netherlands) 3T MR scanner, although many of the techniques are transferable to other systems.

Simultaneous electroencephalography (EEG) and functional Magnetic Resonance imaging (fMRI) is a powerful neuroimaging tool. However, the inside of an MRI scanner forms a difficult environment for EEG data recording and safety must be considered whenever operating EEG equipment inside a scanner. Here, we present an optimised EEG-fMRI data acquisition protocol.

获得高质量的脑电数据在同步功能磁共振成像的当前最佳实践

Simultaneous  EEG-fMRI allows the excellent temporal resolution of EEG to be combined with the  high spatial accuracy of fMRI. The data  from these two ...

Stimulating the Lip Motor Cortex with Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) has proven to be a useful tool in investigating the role of the articulatory motor cortex in speech perception. Researchers have used single-pulse and repetitive TMS to stimulate the lip representation in the motor cortex. The excitability of the lip motor representation can be investigated by applying single TMS pulses over this cortical area and recording TMS-induced motor evoked potentials (MEPs) via electrodes attached to the lip muscles (electromyography; EMG). Larger MEPs reflect increased cortical excitability. Studies have shown that excitability increases during listening to speech as well as during&#160;viewing speech-related movements. TMS can be used also to disrupt the lip motor representation. A 15-min train of low-frequency sub-threshold repetitive stimulation has been shown to suppress motor excitability for a further 15-20 min. This TMS-induced disruption of the motor lip representation impairs subsequent performance in demanding speech perception tasks and modulates auditory-cortex responses to speech sounds. These findings are consistent with the suggestion that the motor cortex contributes to speech perception. This article describes how to localize the lip representation in the motor cortex and how to define the appropriate stimulation intensity for carrying out both single-pulse and repetitive TMS experiments.

Transcranial magnetic stimulation (TMS) has proven to be a useful tool in investigating the role of the articulatory motor cortex in speech perception.&#160; This article describes how to record motor evoked potentials (MEPs) from the lip muscles and how to disrupt the motor lip representation using repetitive TMS.

刺激唇部运动皮层与经颅磁刺激

Transcranial magnetic stimulation (TMS) has proven to be a useful tool in investigating the role of the articulatory motor cortex in speech perception. ...

Repetitive Transcranial Magnetic Stimulation to the Unilateral Hemisphere of Rat Brain

Previous rodent models of repetitive transcranial magnetic stimulation (rTMS) adopted whole-brain stimulation instead of unilateral hemispheric rTMS, which is unlike the protocols used for human subjects. We report a successful application of rTMS to the unilateral hemisphere of rat brain. The rTMS was delivered with a low-frequency (1 Hz), high-frequency (20 Hz), or sham stimulation protocol to one side of the brain by using a small 25-mm figure-8 coil. We placed the center of the coil 1 cm lateral to the vertex on the biauricular line and angulated the coil 45&#176; to the ground to minimize a potential direct effect of rTMS on the contralateral cortex. We also used an in-house water cooling system to enable repetitive magnetic stimulation for more than 20 min, even at a 20-Hz stimulation frequency. Increases in the transcriptions of immediate early genes (Arc, Junb, and Egr2) were greater after rTMS than after sham stimulation. After 5 consecutive days of 20-min 1-Hz rTMS, bdnf mRNA expression was significantly higher in stimulated cortex than in contralateral side. The model presented herein will elucidate the molecular mechanisms of rTMS by allowing analysis of the inter-hemispheric difference in its effect.

We applied repetitive transcranial magnetic stimulation (rTMS) to the unilateral hemisphere of rat brain, by placing a 25-mm figure-8 coil 1 cm lateral to the vertex on the biauricular line and angulating the coil by 45&#176;. An in-house water cooling system was used for rTMS for more than 20 min.

重复经颅磁刺激对大鼠大脑的单边半球

Previous rodent models of repetitive transcranial magnetic stimulation (rTMS) adopted whole-brain stimulation instead of unilateral hemispheric rTMS, ...

Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia

Transcranial magnetic stimulation (TMS) has been shown to significantly improve language function in patients with non-fluent aphasia1. In this experiment, we demonstrate the administration of low-frequency repetitive TMS (rTMS) to an optimal stimulation site in the right hemisphere in patients with chronic non-fluent aphasia. A battery of standardized language measures is administered in order to assess baseline performance. Patients are subsequently randomized to either receive real rTMS or initial sham stimulation. Patients in the real stimulation undergo a site-finding phase, comprised of a series of six rTMS sessions administered over five days; stimulation is delivered to a different site in the right frontal lobe during each of these sessions. Each site-finding session consists of 600 pulses of 1 Hz rTMS, preceded and followed by a picture-naming task. By comparing the degree of transient change in naming ability elicited by stimulation of candidate sites, we are able to locate the area of optimal response for each individual patient. We then administer rTMS to this site during the treatment phase. During treatment, patients undergo a total of ten days of stimulation over the span of two weeks; each session is comprised of 20 min of 1 Hz rTMS delivered at 90% resting motor threshold. Stimulation is paired with an fMRI-naming task on the first and last days of treatment. After the treatment phase is complete, the language battery obtained at baseline is repeated two and six months following stimulation in order to identify rTMS-induced changes in performance. The fMRI-naming task is also repeated two and six months following treatment. Patients who are randomized to the sham arm of the study undergo sham site-finding, sham treatment, fMRI-naming studies, and repeat language testing two months after completing sham treatment. Sham patients then cross over into the real stimulation arm, completing real site-finding, real treatment, fMRI, and two- and six-month post-stimulation language testing.

We explore the use of repetitive transcranial magnetic stimulation (rTMS) to improve language abilities in patients with chronic stroke and non-fluent aphasia. After identifying a site in the right frontal gyrus for each patient that responds optimally to stimulation, we target this site during ten days of rTMS treatment.

利用重复经颅磁刺激改善脑卒中患者的语言功能与慢性非流利性失语

Transcranial magnetic stimulation (TMS) has been shown to significantly improve language function in patients with non-fluent aphasia1. In this ...

医学

Individualized rTMS Treatment for Depression using an fMRI-Based Targeting Method

To achieve greater clinical efficacy, a revolution in treatment for major depressive disorder (MDD) is highly anticipated. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and safe neuromodulation technique that immediately changes brain activity. Despite its wide application in the treatment for MDD, the treatment response remains different among individuals, which may be attributable to the inaccurate positioning of the stimulation target. Our study aims to examine whether the functional magnetic resonance imaging (fMRI)-assisted positioning improves the efficacy of rTMS in treating depression. We intend to identify and stimulate the subregion of dorsolateral prefrontal cortex (DLPFC) in MDD with strongest anti-correlation with the subgenual anterior cingulate cortex (sgACC), and to conduct a comparative investigation of this novel method and the traditional 5-cm rule. To achieve more precise stimulation, both methods were applied under the guidance of neuronavigation system. We expected that the TMS treatment with individualized positioning based on resting state functional connectivity may show better clinical efficacy than the 5-cm method.

The present protocol describes the application of repetitive transcranial magnetic stimulation (rTMS), where a subregion of the dorsolateral prefrontal cortex (DLPFC) with the strongest functional anticorrelation with the subgenual anterior cingulate cortex (sgACC) was located as the stimulation target under the assistance of a fMRI-based neuronavigation system.

使用基于fMRI的靶向方法对抑郁症进行个体化的rTMS治疗

To achieve greater clinical efficacy, a revolution in treatment for major depressive disorder (MDD) is highly anticipated. Repetitive transcranial ...

MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder

Here we outline the protocol for magnetic resonance imaging (MRI) guided repetitive transcranial magnetic stimulation (rTMS) to the dorsal medial prefrontal cortex (dmPFC) in patients with major depressive disorder (MDD). Technicians used a neuronavigation system to process patient MRIs to generate a 3-dimensional head model. The head model was subsequently used to identify patient-specific stimulatory targets. The dmPFC was stimulated daily for 20 sessions. Stimulation intensity was titrated to address scalp pain associated with rTMS. Weekly assessments were conducted on the patients using the Hamilton Rating Scale for Depression (HamD17) and Beck Depression Index II (BDI-II). Treatment-resistant MDD patients achieved significant improvements on both HAMD and BDI-II. Of note, angled, double-cone coil rTMS at 120% resting motor threshold allows for optimal stimulation of deeper midline prefrontal regions, which results in a possible therapeutic application for MDD. One major limitation of the rTMS field is the heterogeneity of treatment parameters across studies, including duty cycle, number of pulses per session and intensity. Further work should be done to clarify the effect of stimulation parameters on outcome. Future dmPFC-rTMS work should include sham-controlled studies to confirm its clinical efficacy in MDD.

Here we outline the procedure for MRI-guided repetitive transcranial magnetic stimulation to the dorsomedial prefrontal cortex as an experimental treatment for major depressive disorder.

MRI引导dmPFC-rTMS治疗作为治疗难治性抑郁症

Here we outline the protocol for magnetic resonance imaging (MRI) guided repetitive transcranial magnetic stimulation (rTMS) to the dorsal medial ...

Combined Transcranial Magnetic Stimulation and Electroencephalography of the Dorsolateral Prefrontal Cortex

Transcranial magnetic stimulation (TMS) is a non-invasive method that produces neural excitation in the cortex by means of brief, time-varying magnetic field pulses. The initiation of cortical activation or its modulation depends on the background activation of the neurons of the cortical region activated, the characteristics of the coil, its position and its orientation with respect to the head. TMS combined with simultaneous electrocephalography (EEG) and neuronavigation (nTMS-EEG) allows for the assessment of cortico-cortical excitability and connectivity in almost all cortical areas in a reproducible manner. This advance makes nTMS-EEG a powerful tool that can accurately assess brain dynamics and neurophysiology in test-retest paradigms that are required for clinical trials. Limitations of this method include artifacts that cover the initial brain reactivity to stimulation. Thus, the process of removing artifacts may also extract valuable information. Moreover, the optimal parameters for dorsolateral prefrontal (DLPFC) stimulation are not fully known and current protocols utilize variations from the motor cortex (M1) stimulation paradigms. However, evolving nTMS-EEG designs hope to address these issues. The protocol presented here introduces some standard practices for assessing neurophysiological functioning from stimulation to the DLPFC that can be applied in patients with treatment resistant psychiatric disorders that receive treatment such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST) or electroconvulsive therapy (ECT).

The protocol presented here is for TMS-EEG studies utilizing intracortical excitability test-retest design paradigms. The intent of the protocol is to produce reliable and reproducible cortical excitability measures for assessing neurophysiological functioning related to therapeutic interventions in the treatment of neuropsychiatric diseases such as major depression.

侧前额叶皮质联合经颅磁刺激与脑电图的研究

Transcranial magnetic stimulation (TMS) is a non-invasive method that produces neural excitation in the cortex by means of brief, time-varying magnetic ...

神经科学

Study Design for Navigated Repetitive Transcranial Magnetic Stimulation for Speech Cortical Mapping

The cortical areas involved in human speech should be characterized reliably prior to surgery for brain tumors or drug-resistant epilepsy. The functional mapping of language areas for surgical decision-making is usually done invasively by electrical direct cortical stimulation (DCS), which is used to identify the organization of the crucial cortical and subcortical structures within each patient. Accurate preoperative non-invasive mapping aids surgical planning, reduces time, costs, and risks in the operating room, and provides an alternative for patients not suitable for awake craniotomy. Non-invasive imaging methods like MRI, fMRI, MEG, and PET are currently applied in presurgical design and planning. Although anatomical and functional imaging can identify the brain regions involved in speech, they cannot determine whether these regions are critical for speech. Transcranial magnetic stimulation (TMS) non-invasively excites the cortical neuronal populations by means of electric field induction in the brain. When applied in its repetitive mode (rTMS) to stimulate a speech-related cortical site, it can produce speech-related errors analogous to those induced by intraoperative DCS. rTMS combined with neuronavigation (nrTMS) enables neurosurgeons to preoperatively assess where these errors occur and to plan the DCS and the operation to preserve the language function. A detailed protocol is provided here for non-invasive speech cortical mapping (SCM) using nrTMS. The proposed protocol can be modified to best fit the patient- and site-specific demands. It can also be applied to language cortical network studies in healthy subjects or in patients with diseases that are not amenable to surgery.

Navigated repetitive transcranial magnetic stimulation is a highly efficient non-invasive tool for mapping speech-related cortical areas. It helps in designing brain surgery and speeds up the direct cortical stimulation conducted during the surgery. This report describes how to perform speech cortical mapping reliably for preoperative evaluation and research.

用于语音皮质映射的导航重复经颅磁刺激的研究设计

The cortical areas involved in human speech should be characterized reliably prior to surgery for brain tumors or drug-resistant epilepsy. The functional ...

痉挛性脑瘫儿童联合干预训练 

Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy

This study presents the results of a randomized controlled trial utilizing a 2 x 2 factorial design, comparing the effects of repeated transcranial magnetic stimulation (rTMS) and action observation training (AOT) intervention methods on spasticity, balance function, and motor function in children with spastic cerebral palsy (SCP). The study aimed to investigate whether the combination of the two interventions produces greater improvement than either treatment alone or conventional treatment.
Subject children in this study, in accordance with the random number table, were randomly divided into four groups: conventional group, rTMS group, AOT group, and combined intervention group. All the children in the four groups received conventional rehabilitation treatment, on the basis of which they were given different therapeutic programs of rehabilitation measures. The conventional group had no other treatment while the rTMS group received rTMS, the AOT group received AOT and the combined intervention group was given a combined intervention of rTMS and AOT. They were trained five days per week for 12 weeks. Changes in scores of spasticity, balance function, walking ability, and gross motor function were assessed at the onset of the training program and upon completion of 12 weeks of treatment.
A total of 64 Children with SCP completed the study, and their results were analyzed. The total gross motor function efficiency of 87.50% in the experimental group was significantly higher than that of 25.00% in the conventional group, 62.50% in the rTMS group, and 68.75% in the AOT group. The preliminary results showed that combined intervention of rTMS and AOT could effectively improve the balance function and motor function of children, and the therapeutic effect of the combined intervention was better than that of conventional treatment, rTMS or AOT alone. Finally, clinical efficacy and optimal treatment parameters of the combined intervention were clarified to provide a clinical basis for therapists to conduct lower limb function rehabilitation for children with SCP.

作者聚焦： 重复经颅磁刺激结合脑瘫的运动观察

Children with spastic cerebral palsy (SCP) have limb spasticity, movement disorders, and abnormal posture due to injury to the cerebral cortex motor area, resulting in inability to stand and walk normally. Therefore, alleviating limb spasticity and enhancing gross motor function in children with SCP have become important therapeutic goals.

反复经颅磁刺激联合动作观察训练治疗儿童痉挛性脑瘫

This study presents the results of a randomized controlled trial utilizing a 2 x 2 factorial design, comparing the effects of repeated transcranial ...