The authors have no acknowledgments to disclose.

这里介绍的协议符合我们机构的人类研究伦理委员会的指导方针。 注意:谁是管理处理应始终戴上耳塞操作。 1.初次就诊前的准备工作<ol><li>已经在患者完成TMS安全问卷14，以确保他或她是适合于治疗。 </li><li>查看病人的病历要知道任何相关信息，包括注释到文件中。 </li><li>有病人，在那里他们可以问问他们可能对治疗的所有问题，并在程序准备签署一份知情同意书进行咨询。 </li><li>准备需要的患者的个人帽材料:帽，下巴带，一红一黑卷尺。 </li></ol> 2.准备在到达病人<ol><li>让患者在定位在TMS机的车，E的前面坐在椅子nsuring患者是在为线圈舒适上他们的头部被定位在适当的角度。 </li><li>让患者消除任何眼镜，发夹或针，以及任何耳环。 </li><li>给病人耳塞，并确保他们得到适当和稳定地定位。 </li><li>在TMS机器的臂在相对于车保持激励45°的位置。 </li></ol> 3.个人帽放置<ol><li>盖滑到病人的头部，与前在他们的额头就在眉毛上方。帽的红色缝制中线应沿患者头部的中线。 </li><li>拉帽耳盖用力向下伸展帽围绕他们的头和一只耳朵盖附加下巴带其他。 </li><li>向下紧贴拉帽将其头部和拉伸背部外围背带向上和在其头部的背面，紧固带至盖的背面。 </li><li> ATTACH黑，前 - 后，柔性沿盖的中线尺子，与盖的直接定位在标尺的左侧红色中线。在患者的鼻根，这是他们的鼻骨额头的交界处标尺上的"0"点的位置。 </li><li>定位患者的INION（在头部的后下部分的最突出的突出部），并记录在黑色中线标尺的位置。 </li><li>计算鼻根和INION之间的距离的40％，然后将红色，外侧 - 内侧的，灵活的标尺，以便其25厘米标记线与对黑中线标尺此位置（两个标尺现在是垂直的）。 </li></ol> 4.找到个人的运动阈值（MT） <ol><li>对于整个MT流程，排队在头盔的在盖的中线的横向尺"0"点。 </li><li> 7厘米黑色中线统治者头盔线圈盖的前端位置。调整头盔头盔，所以整个前边缘水平与垂直于帽中线统治者。记录在该头盔线圈盖满足病人的头部左侧，红色，横向内侧统治者的位置。 </li><li>按住Shift键在头盔内侧沿红横向内侧统治者2厘米左侧的线圈盖。确保在头盔的前部的线圈盖仍然符合7厘米黑色中线标尺，并在头盔的"0"的标记保持定位在盖的中线。这将线圈的最大磁输出位置大约超过对侧手控件关联的左上运动皮层区域。 </li><li>打开刺激，然后按"单脉冲（MEP）"，然后将"刺激输出"为50％。按绿色键布防机器。 </li><li>用右手搭在自己的腿上枕头病人的位置，掌心朝上，让指尖的任何移动更EASILY看到。 </li><li>运动皮层的位置: <ol><li>开始在步骤4.3中找到的位置。站到患者的左侧。向下按压头盔用一只手同时支持病人与其他脖子，并通过按下刺激脚踏应用单个脉冲。 </li><li>评价病人的右手不自主手指运动0-5，0是没有检测到运动，而5是一个非常有力的不自主运动（ 表1）。 </li><li>等待五秒钟，然后在相同的位置再次执行此。如果有5个单脉冲之后无运动反应，以5％递增的刺激输出。 </li></ol></li><li>在网格模式几个位置重复步骤4.6，首先发现沿中线最一贯活跃的位置，然后在该中线位置停留时，移动一厘米有沿横向内侧尺一时间再次找到最一致主动位置。人ually文档使用笔和纸这一过程（或平板设备上的数字），发现有最强劲的持续运动反应的位置。 </li><li>最小运动阈值: <ol><li>使用在步骤4.7中找到的位置，然后在步骤4.6中找到的强度，给药最多6个单脉冲和计数引起不自主指马达响应的数目。 </li><li>调整刺激的强度由1-2％向上或向下直到引起马达响应从6个单脉冲的数量不小于2并且不大于3.这强度为激活患者的运动神经元的运动阈值（MT） 。文档运动阈值最小这个过程中发现的。 </li></ol></li></ol> 5.治疗<ol><li>线圈位置通过移动头盔的前边缘提供超过左外侧前额叶皮层（PFC）的最大磁输出中，有针对性的治疗区域，下降了6厘米的中线标尺，或PA的电平tient的眉毛，以较高者为准（ 即不要放置头盔患者的眉毛下方的前面）。 </li><li>在处理位置的线圈定位后，通过在头盔的后部向下拉动上衬垫，拧紧旋钮和调整帘线，和固定在头盔的下巴带固定头盔线圈盖到病人的头部。 </li><li>打开冷却系统上，并等待温度测量仪在开始治疗前阅读低于14℃。 </li><li>按下触摸屏刺激的"单脉冲"按钮，返回到单脉冲模式。 </li><li>设置"刺激输出"到患者的建立的MT，其在步骤4.8确定。设置"MT％"为100％，这是指患者的建立MT的100％。 </li><li>按"重复模式"的刺激触摸屏，输入以下治疗参数:频率18赫兹（每秒18脉冲）; 2.0工期秒;等待20秒的时间; 55列车。脉冲（36）的数量将根据持续时间和频率，和"权力"自动填充会自动填充基于刺激器输出和MT％先前屏幕上输入的值。按"运行会话。" </li><li>按绿色键布防机器。 </li><li>描述给病人他们将体验（ 即 36个脉冲，20秒无刺激间隔隔开2秒火车），并确认他们已经准备好开始治疗。 </li><li>倒计时大声明确地"3-2-1"，在病人面前，让他们准备好了第一列火车用手指。按下面板上的黄色启动按钮来管理在倒计时结束的第一列火车。 </li><li>观察患者的面部及四肢，然后第一个脉冲后，问这是什么感觉。如果患者遇到任何比轻度不适或轻度的面部收缩越多，那么治疗可通过按下停止面板上的红色按钮，并且位置可调节（最大2厘米的任何方向），以消除不适和收缩。 </li><li>通过在相对于患者的MT响应值100％功率施用开始第一处理会议（在步骤4.8中）。在第二疗程，滴定患者高达110％，以及完整的120％，在第三处理会话。如果功率的增加产生显著不适，恢复到以前的电源设置，让病人尝试再次提高功率之前进一步适应在低功耗的感觉。 </li><li>在治疗会话，继续监视面部收缩，肢体运动或头盔的19-9的任何迹象的病人。 </li><li>一旦治疗完成:去除线圈，取出患者的个人帽，并在必要时协助他们出治疗椅的。 </li></ol>

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The authors have nothing to disclose.

该协议涵盖了使用DTM的H1-线圈的治疗MDD的方法。这个协议解释导致对和初始治疗旅行期间的步骤，其中所述患者的运动阈值，首先确定，然后处理施用。一个典型的处理会话的各个参数进行了介绍。它是整个运动阈值的决心和后续治疗会照顾这个协议的所有步骤都被正确执行的过程中很重要，而患者沟通与TMS心理医生，以确保最佳的治疗计划正在执行。疗程一般6周每日治疗参观，周一至周五，随后几个星期的锥时期。本治疗计划跨越基于TMS精神科医生的最好的临床判断患者而不同，并且是依赖于个体如何响应治疗，它可以是测定值使用验证的抑郁量表被保险。 从患者接收口头反馈规划和修改他们的治疗过程时，但对于抑郁症状，如BDI-II蒙哥马利艾森贝格评定量表，患者健康问卷9或汉密尔顿抑郁量表评定量表，通常用作是重要更客观的措施，以监测患者对治疗的反应。每个这些尺度都有自己的长处，并可能跨越患者变化用于评估特定患者的抑郁症状的最有效的方法。 一种电动机阈重新校准，这涉及到重新评估需要产生可靠手指抽搐（协议步骤4.8）的强度，应定期进行 - 为了确保病人的治疗正在整个治疗过程中 - 每周理想地一次在最佳强度施用。 一运动阈值重新校准之后，如果运动阈值已经增加，则患者可能需要上升到它们的新的治疗剂量（这是既定的运动阈值的120％） - 这是在TMS精神科医生的最好的临床判断，并可能影响所述患者经受的治疗会话的总数。对于规划何时结束每日治疗和开始锥度期间，TMS精神科医生应考虑到病人的主观考虑他们的症状的改善，以及它们在上面列出的客观测量的评分。每个凹陷评定量表的接受截止点什么被认为是抑郁发作的缓解，如果患者已经达到充分缓解便会通常进入治疗的锥度相。这种治疗方法是护理的当前建立的标准TMS治疗，这已被证明是effecti的反射已经在许多试验，包括以上7，8，13中讨论的那些。 这种治疗方法是通过其对治疗严重，治疗有抗性，严重抑郁障碍的唯一指示的限制。用于该处理的H1-线圈被设计成特异性地靶向与MDD相关的脑的区域，因此，使用H1-线圈治疗其它诊断，如强迫症（OCD）或创伤后应激障碍（PTSD） ，目前不是一个可行的选择。然而，其他的线圈已经开发了被设计为靶向与这些病症相关的大脑区域，和研究目前正在进行研究的DTM的用于治疗其他诊断，如OCD和创伤后应激障碍的功效，使用的不同的模型^ h线圈。随着越来越多的研究继续挺身而出有关的DTM治疗MDD和其他疾病的功效，这将是重要的临床医生及时了解任何修改要以既定的治疗方法，确保患者正在接受提供给他们最好的治疗。

重性抑郁障碍（MDD）是受发病率和死亡率1,2显著水平标志着一个普遍的和衰弱条件。抗抑郁药物和心理疗法被认为是治疗抑郁症的第一线;然而，被诊断为抑郁症患者有很大一部分不用药或治疗的连续试验回复，被归为难治性抑郁症（TRD）3,4。电休克治疗（ECT）是TRD病人传统的干预，但由于显著的副作用负担，包括偶尔的长期认知缺陷，以及必要的麻醉给药每ECT治疗参观许多TRD患者不愿意接受ECT ，其承载所述患者获得，并从每ECT治疗输送的额外困难。可替代地，TMS为非侵入性的，不需要麻醉，使其成为一个有价值的替代ECT在m任何TRD患者。 重复经颅磁刺激（磁刺激）已成为一种新的替代方法来治疗TRD，以及一些其他的精神和神经紊乱。磁刺激利用包含创建在接近患者的颅骨磁脉冲电磁线圈装置。磁脉冲出行畅通无阻通过头皮和颅骨，激活神经元。用高频率发出的脉冲（ 例如，10〜20赫兹）被认为是提高神经兴奋而产生的长时程增强（LTP），持续增加的发放率的状态下，在由所述脉冲激活的神经元回路;而具有低频率发出的脉冲（ 例如 ，&lt;5赫兹）被认为是减少神经兴奋性，产生长期抑制（LTD），或者降低燃烧率5。因此，通过选择性靶向特定脑区，经颅磁刺激可以增加或在该区域减少基线活动。 H瞄准左背外侧前额叶皮层（DLPFC），并在MDD活性降低相关联的区域IGH频率颅磁刺激，已被成功地用于改善MDD 6的症状。 传统的经颅磁刺激设备由旁边的头骨直接通过有针对性的大脑区域定位8字形电磁线圈针对特定的大脑区域。这种方法通常能安全地提供磁场的下方的皮质表面约2厘米的最大深度。这产生目标脑区域的有限体积的直接活化。最近具有新颖线圈设计，该H-线圈的装置，是由FDA批准用于治疗TRD清零。该H-线圈采用独特的线圈结构，其目的是直接激活脑组织比传统的线圈更大的深度，如图8字形设计7,8,9。其结果是，使用H-线圈处理称作"深的"TMS（DTMS），以从conventio区分它最终的rTMS面接近。然而，研究，在H-线圈穿透相对于常规数字-的八个线圈的深度之间，出现了有争议的发现。通过Fadini和他的同事2009年发表的一项研究报告称，有与问候穿透深度10两个线圈之间无显著差异（作进一步讨论，请参见引用11,12）。 2015年，Levkovitz和他的同事发表了双盲，多中心，随机，假对照试验研究的安全性和使用H1-线圈（设计目标是满足左前额皮质）治疗MDD 13 DTMS的功效。 MDD患者谁没有抗抑郁药物的一至四个适当的试验，或者未能在当前抑郁发作容忍2抗抑郁药治疗，被随机分为:接收每日DTMS（MF）的处理20在四个周，随后每两周特雷atments了到十二点周;或接收的其他相同的治疗参数无效假治疗。 181参与者被纳入最后的分析。 显著更多的患者接受积极的DTM相对于未激活的DTM假治疗经历了抑郁症的缓解（汉密尔顿抑郁量表评分&lt;10; P = 0.0051）。这一结果表明，在这项研究中，这是我们下面的描述相同使用的技术，是针对在电路抑郁症背后的效益。在本文中，我们将审查使用H1-线圈，它仅仅是由受过训练的持牌医疗专业人员进行的DTM治疗方法。

<table><tbody><tr><td>TMS Neurostimulator</td><td>Magstim</td><td>N/A</td><td>Magstim Rapid or Magstim Rapid&lt;sup&gt;2&lt;/sup&gt;</td></tr><tr><td>TMS H-coil</td><td>Brainsway</td><td>N/A</td><td></td></tr><tr><td>TMS Cooling System</td><td>Brainsway</td><td>N/A</td><td></td></tr><tr><td>TMS positioning System</td><td>Brainsway</td><td>N/A</td><td></td></tr><tr><td>Mobile Medical Cart</td><td>Brainsway</td><td>N/A</td><td>The mobile medical cart contains the cooling system, the controller and the stimulator,</td></tr><tr><td>Personal cap and associated fixings</td><td>Brainsway</td><td>N/A</td><td>and enables mobility of the system inside the treatment area.</td></tr><tr><td>Ear plugs</td><td>Any</td><td>N/A</td><td>Rating of at least 30 dB noise reduction</td></tr><tr><td>Pillow</td><td>Any</td><td>N/A</td><td>Used for positioning arm when determining the motor threshold</td></tr><tr><td>dTMS instruction manual</td><td>Brainsway</td><td>N/A</td><td></td></tr></tbody></table>

treating clinical depression with repetitive deep transcranial magnetic stimulation using the brainsway h1-coil

重复经颅磁刺激（rTMS治疗）是一种新兴的非药物的方法来治疗许多基于大脑的障碍。磁刺激使用电磁线圈刺激脑部非侵入性的区域。深经颅磁刺激（DTMS）与Brainsway H1-线圈系统特别是一种与严重抑郁症（MDD）谁是药物治疗耐药的患者表示rTMS治疗的。这种装置的独特的H1-线圈设计能够刺激该在于比由常规的rTMS线圈达到目标脑区域更深神经通路。 DTMS被认为是低风险的，耐受性好，使之成为谁没有回应药物或心理治疗临床试验为他们的抑郁症的人一个可行的治疗选择。 随机，假控制研究已经表明，DTMS产生显著更大的改善抑郁症状比假DTMS治疗的患者抑郁症已没有回应抗抑郁药物。在本文中，我们将回顾与使用H1-线圈的DTM治疗抑郁症的方法。

DTMS代表为临床抑郁症的疗效建立一个没有回应抗抑郁药临床试验的重要非药物治疗方式，同时也显示了治疗许多其他神经精神障碍的承诺。技术进步，允许在大脑中的扰动电路的改进目标代表了它的DTM疗法将作为治疗进展的重要手段。在H1-线圈的开发是为了激活摆在比常规TMS线圈激活安全的深度更深的目标脑区组织设计新颖。 的疗效和DTMS的安全性尚未直接相比，在一个头 - 头研究常规TMS线圈;然而，可比的研究已经在两个系统之间执行的。研究即是代表疗效的举足轻重的多中心研究证实第一种传统的经颅磁刺激器（使用数字8字形线圈）被降级到谁没有一个单一的抗抑郁药15科目;而对于DTMS进行的关键性研究证明疗效的患者1-4疗程失败的试验13。 在（建立手MT的120％）上述目标治疗刺激的强度，在H1-线圈产生穿透更深比传统的表面图-的八个线圈的靶向脑区域中的电场分布。 图1中的电场分布图是用一个幻象脑模型和测量在假想头各点的电场强度建立。这是使用放置在相对于所述假想头的处理位置的线圈完成的，并在手MT的120％的处理强度。神经激活电平以上的电场延伸1.5厘米下面的脑表面的8字形线圈和4.5厘米脑表面下方为H1-线圈15。 从开始每天的DTM治疗时，患者经历在他们的症状显著的临床改善跨不同的患者需要的时间;有些人开始表现出对治疗的早期反应，抑郁量表得分下降后约三至四个星期的日常治疗。话虽这么说，这是抑郁症状真正的全缓解常见的没有出现，直到5周左右每天治疗后。出于这个原因，DTMS治疗的典型课程涉及六周之前开始锥度期间，最大化并延长对治疗的反应的每日治疗。 这里介绍的是谁用上述的DTM协议处理最近的两个患者的数据，和有经验的重它们的严重难治性抑郁症的使命，由贝克抑郁量表II（BDI-II）测量。在BDI-II，充分缓解被认为是10或更低的得分，而最高得分可以得到在BDI-II是63由于不同的患者在不同时间点的治疗有反应，这是重要通过全面的日常会话30继续治疗，因为有些人不直到接近年底作出回应;提前终止治疗可核销的DTM作为无效的病人谁可能仍然有积极的回应，如果给予治疗的全部课程。这是特别不利的，由于具有已经尝试了几种治疗方式失败，导致被归类此患者群体"治疗有抗性"。 患者Ð第一次体验在治疗的第五周，这是推入一个FUL抑郁症状减轻<html>升和持续缓解治疗期间，通过1个月的治疗后随访（ 图2）的持续的第六周。病人的第一次展示治疗的第二周结束期间，症状减轻，但没有达到症状的全面和持续缓解等到4周结束 - 它通过三个月的治疗后随访持续（ 图3）。它是为患者（如S， 图3所示），以经历一个初始浸在他们的症状，这可能是由于增加在充满希望，甚至安慰剂效应普遍;通常，这样效果会消散，从而导致他们的抑郁症状的增加（或返回到其基线症状），和患者的抑郁症状的真正持续缓解会在治疗过程中进一步上呈现。 3858fig1.jpg"/&gt; 图1:图-8和H1-线圈的电场分布的彩色野外地图的H1-线圈和图8线圈，说明每个像素超过10冠状切片相距1厘米的电场绝对值。红色像素表示上述神经元激活，将其设定为100伏/米的阈字段大小。现场图进行调整，以获得手运动阈值的120％所需的刺激功率输出水平。这个数字是从罗森堡，Shoenfeld，Zangen，科特勒和达能，2010年第13。 <a href="https://jove.unicartagenaproxy.elogim.com/files/ftp_upload/53858/53858fig1large.jpg" target="_blank">请点击此处查看本图的放大版本。</a> <img alt="图2" src="/files/ftp_upload/53858/53858fig2.jpg" /> 图2:患者D:BDI-II分数治疗对面患者D&#39;s到DTMS治疗回应该议定书。S按在各种处理/时间点测量，与在Y轴表示BDI-II评分，和治疗数/时间点BDI-II评分示出显示在X轴上。患者Ð开始显现在治疗期间（28-35日）第五周治疗适度的反应，但直到急剧下降分数从治疗22看到27没有提高缓解水平的点（35-42日） ，这是在治疗的第六周。 X轴表示自第1天治疗每天施用第一TMS治疗开始的天数（周一至周五），从而无法在X轴每天用TMS给患者的给药相关。 <a href="https://jove.unicartagenaproxy.elogim.com/files/ftp_upload/53858/53858fig2large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图3" src="/files/ftp_upload/53858/53858fig3.jpg" /> 图3:病人的:BDI-II比分横跨治疗。病人的对DTMS治疗的反应与该协议是由在各种处理/时间点测量，与在Y轴表示BDI-II评分，和点是治疗数/时间BDI-II评分示在X轴上显示。病人的表现出对治疗有强烈的初步反应，而没有在那个时候维持，但没有约处理18 X轴表示自第1天的第一个TMS治疗开始的天数下降回落到缓解。治疗因而不是天天服用，每天（周一至周五），在X轴与TMS对病人的管理有关。 <a href="https://jove.unicartagenaproxy.elogim.com/files/ftp_upload/53858/53858fig3large.jpg" target="_blank">请点击此处查看该图的放大版本。</a>

Watch this Scientific Journal Video about Treating Clinical Depression with Repetitive Deep Transcranial Magnetic Stimulation Using the Brainsway H1-coil at JoVE.com

Treating Clinical Depression with Repetitive Deep Transcranial Magnetic Stimulation Using the Brainsway H1-coil

在这里，我们提出了一个协议，概述了使用深经颅磁刺激（DTMS）系统治疗重度抑郁症的方法。

临床治疗抑郁症的深层重复经颅磁刺激使用Brainsway H1线圈

Repetitive transcranial magnetic stimulation (rTMS) is an emerging non-pharmacological approach to treating many brain-based disorders. rTMS uses ...

treating-clinical-depression-with-repetitive-deep-transcranial

Universidad de Cartagena UDEC

Research

JoVE Journal

Behavior

22.2K 次观看.  University of California, San Diego. 在这里，我们提出了一个协议，概述了使用深经颅磁刺激（DTMS）系统治疗重度抑郁症的方法。 

视频: Treating Clinical Depression with Repetitive Deep Transcranial Magnetic Stimulation Using the Brainsway H1-coil

Simultaneous EEG Monitoring During Transcranial Direct Current Stimulation

Transcranial direct current stimulation (tDCS) is a technique that delivers weak electric currents through the scalp. This constant electric current induces shifts in neuronal membrane excitability, resulting in secondary changes in cortical activity. Although tDCS has most of its neuromodulatory effects on the underlying cortex, tDCS effects can also be observed in distant neural networks. Therefore, concomitant EEG monitoring of the effects of tDCS can provide valuable information on the mechanisms of tDCS. In addition, EEG findings can be an important surrogate marker for the effects of tDCS and thus can be used to optimize its parameters. This combined EEG-tDCS system can also be used for preventive treatment of neurological conditions characterized by abnormal peaks of cortical excitability, such as seizures. Such a system would be the basis of a non-invasive closed-loop device. In this article, we present a novel device that is capable of utilizing tDCS and EEG simultaneously. For that, we describe in a step-by-step fashion the main procedures of the application of this device using schematic figures, tables and video demonstrations. Additionally, we provide a literature review on clinical uses of tDCS and its cortical effects measured by EEG techniques.

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has shown initial therapeutic effects in several neurological conditions. The main mechanism underlying these therapeutic effects is the modulation of cortical excitability. Therefore, online monitoring of cortical excitability would help guide stimulation parameters and optimize its therapeutic effects. In the present article we review the use of a novel device that combines simultaneous tDCS and EEG monitoring in real time.

同时脑电图监测在经颅直流电刺激

Transcranial  direct current stimulation (tDCS) is a technique that delivers weak electric  currents through the scalp. This constant electric current ...

科研

行为学

Transcranial Magnetic Stimulation for Investigating Causal Brain-behavioral Relationships and their Time Course

Transcranial magnetic stimulation (TMS) is a safe, non-invasive brain stimulation technique that uses a strong electromagnet in order to temporarily disrupt information processing in a brain region, generating a short-lived &#8220;virtual lesion.&#8221; Stimulation that interferes with task performance indicates that the affected brain region is necessary to perform the task normally. In other words, unlike neuroimaging methods such as functional magnetic resonance imaging (fMRI) that indicate correlations between brain and behavior, TMS can be used to demonstrate causal brain-behavior relations. Furthermore, by varying the duration and onset of the virtual lesion, TMS can also reveal the time course of normal processing. As a result, TMS has become an important tool in cognitive neuroscience. Advantages of the technique over lesion-deficit studies include better spatial-temporal precision of the disruption effect, the ability to use participants as their own control subjects, and the accessibility of participants. Limitations include concurrent auditory and somatosensory stimulation that may influence task performance, limited access to structures more than a few centimeters from the surface of the scalp, and the relatively large space of free parameters that need to be optimized in order for the experiment to work. Experimental designs that give careful consideration to appropriate control conditions help to address these concerns. This article illustrates these issues with TMS results that investigate the spatial and temporal contributions of the left supramarginal gyrus (SMG) to reading.

Transcranial magnetic stimulation (TMS) is a technique for non-invasively disrupting neural information processing and measuring its effect on behavior. When TMS interferes with a task, it indicates that the stimulated brain region is necessary for normal task performance, allowing one to systematically relate brain regions to cognitive functions.

经颅磁刺激对调查因果脑 - 行为关系及其时间进程

Transcranial magnetic stimulation (TMS) is a safe, non-invasive brain stimulation technique that uses a strong electromagnet in order to temporarily ...

The NeuroStar TMS Device: Conducting the FDA Approved Protocol for Treatment of Depression

The Neuronetics NeuroStar Transcranial Magnetic Stimulation (TMS) System is a class II medical device that produces brief duration, pulsed magnetic fields. These rapidly alternating fields induce electrical currents within localized, targeted regions of the cortex which are associated with various physiological and functional brain changes.1,2,3
In 2007, O'Reardon et al., utilizing the NeuroStar device, published the results of an industry-sponsored, multisite, randomized, sham-stimulation controlled clinical trial in which 301 patients with major depression, who had previously failed to respond to at least one adequate antidepressant treatment trial, underwent either active or sham TMS over the left dorsolateral prefrontal cortex (DLPFC). The patients, who were medication-free at the time of the study, received TMS five times per week over 4-6 weeks.4
The results demonstrated that a sub-population of patients (those who were relatively less resistant to medication, having failed not more than two good pharmacologic trials) showed a statistically significant improvement on the Montgomery-Asberg Depression Scale (MADRS), the Hamilton Depression Rating Scale (HAMD), and various other outcome measures. In October 2008, supported by these and other similar results5,6,7, Neuronetics obtained the first and only Food and Drug Administration (FDA) approval for the clinical treatment of a specific form of medication-refractory depression using a TMS Therapy device (FDA approval K061053).
In this paper, we will explore the specified FDA approved NeuroStar depression treatment protocol (to be administered only under prescription and by a licensed medical profession in either an in- or outpatient setting).

In this article, we examine the methodology and considerations relevant to the FDA approved depression treatment protocol using the Neuronetics NeuroStar TMS device.

NeuroStar TMS的设备进行美国FDA批准用于治疗抑郁症的议定书“

The Neuronetics NeuroStar Transcranial Magnetic Stimulation (TMS) System is a class II medical device that produces brief duration, pulsed magnetic ...

神经科学

Non-Invasive Electrical Brain Stimulation Montages for Modulation of Human Motor Function

Non-invasive electrical brain stimulation (NEBS) is used to modulate brain function and behavior, both for research and clinical purposes. In particular, NEBS can be applied transcranially either as direct current stimulation (tDCS) or alternating current stimulation (tACS). These stimulation types exert time-, dose- and in the case of tDCS polarity-specific effects on motor function and skill learning in healthy subjects. Lately, tDCS has been used to augment the therapy of motor disabilities in patients with stroke or movement disorders. This article provides a step-by-step protocol for targeting the primary motor cortex with tDCS and transcranial random noise stimulation (tRNS), a specific form of tACS using an electrical current applied randomly within a pre-defined frequency range. The setup of two different stimulation montages is explained. In both montages the emitting electrode (the anode for tDCS) is placed on the primary motor cortex of interest. For unilateral motor cortex stimulation the receiving electrode is placed on the contralateral forehead while for bilateral motor cortex stimulation the receiving electrode is placed on the opposite primary motor cortex. The advantages and disadvantages of each montage for the modulation of cortical excitability and motor function including learning are discussed, as well as safety, tolerability and blinding aspects.

Non-invasive electrical brain stimulation can modulate cortical function and behavior, both for research and clinical purposes. This protocol describes different brain stimulation approaches for modulation of the human motor system.

非侵入电脑刺激蒙太奇的人体运动功能的调节

Non-invasive electrical brain stimulation (NEBS) is used to modulate brain function and behavior, both for research and clinical purposes. In particular, ...

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, ...

How to Use the H1 Deep Transcranial Magnetic Stimulation Coil for Conditions Other than Depression

Deep transcranial magnetic stimulation (dTMS) is a relatively new technique that uses different coils for the treatment of different neuropathologies. The coils are made of soft copper windings in multiple planes that lie adjacent to the skull. They are located within a special helmet so that their magnetic fields combine and improve depth penetration. The H1 dTMS coil is designed to stimulate bilateral prefrontal cortices with greater effective stimulation over the left than the right. By positioning the left side of the coil close to the left dorsolateral prefrontal cortex (DLPFC), the H1 coil was used in a multisite study, leading to FDA approval for treatment-resistant depression. In this same position, the H1 coil was also explored as a possible treatment for negative symptoms of schizophrenia, bipolar depression, and migraine. When moved to different positions over the subject's skull, the H1 coil was also explored as a possible treatment for other conditions. Such manipulation of the H1 coil was demonstrated for PTSD and alcohol dependence by positioning it over the medial prefrontal cortex (mPFC), for anxiety by positioning it over the right prefrontal cortex (rPFC), for auditory hallucinations and tinnitus by positioning it over the temporoparietal junction (TPJ), and for Parkinson's and fatigue from multiple sclerosis (MS) by positioning it over the motor cortex (MC) and PFC. Corresponding electrical field diagrams measured with an oscilloscope through a saline-filled head are included.

The H1 deep transcranial magnetic stimulation coil is FDA-cleared for the treatment of depression. We demonstrate how to utilize the H1 for other conditions, such as auditory hallucinations and PTSD, by moving the helmet to different locations over the subject's skull.

如何使用H1深经颅磁刺激线圈条件除抑郁症

Deep transcranial magnetic stimulation (dTMS) is a relatively new technique that uses different coils for the treatment of different neuropathologies. The ...

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 ...

The Use of Magnetic Resonance Spectroscopy as a Tool for the Measurement of Bi-hemispheric Transcranial Electric Stimulation Effects on Primary Motor Cortex Metabolism

Transcranial direct current stimulation (tDCS) is a neuromodulation technique that has been increasingly used over the past decade in the treatment of neurological and psychiatric disorders such as stroke and depression. Yet, the mechanisms underlying its ability to modulate brain excitability to improve clinical symptoms remains poorly understood 33. To help improve this understanding, proton magnetic resonance spectroscopy (1H-MRS) can be used as it allows the in vivo quantification of brain metabolites such as &#947;-aminobutyric acid (GABA) and glutamate in a region-specific manner 41. In fact, a recent study demonstrated that 1H-MRS is indeed a powerful means to better understand the effects of tDCS on neurotransmitter concentration 34. This article aims to describe the complete protocol for combining tDCS (NeuroConn MR compatible stimulator) with 1H-MRS at 3 T using a MEGA-PRESS sequence. We will describe the impact of a protocol that has shown great promise for the treatment of motor dysfunctions after stroke, which consists of bilateral stimulation of primary motor cortices 27,30,31. Methodological factors to consider and possible modifications to the protocol are also discussed.

This article aims to describe a basic protocol for combining transcranial direct current stimulation (tDCS) with proton magnetic resonance spectroscopy (1H-MRS) measurements to investigate the effects of bilateral stimulation on primary motor cortex metabolism.

磁共振波谱的用途，用于对初级运动皮层新陈代谢双半球经颅电刺激效果的测量工具一

Transcranial direct current stimulation (tDCS) is a neuromodulation technique that has been increasingly used over the past decade in the treatment of ...

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 ...

医学

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 ...