The overall goal of this deep TMS protocol is to demonstrate how the H1 deep TMS coil can be repositioned on the skull to target different anatomical regions and disorders. This method can help answer key questions in the TMS field. Such as, how to stimulate the medial prefrontal cortex or the temperoparietal junction, if you only have the H1 coil.
The main advantage of this technique is that it is easy to apply and be confident that the targeted anatomical region is being stimulated since the coil is so large. This method can provide insight into neuro circuits of the specific symptoms treated. It can also be applied to other H coils, and other conditions, such as using the H7 coil over the motor cortex to treat neuropathic pain, or examine the integrity of the cortico spinal tract.
Begin by placing the blue cap with the two intercepting woolers, on to the subject. Then place the zero cm mark of the white saggital ruler on the nasion. And the 25 cm mark of the clear coronal ruler, at 40%of the nasion inion distance, with the zero on the left side of the patient's head.
Use the helmet to find the resting motor threshold or MT, of the right hand, by starting with the front of the helmet, seven cm from the nasion, and the left side of the coil tilted two cm to the right. Then, identify the minimal motor threshold, also known as the hot spot. Advance the coil, six cm anteriorly over the nasion inion ruler, to stimulate the left prefrontal cortex.
Finally, adjust the helmet over the left pre frontal cortex. Begin by pressing repetitive mode on the stimulator touch screen. Then, enter the parameters by touching the boxes on the screen, and adjusting them using the side wheel.
Press, run session. Charge the machine by pressing the green button. Warn the patient that the stimulation is starting.
Then start the stimulation with the yellow button. Straighten the helmet in a symmetrical fashion over the motor cortex, or MC, with a zero on the front of the helmet, over the saggital ruler, so that the coil inside the helmet is over the MC.Advance the coil six cm anteriorly over the nasion inion ruler, to stimulate the left pre frontal cortex. Advance the tilted bear coil from the MT location over the motor cortex, or MC, that the left pre frontal cortex, or PFC, by moving it six cm forward along the saggital ruler.
Move the helmet six cm forward along the saggital ruler, from the motor cortex, to reach the medial PFC, while keeping the helmet symmetrical. Then place the coil over the medial PFC, symmetrically with respect to right left. With the zero mark on the helmet's front edge aligned with the three cm mark on the saggital ruler of the cap.
Next, find the left hand MT hot spot, by tilting the right side of the coil, two cm to the left, and watching the resting left hand. Following that, move the tilted helmet six cm forward along the saggital ruler, so that the coil within the helmet, rests above the right PFC. Finally, place the helmet over the left temporoparietal junction.
By moving the coil 4.5 cm posterially, and 6.5 cm laterally to the left shoulder, from the right hand MC hot spot. The position of the coil holds great importance, as in this case the medial PFC is clearly stimulated. However this is not the same pattern of neuromoactivation that is seen when the H1 coal is placed over the left PFC.
This study, with 30 ptsd patients, who failed to benefit from anti depressants, or psycho therapy, indicated a significant improvement, only in the group that received active DTMS, after brief exposure to a script of the traumatic event. With a group by time interaction for the intrusion component of the CAPS. Once mastered, this technique can be done in less than 10 minutes.
The implications of this technique extends towards therapy of major depressive disorder bi polar depression, negative symptoms of schizophrenia, auditory hallucinations, migraine, post traumatic stress disorder, addiction, tinnitus panic attacks, generalized anxiety, parkinsons disease, and multiple sclerosis. While attempting this procedure, it is important to remember that everyone in the room should utilize hearing protection to minimize the risk of hearing loss. Also, the subject's motor threshold should be rechecked at least once a week or if any medications are changed.
After watching this video, you should have a good understanding of how to utilize the H1 coil for the treatment of numerous conditions, other than major depressive disorder. By moving the coil to treat brain regions, other than the left pre frontal cortex.
