The authors wish to thank Elyssa Sisko and Bella Tendler for manuscript review and editing.

注:在开始任何TMS协议之前，有三种警示性说明。首先，患者和运营商应使用带有30分贝评级耳塞。第二，病人铁磁材料在颅骨不能接收的TMS。最后，癫痫患者必须有协议的修改。此外，个人的运动阈值（MT）必须确定（参见下文的具体过程）。的MT被定义为必要激活五个，十个尝试（50％）肌肉最低机器强度，典型的展拇短，通过目视检查。 MT被用于调整特定个人接受治疗的刺激器输出。每个协议包括特定的参数，如刺激频率，列车的数量，在列车间间隔（ITI），或在各列车的脉冲数。每一个障碍有每天或每周三次治疗的最低数量，应该尝试之前，有人可以bË认为是治疗失败，和反应一般需要每周两次的治疗病程迁延，以获得最大的效益持续。此外，患者恢复可能受益于每周维持治疗。对于不同的疾病继续和维护协议仍在研究之中，但都在初步调查中使用的参数的在表1中提供的，并应被称作针对每个特定病症。经历DTMS患者应与医生和患者量表，以及后续的尺度基线评估。疾病状态和评级表选项定义改善和缓解的定义已经超出了本文的范围。病人抑郁量表的一个例子是抑郁症状或贝克抑郁量表快速库存。临床医师评定量表的一个例子是临床医生的全局印象或汉密尔顿抑郁量表。这些秤定义为缓解截止，而在得分50％的下降定义为响应。 <table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>紊乱</td><td>解剖目标/ H1位置</td><td>刺激方案</td><td>处理频率</td><td>治疗的变化</td></tr><tr><td> MDD 6，7，8 </td><td>左PFC 线圈倾斜</td><td> 120吨，18赫兹，2秒的火车，20秒间隔，55列车有1,980总脉冲数</td><td> 5d的一个星期，直到病情缓解或持续改善。如果44后的治疗选择其他的治疗方法未改善。 </td><td>两周持续改善或缓解降低频率后，以2倍一周三个月。 </td></tr><tr><td>双相抑郁症9,10 </td><td>大号EFT PFC 线圈倾斜</td><td> 120吨，20赫兹，2秒的火车，20秒间隔，42列车，1680总脉冲数</td><td> 5d的一个星期，直到病情缓解或持续改善。如果20后选择治疗的替代疗法未经改进。 </td><td>如果患者在缓解期或持续改善，继续治疗一周两次，为期三个月。 </td></tr><tr><td>精神分裂症-阴性症状11，12 </td><td>左PFC 线圈倾斜</td><td> 120吨，20赫兹，2秒的火车，20秒间隔，42列车，1680总脉冲数</td><td> 5d的一个星期，直到病情缓解或改善持续。如果病人是未经改良的20后选择治疗的替代疗法。 </td><td>如果患者在缓解期或持续改善，继续治疗一周两次，为期三个月。 </td></tr><tr><td>偏头痛13 </td><td>左PFC <td> 100吨，10赫兹，2秒的火车，20秒间隔，18列车，共360个脉冲</td><td>图3d一周四个星期。如果患者没有经过12次回应，选择一个替代治疗。 </td><td>如果患者在缓解期或持续改善，继续治疗一周两次，为期三个月。 </td></tr><tr><td> PTSD 14 </td><td>内侧PFC 线圈对称</td><td>听一个个性化的创伤性脚本，120吨，20赫兹，2秒的火车，20秒间隔，42列车，共1680脉冲之后</td><td>图3d每周5周。如果患者不经过治疗15响应，选择一个替代治疗。 </td><td>如果患者进入缓解期或有持续改善，继续治疗一周两次，为期三个月。对于具有多个创伤事件的复杂PTSD，改变创伤脚本，并重新开始</td></tr><tr><td>一个lcohol成瘾15，16，17，18，19 </td><td>内侧PFC 线圈对称</td><td>经过酒精的渴望90秒个性化的挑衅，120吨，20赫兹，2.5秒的火车，30秒间隔，30列车，共1500个脉冲</td><td> 5d的一个星期，直到病情缓解或持续改善。如果患者经过20理疗选择一种替代治疗没有反应。 </td><td>如果患者进入缓解期，继续治疗一周两次，为期三个月。 </td></tr><tr><td>精神分裂症-幻听20，21 </td><td>左TPJ 线圈倾斜</td><td> 110 MT，1赫兹，600脉冲</td><td>图5d每周4周。如果患者没有经过20次回应，选择一个替代治疗。 </td><td>如果患者进入缓解期或有持续改善，继续治疗一周两次，为期三个月。 </td></tr><tr><td>慢性耳鸣22 </td><td>左TPJ 线圈倾斜</td><td> 110吨，18赫兹，2秒的火车，20秒间隔，55列车有1,980总脉冲数</td><td>图5d每周2周。如果患者没有经过10次回应，选择一个替代治疗。 </td><td>如果患者进入缓解期或有持续改善，继续治疗一周两次，为期三个月。 </td></tr><tr><td>焦虑23 </td><td> PFC权 线圈倾斜</td><td> 120 MT 1赫兹脉冲600-2,000 </td><td>图5d每周6周。如果患者没有经过30届回应，选择一个替代治疗。 </td><td>如果患者进入缓解期或有持续改善，继续治疗一周两次为期Ô˚F三个月。 </td></tr><tr><td>帕金森氏病24 </td><td>运动皮层和PFC 线圈对称</td><td>皮质运动区:110 MT，1赫兹，豆类1000 PFC:120吨，20赫兹，2秒的火车，20秒的时间间隔50的列车，2000个脉冲</td><td>图5d每周4周。如果患者没有经过20次回应，选择一个替代治疗。应答器可降低左旋多巴的剂量。 </td><td>持续应答后继续治疗，每周两次，以实现效益最大化。三个月后，患者将减轻无需维护。 </td></tr><tr><td> MS疲劳25 </td><td>运动皮层和PFC 线圈对称</td><td>皮质运动区:80吨，10赫兹，2秒列车，1秒的时间间隔，列车70 1400总脉冲数 PFC:120吨，18赫兹，2秒的火车，20秒间隔，39列车，1404总脉冲数</td><td>图5d每周4周。如果患者不响应AFTER 20届，选择一个替代治疗。 </td><td>患者应在需要的基础上接受加强治疗。 </td></tr></tbody></table>注:H1协议:本文的重点是展示线圈在MC，LPFC，内侧前额叶皮质，RPFC的定位，并留下TPJ（请参阅以下步骤2-7）。它不会专注于编程的刺激。这些信息是该设备附带的使用说明书更容易获得。这些协议被设计按照赫尔辛基宣言的各项原则。 1.测量运动阈值<ol><li>将关于这个问题的两个拦截统治者蓝帽。 </li><li>放置在鼻根白色矢状标尺，并在鼻根-INION距离的40％的清澈冠状标尺的25厘米标记的0厘米标记，用0在患者的头部的左侧。 </li><li>使用头盔找到右侧的搁MT另一方面，在开始与头盔7厘米从鼻根正面和倾斜2cm至右侧的线圈的左侧。 </li><li>在刺激输出的50％的刺激器在触摸屏上使用"单脉冲"模式，管理单脉冲同时观察患者的静息右手。如果没有可见的运动被观察到，或者如果一个可见运动观察的时间小于50％增加刺激强度。最初，用5％的区间。 </li><li>如果一个明显的运动被观察的时间的50％以上降低刺激强度。开始用5％区间，然后进行微调了。 </li><li>重复步骤1.4和1.5，以确定最小的MT。这个位置被称为"热点"。 </li></ol> 2.设置参数范围内的设备用户界面<ol><li>按"重复模式"的刺激触摸屏。 </li><li>通过触摸屏幕上的框和调整它们使用SID输入参数Ë轮。从表1中输入参数，并按下"运行会话。" </li><li>按绿色键布防机器。警告刺激开始病人，并与黄色按钮或踏板启动刺激。 </li></ol> 3.刺激MC帕金森或MS疲劳<ol><li>找到后MT，理顺在头盔上的矢状统治者前以对称的方式在MC头盔，用0。 </li></ol> 4.刺激左PFC为抑郁症，双相抑郁症，精神分裂症阴性症状，和偏头痛<ol><li>通过向前6厘米移动它沿矢状统治者事先向MT位置在MC左侧PFC倾斜头盔。 </li></ol> 5.刺激内侧前额叶皮质酒精依赖或者PTSD <ol><li>将头盔在内侧前额叶皮质，对称地左右，与头盔的0马克9;的前边缘与3厘米标记在盖的矢状标尺对准的（ 即，从鼻根3cm）中。 </li></ol> 6.刺激右击PFC广泛性焦虑或恐慌症<ol><li>找到与头盔（的倾斜头盔2cm至左边和观看搁左手步骤1.3-1.4镜像以下）的左手的MT。 </li><li>前锋6厘米移动头盔倾斜沿矢状统治者的权利PFC。 </li></ol> 7.刺激左TPJ耳鸣或幻听<ol><li>从右侧MC移动线圈4.5厘米向后和6.5厘米横向（左肩）将在左TPJ头盔"热点"。 </li></ol> 8.电场测量<ol><li>线圈，在左DLPFC连接到一个倒置的盐水充注头。刺激器强度设定为50％。使用连接到示波器偶极探头，移动cm的通过厘米，这样，当单脉冲通过线圈传递时，示波器措施在生理盐水填充头26的每个点的感应电场。 注:根据头部模型测量生产野外地图的过程是超出了本文的范围。总之，在任何点字段值是根据相关的协议标准化。例如，用于治疗抑郁症，所接受的协议是MT的120％。因此，字段值进行缩放，以便在手的MC的值是120伏/米，而对神经刺激的阈值被定义为100伏/米。然后，在大脑中的电场分布的色彩映射产生，其中，以100伏/米或更高的场像素中的红色指示，使人们可以看到其大脑区域以上用于神经刺激的阈值的刺激。着色场图被叠加在大脑26,27的MRI扫描。 </li></ol>

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Combined motor threshold and electric field distribution study.</a> Clin Neurophysiol. 125 (2), 336-343 (2014).</li><li>Rosenberg, O., Roth, Y., Kotler, M., Zangen, A., Dannon, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deep+transcranial+magnetic+stimulation+for+the+treatment+of+auditory+hallucinations:+a+preliminary+open-label+study.">Deep transcranial magnetic stimulation for the treatment of auditory hallucinations: a preliminary open-label study.</a> Ann Gen Psychiatry. 10 (1), 3 (2011).</li><li>George, M. 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Aron Tendler, Yiftach Roth, and Abraham Zangen own stock and receive income from Brainsway, the manufacturer of the H1 coil.

关键步骤的协议中 任何的DTM协议中最重要的组成部分是MT的正确的测量。 MT确定的个性化的剂量或刺激强度必要和安全的治疗的患者。如果患者的MT是在比他们的实际MT更高的测量不正确，他们最终将得到一个较高的强度治疗，增加患者的癫痫发作风险。同样，如果患者接受太低的剂量（ 例如，MT的110％，而不是治疗抑郁症时的120％），他们不会进入缓解。它也必须是正在使用的线圈的部件就在这个区域人试图刺激位于头部。当刺激左侧PFC，从头盔的左侧前半部分的电线应该触摸颅骨覆盖左侧PFC;可能存在的头盔和头骨的右侧之间的空间几厘米。当刺激权PFC，头盔的右前一半应该是触摸颅骨覆盖右边的PFC，并有可能会是头盔和头骨的左侧之间的空间。当刺激内侧前额叶皮质，头盔前部应倒推到额头的顶端。线圈的侧面可以通过在线圈的背面紧固束带靠得更近提出。 修改和故障排除 在临床实践中最常见的修改是调整线圈的倾斜，而它是在PFC，由于舒适性，并且在从MC线圈，致在头尺寸的变化的距离差。如果患者对抑郁症左PFC协议期间感觉太右颞刺激，头盔可以向对称位置倾斜。此外，如果从MC推进线圈6厘米提出以下病人的眉毛的头盔的前部，头盔应向后调整。如果难以找到静止MT，第一步应找到活性MT，这始终是低。 该技术的局限性 表1中列出，抑郁症的异常刺激方案，还远远没有最终决定。即使在凹陷协议可能不是最佳的。这些是分别根据在该特定实验的时间可用的知识设想潜在协议，并且当它们被用于对这些解剖区域，它们是成功的。随着时间的推移，协议可以由于关于脑网络中所涉及的特定神经病理学，DTMS场分布，作用机理，最佳参数，安全数据，装置的耐久性数据，和多出版物的知识积累改善和更大的病例。此外，如果有人想刺激非常焦，具体的目标，这不会是一个适当的线圈。为这样的目标，在Figure-8线圈，刺激大脑皮层表面上很焦点和肤浅的地区，会更适合。但是，由于刺激由图8线圈是如此的焦点，它可以很容易错过相关情绪障碍的重要DLPFC结构。事实上，用简单的5厘米规则，该图8甚至可以位于PFC 1，29外面。此外，最近的研究表明，与对膝下扣带广泛的联系前额叶皮层区域的刺激可以是用于标准的rTMS 2，3，30的抗抑郁剂作用是至关重要的。由于这些脑皮质区域的确切位置，3个人之间的差异很大，最佳刺激目标可能很容易错过了8字形线圈。为了解决这个问题，医生必须把病人有一个功能磁共振成像和必须使用神经导航。所有THES不与H1的出现E麻烦，因为它的广泛领域刺激所有相关的PFC目标。 相对于现有的/替代方法的技术意义 在H1的DTM线圈是进入竞技场rTMS治疗的最新线圈。它已被广泛地通过精神科医生由于其高疗效和耐受性的患者治疗性抑郁症，其治疗时间短，其在确定的MT容易通过。所有这些都是在H1的刺激神经元组织的比8字形线圈更深和更大体积的能力的功能。然而，事实上，线圈是在头盔和不是肉眼可见使线圈从其预期目标几乎异端移动的想法。此外，外部硬头盔会使临床医生忘记了H-线圈的一个重要方面是它们具有柔软，可弯曲的铜线的设计。线圈的碱是指为邻近一个想要的神经纤维附近的颅骨s到刺激。它是谁没有采取数学和物理多年领悟的DTM线圈的设计概念临床医生很难。 图8线圈更容易理解，完全可见，它们的效果都非常焦点。临床医生更乐于从位置移动他们的位置。此外，他们已使用了很多年，并且有更多的出版物描述用于关闭标签的条件的使用。但是，这不应妨碍按照该在这里，或以新的方式回顾了协议的H1线圈的DLPFC外的应用目标。 关于电场图作为的设备的潜在影响的测定，电场图表从盐溶液填充头模型测定具有超过其他方法的优点。一些研究者计算或使用球形头部模型模拟感应场，W高血压脑出血少31，32，33，34准确。测量在填充盐水一个现实形头部模型的实际线圈的感应场是比任何数学模型更具有代表性，但它是不完全准确35。最近，研究人员已经在模拟解剖，正确的虚拟组织的34，36，37，38的电场。更准确的电场的图可以从具有多个记录电极植入尸体获得，但本实验尚未完成。 掌握这一技术后，未来的应用或指示 理解审查线圈图和电场图的概念后应用线圈不同ANATomical目标，用于基于什么在文献中是已知的对于可能的目标和刺激参数不同的H-线圈和病症相同的步骤。例如，H7线圈被设计成放置在mPFC的和前扣带回皮层（ACC）为强迫症的治疗。该H7线圈可以被放置在内侧的MC为脚的糖尿病性神经病的治疗，并通过后顶叶（PPC）为轻度认知障碍的楔前的刺激。

直到最近，只是表面现象，重复经颅磁刺激（rTMS治疗）线圈，如圆形，8字型，或双锥形线圈，都已经具备。虽然这些线圈可以很容易地在任何地方移到头骨针对不同疾病改变大脑的活动，其电场的衰减是相当迅速的。这种快速衰减限制了它们的功效，使他们不切实际的在更深的刺激是必要的情况下使用，因为这需要可能是危险和痛苦的病人高刺激输出。此外，图8和双锥线圈的focality真正需要神经导航，特别是如果一个人想可以肯定，他们是影响正确的解剖目标1，2，3。 近年来，临床上使用磁刺激的已取得进展，因为两种因素。首先是好玩的进步虚构神经影像学检查，明确有意义的和具体的神经解剖目标精神和神经系统症状和疾病。二是生物工程的进步是启用非侵入性的，可容忍的，高频刺激脑深部地区设有专门设计的DTM H-线圈4,5的交付和改进的冷却技术（火车结果之间的长期冷却时间很长疗程）。一起，这些发展允许在各种被认定为一特定的症状或病症的目标病理大脑活动的长期正常化。这些进步的结合极大地扩展了医生的工具箱，改变精神病学和神经学的做法，因为它提供了一种安全有效的方法来治疗，甚至药物耐药的患者。 有设计为靶向特定脑区14个不同的H-线圈，并且它们阿瓦伊标贴用于研究或在不同的国家临床使用。然而，只有在H1线圈FDA批准用于商业用途，并因此，不同的H-线圈之间，这是对患者最方便的线圈。正因为如此，对于临床医生熟悉可使用在H1线圈给药以及每个可以用于他们的难治性患者受益的替代方案是非常重要的。它来限定，有设计更好-H-线圈为症状不能由定位左DLPFC被减轻是重要的。然而，由于H1线圈是目前最容易获得的H-线圈，本文意在说明如何把它适当地在关闭标签的时尚定位。

<table><tbody><tr><td>dTMS System</td><td>Brainsway</td><td></td><td>Includes H1 coil, positioning arm, cart,stimulator, cooling system</td></tr><tr><td>Patient Caps</td><td>Brainsway</td><td></td><td>Includes blue caps with rulers</td></tr><tr><td>Ear plugs</td><td></td><td></td><td>Rated to 30 dB</td></tr></tbody></table>

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.

见的各种协议的初步结果列于表1的参考文献。 图2-5是在不同的解剖位置H1的线圈的代表电场图。到不同的位置的H1操纵的一个例子是与未能从抗抑郁药或心理14受益PTSD的患者。在这项研究中，在H1线圈被定位在内侧前额叶皮质。如在图3看到的那样，以这种方式，线圈定位清楚地刺激mPFC的;这不是神经元激活的相同的图案时，H1线圈被放置在左侧的PFC，在图2中所看到的。三十PTSD患者被随机分配接受短暂接触后的DTM他们的创伤事件的录制的脚本，短暂暴露于一种无创性的脚本，或假刺激短暂接触他们的创伤后脚本后DTMS。海峡时报指数mulation施用包括20赫兹刺激12次（3每周4周）在MT的120％，以40个-两张2秒火车和总共1680个脉冲的20秒列车间间隔。主要成果的措施是CAPS得分四周。选定的结果的图形表示在图6中14所示。结果的分析只在接受活性DTMS短暂暴露于创伤事件后，与用于CAPS的侵入成分的组×时间相互作用的组揭示了显著改善。以下本研究的完成，DTMS的mPFC的创伤后应激障碍的一个多中心研究已启动。 <img alt="图1" src="/files/ftp_upload/55100/55100fig1.jpg" /> 图1:深TMS的设备。在H1线圈（a）和照片的DTMS系统与H1头盔，定位臂的线图，刺激，冷却系统，以及购物车（B）。 <a href="http://ecsource.jove.com/files/ftp_upload/55100/55100fig1large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图2" src="/files/ftp_upload/55100/55100fig2.jpg" /> 图2:H1在左PFC的电场图。彩色场图表示的电场在手的120％的MT 10冠状切片相距1厘米每个像素的绝对幅度。红色像素指示与上述用于神经元激活的阈值，其为100V / m的电场强度的区域。 <a href="http://ecsource.jove.com/files/ftp_upload/55100/55100fig2large.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/55100/55100fig3.jpg" /> <st<html>荣&gt;图3:H1在内侧PFC的电场图。彩色场图表示的电场在手的MT 10冠状切片相距1cm处120％的每个像素的绝对幅度。红色像素指示与上述用于神经元激活的阈值，其为100V / m的电场强度的区域。 <a href="http://ecsource.jove.com/files/ftp_upload/55100/55100fig3large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <img alt="图4" src="/files/ftp_upload/55100/55100fig4.jpg" /> 图4:H1在右PFC的电场图。彩色场图表示的电场在手的120％的MT 10冠状切片相距1厘米每个像素的绝对幅度。红色像素指示与上述用于神经元激活的阈值，其为100V / m的电场强度的区域。/ecsource.jove.com/files/ftp_upload/55100/55100fig4large.jpg"目标="_空白"&gt;点击此处查看该图的放大版本。 <img alt="图5" src="/files/ftp_upload/55100/55100fig5.jpg" /> 图5: 在H1在左TPJ的电场图。彩色场图表示的电场在手的110％的MT的各像素的绝对值为冠状切片相距1厘米。红色像素指示与上述用于神经元激活的阈值，其为100V / m的电场强度的区域。这个数字是从参考28.修改<a href="http://ecsource.jove.com/files/ftp_upload/55100/55100fig5large.jpg" target="_blank">请点击这里查看该图的放大版本。</a> <img alt="图6" src="/files/ftp_upload/55100/55100fig6.jpg" /> 图6:临床医生administerd创伤后应激障碍量表（CAPS）在基线严重程度评分和后处理在第一（盲）阶段。图A示出了总的CAPS分别得分，而图B，C和D示出的侵入，回避/麻木，和超兴奋分量。值被表示为平均值±标准误差。 * P &lt;0.05相对于基线。从参考14重复使用许可。 <a href="http://ecsource.jove.com/files/ftp_upload/55100/55100fig6large.jpg" target="_blank">请点击此处查看该图的放大版本。</a>

Watch this Scientific Journal Video about How to Use the H1 Deep Transcranial Magnetic Stimulation Coil for Conditions Other than Depression at JoVE.com

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

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 ...

how-to-use-h1-deep-transcranial-magnetic-stimulation-coil-for

Research

JoVE Journal

Behavior

23.9K 次观看.  Brainsway LTD. 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.

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

Transcranial Direct Current Stimulation and Simultaneous  Functional Magnetic Resonance Imaging

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that uses weak electrical currents administered to the scalp to manipulate cortical excitability and, consequently, behavior and brain function. In the last decade, numerous studies have addressed short-term and long-term effects of tDCS on different measures of behavioral performance during motor and cognitive tasks, both in healthy individuals and in a number of different patient populations. So far, however, little is known about the neural underpinnings of tDCS-action in humans with regard to large-scale brain networks. This issue can be addressed by combining tDCS with functional brain imaging techniques like functional magnetic resonance imaging (fMRI) or electroencephalography (EEG).
In particular, fMRI is the most widely used brain imaging technique to investigate the neural mechanisms underlying cognition and motor functions. Application of tDCS during fMRI allows analysis of the neural mechanisms underlying behavioral tDCS effects with high spatial resolution across the entire brain. Recent studies using this technique identified stimulation induced changes in task-related functional brain activity at the stimulation site&#160;and also in more distant brain regions, which were associated with behavioral improvement. In addition, tDCS administered during resting-state fMRI allowed identification of widespread changes in whole brain functional connectivity.
Future studies using this combined protocol should yield new insights into the mechanisms of tDCS action in health and disease and new options for more targeted application of tDCS in research and clinical settings. The present manuscript describes this novel technique in a step-by-step fashion, with a focus on technical aspects of tDCS administered during fMRI.

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique. It has successfully been used in basic research and clinical settings to modulate brain function in humans. This article describes the implementation of tDCS and simultaneous functional magnetic resonance imaging (fMRI), to investigate the neural basis of tDCS effects.

经颅直流电刺激和同步功能磁共振成像

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that uses weak electrical currents administered to the scalp ...

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 ...

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, ...

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

Repetitive transcranial magnetic stimulation (rTMS) is an emerging non-pharmacological approach to treating many brain-based disorders. rTMS uses electromagnetic coils to stimulate areas of the brain non-invasively. Deep transcranial magnetic stimulation (dTMS) with the Brainsway H1-coil system specifically is a type of rTMS indicated for treating patients with major depressive disorder (MDD) who are resistant to medication. The unique H1-coil design of this device is able to stimulate neuronal pathways that lie deeper in the targeted brain areas than those reached by conventional rTMS coils. dTMS is considered to be low-risk and well tolerated, making it a viable treatment option for people who have not responded to medication or psychotherapy trials for their depression.
Randomized, sham-control studies have demonstrated that dTMS produces significantly greater improvement in depressive symptoms than sham dTMS treatment in patients with major depression that has not responded to antidepressant medication. In this paper, we will review the methodology for treating major depression with dTMS using an H1-coil.

Here we present a protocol outlining the methodology for treatment of Major Depressive Disorder using the deep Transcranial Magnetic Stimulation (dTMS) system.

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 ...

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, ...

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 ...

神经科学

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 ...

Measuring and Manipulating Functionally Specific Neural Pathways in the Human Motor System with Transcranial Magnetic Stimulation

Understanding interactions between brain areas is important for the study of goal-directed behavior. Functional neuroimaging of brain connectivity has provided important insights into fundamental processes of the brain like cognition, learning, and motor control. However, this approach cannot provide causal evidence for the involvement of brain areas of interest. Transcranial magnetic stimulation (TMS) is a powerful, noninvasive tool for studying the human brain that can overcome this limitation by transiently modifying brain activity. Here, we highlight recent advances using a paired-pulse, dual-site TMS method with two coils that causally probes cortico-cortical interactions in the human motor system during different task contexts. Additionally, we describe a dual-site TMS protocol based on cortical paired associative stimulation (cPAS) that transiently enhances synaptic efficiency in two interconnected brain areas by applying repeated pairs of cortical stimuli with two coils. These methods can provide a better understanding of the mechanisms underlying cognitive-motor function as well as a new perspective on manipulating specific neural pathways in a targeted fashion to modulate brain circuits and improve behavior. This approach may prove to be an effective tool to develop more sophisticated models of brain-behavior relations and improve diagnosis and treatment of many neurological and psychiatric disorders.

This article describes new approaches to measure and strengthen functionally specific neural pathways with transcranial magnetic stimulation. These advanced noninvasive brain stimulation methodologies can provide new opportunities for the understanding of brain-behavior relations and development of new therapies to treat brain disorders.

利用颅内磁刺激测量和操纵人体运动系统中功能特定的神经通路

Understanding interactions between brain areas is important for the study of goal-directed behavior. Functional neuroimaging of brain connectivity has ...

Conventional and Threshold-Tracking Transcranial Magnetic Stimulation Tests for Single-handed Operation

Most single-pulse transcranial magnetic stimulation (TMS) parameters (e.g., motor threshold, stimulus-response function, cortical silent period) are used to examine corticospinal excitability. Paired-pulse TMS paradigms (e.g., short- and long-interval intracortical inhibition (SICI/LICI), short-interval intracortical facilitation (SICF), and short- and long-latency afferent inhibition (SAI/LAI)) provide information about intracortical inhibitory and facilitatory networks. This has long been done by the conventional TMS method of measuring changes in the size of the motor-evoked potentials (MEPs) in response to stimuli of constant intensity. An alternative threshold-tracking approach has recently been introduced whereby the stimulus intensity for a target amplitude is tracked. The diagnostic utility of threshold-tracking SICI in amyotrophic lateral sclerosis (ALS) has been shown in previous studies. However, threshold-tracking TMS has only been used in a few centers, in part due to the lack of readily available software but also perhaps due to uncertainty over its relationship to conventional single- and paired-pulse TMS measurements.
A menu-driven suite of semi-automatic programs has been developed to facilitate the broader use of threshold-tracking TMS techniques and to enable direct comparisons with conventional amplitude measurements. These have been designed to control three types of magnetic stimulators and allow recording by a single operator of the common single- and paired-pulse TMS protocols.
This paper shows how to record a number of single- and paired-pulse TMS protocols on healthy subjects and analyze the recordings. These TMS protocols are fast and easy to perform and can provide useful biomarkers in different neurological disorders, particularly neurodegenerative diseases such as ALS.

We present a suite of standardized single- and paired-pulse transcranial magnetic stimulation (TMS) recording protocols, with options for conventional amplitude measurements and threshold-tracking. This program can control three different types of magnetic stimulators and is designed to enable all tests to be performed conveniently by a single operator.

单手操作的常规和阈值跟踪经颅磁刺激测试

Most single-pulse transcranial magnetic stimulation (TMS) parameters (e.g., motor threshold, stimulus-response function, cortical silent period) are used ...