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Gutiérrez-Muto AM, Bestmann S, Sánchez de la Torre R, Pons JL, Oliviero A, Tornero J. The complex landscape of TMS devices: A brief overview. PLoS One 2023; 18:e0292733. [PMID: 38015924 PMCID: PMC10684101 DOI: 10.1371/journal.pone.0292733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/27/2023] [Indexed: 11/30/2023] Open
Abstract
The increasing application of TMS in research and therapy has spawned an ever-growing number of commercial and non-commercial TMS devices and technology development. New CE-marked devices appear at a rate of approximately one every two years, with new FDA-approved application of TMS occurring at a similar rate. With the resulting complex landscape of TMS devices and their application, accessible information about the technological characteristics of the TMS devices, such as the type of their circuitry, their pulse characteristics, or permitted protocols would be beneficial. We here present an overview and open access database summarizing key features and applications of available commercial and non-commercial TMS devices (http://www.tmsbase.info). This may guide comparison and decision making about the use of these devices. A bibliometric analysis was performed by identifying commercial and non-commercial TMS devices from which a comprehensive database was created summarizing their publicly available characteristics, both from a technical and clinical point of view. In this document, we introduce both the commercial devices and prototypes found in the literature. The technical specifications that unify these devices are briefly analysed in two separate tables: power electronics, waveform, protocols, and coil types. In the prototype TMS systems, the proposed innovations are focused on improving the treatment regarding the patient: noise cancellation, controllable parameters, and multiple stimulation. This analysis shows that the landscape of TMS is becoming increasingly fragmented, with new devices appearing ever more frequently. The review provided here can support development of benchmarking frameworks and comparison between TMS systems, inform the choice of TMS platforms for specific research and therapeutic applications, and guide future technology development for neuromodulation devices. This standardisation strategy will allow a better end-user choice, with an impact on the TMS manufacturing industry and a homogenisation of patient samples in multi-centre clinical studies. As an open access repository, we envisage the database to grow along with the dynamic development of TMS devices and applications through community-lead curation.
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Affiliation(s)
| | - Sven Bestmann
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | | | - José L. Pons
- Legs and Walking Lab, Shirley Ryan Ability Laboratory (Formerly Rehabilitation Institute of Chicago), Chicago, IL, United States of America
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Antonio Oliviero
- Center for Clinical Neuroscience, Hospital Los Madroños, Brunete, Madrid, Spain
- Advanced Neurorehabilitation Unit, Hospital Los Madroños, Brunete, Madrid, Spain
| | - Jesús Tornero
- Center for Clinical Neuroscience, Hospital Los Madroños, Brunete, Madrid, Spain
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Gutierrez MI, Poblete-Naredo I, Mercado-Gutierrez JA, Toledo-Peral CL, Quinzaños-Fresnedo J, Yanez-Suarez O, Gutierrez-Martinez J. Devices and Technology in Transcranial Magnetic Stimulation: A Systematic Review. Brain Sci 2022; 12:1218. [PMID: 36138954 PMCID: PMC9496961 DOI: 10.3390/brainsci12091218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 01/18/2023] Open
Abstract
The technology for transcranial magnetic stimulation (TMS) has significantly changed over the years, with important improvements in the signal generators, the coils, the positioning systems, and the software for modeling, optimization, and therapy planning. In this systematic literature review (SLR), the evolution of each component of TMS technology is presented and analyzed to assess the limitations to overcome. This SLR was carried out following the PRISMA 2020 statement. Published articles of TMS were searched for in four databases (Web of Science, PubMed, Scopus, IEEE). Conference papers and other reviews were excluded. Records were filtered using terms about TMS technology with a semi-automatic software; articles that did not present new technology developments were excluded manually. After this screening, 101 records were included, with 19 articles proposing new stimulator designs (18.8%), 46 presenting or adapting coils (45.5%), 18 proposing systems for coil placement (17.8%), and 43 implementing algorithms for coil optimization (42.6%). The articles were blindly classified by the authors to reduce the risk of bias. However, our results could have been influenced by our research interests, which would affect conclusions for applications in psychiatric and neurological diseases. Our analysis indicates that more emphasis should be placed on optimizing the current technology with a special focus on the experimental validation of models. With this review, we expect to establish the base for future TMS technological developments.
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Affiliation(s)
- Mario Ibrahin Gutierrez
- Subdirección de Investigación Tecnológica, División de Investigación en Ingeniería Médica, CONACYT —Instituto Nacional de Rehabilitación LGII, Mexico City 14389, Mexico
| | | | - Jorge Airy Mercado-Gutierrez
- Subdirección de Investigación Tecnológica, División de Investigación en Ingeniería Médica, Instituto Nacional de Rehabilitación LGII, Mexico City 14389, Mexico
| | - Cinthya Lourdes Toledo-Peral
- Subdirección de Investigación Tecnológica, División de Investigación en Ingeniería Médica, Instituto Nacional de Rehabilitación LGII, Mexico City 14389, Mexico
| | - Jimena Quinzaños-Fresnedo
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación LGII, Mexico City 14389, Mexico
| | - Oscar Yanez-Suarez
- Neuroimaging Research Laboratory, Electrical Engineering Department, Universidad Autonoma Metropolitana Unidad Iztapalapa, Mexico City 14389, Mexico
| | - Josefina Gutierrez-Martinez
- Subdirección de Investigación Tecnológica, División de Investigación en Ingeniería Médica, Instituto Nacional de Rehabilitación LGII, Mexico City 14389, Mexico
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McClintock SM, Reti IM, Carpenter LL, McDonald WM, Dubin M, Taylor SF, Cook IA, O’Reardon J, Husain MM, Wall C, Krystal AD, Sampson SM, Morales O, Nelson BG, Latoussakis V, George MS, Lisanby SH. Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression. J Clin Psychiatry 2018; 79:16cs10905. [PMID: 28541649 PMCID: PMC5846193 DOI: 10.4088/jcp.16cs10905] [Citation(s) in RCA: 334] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/20/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To provide expert recommendations for the safe and effective application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depressive disorder (MDD). PARTICIPANTS Participants included a group of 17 expert clinicians and researchers with expertise in the clinical application of rTMS, representing both the National Network of Depression Centers (NNDC) rTMS Task Group and the American Psychiatric Association Council on Research (APA CoR) Task Force on Novel Biomarkers and Treatments. EVIDENCE The consensus statement is based on a review of extensive literature from 2 databases (OvidSP MEDLINE and PsycINFO) searched from 1990 through 2016. The search terms included variants of major depressive disorder and transcranial magnetic stimulation. The results were limited to articles written in English that focused on adult populations. Of the approximately 1,500 retrieved studies, a total of 118 publications were included in the consensus statement and were supplemented with expert opinion to achieve consensus recommendations on key issues surrounding the administration of rTMS for MDD in clinical practice settings. CONSENSUS PROCESS In cases in which the research evidence was equivocal or unclear, a consensus decision on how rTMS should be administered was reached by the authors of this article and is denoted in the article as "expert opinion." CONCLUSIONS Multiple randomized controlled trials and published literature have supported the safety and efficacy of rTMS antidepressant therapy. These consensus recommendations, developed by the NNDC rTMS Task Group and APA CoR Task Force on Novel Biomarkers and Treatments, provide comprehensive information for the safe and effective clinical application of rTMS in the treatment of MDD.
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Affiliation(s)
- Shawn M. McClintock
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas,Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina,Corresponding author: Shawn M. McClintock, PhD, Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8898 ()
| | - Irving M. Reti
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Linda L. Carpenter
- Butler Hospital, Brown Department of Psychiatry and Human Behavior, Providence, Rhode Island
| | - William M. McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Marc Dubin
- Department of Psychiatry, Weill Cornell Medical College, White Plains, New York
| | | | - Ian A. Cook
- Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Behavioral Sciences and of Bioengineering, University of California at Los Angeles, Los Angeles
| | - John O’Reardon
- Department of Psychiatry and Behavioral Sciences, Rowan University School of Medicine, Stratford, New Jersey
| | - Mustafa M. Husain
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas,Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Andrew D. Krystal
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina,Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco
| | | | - Oscar Morales
- Psychiatric Neurotherapeutics Program, McLean Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brent G. Nelson
- Department of Psychiatry, University of Minnesota, St Louis Park
| | | | - Mark S. George
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston,Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Sarah H. Lisanby
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
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Fernández-Corazza M, Turovets S, Luu P, Anderson E, Tucker D. Transcranial Electrical Neuromodulation Based on the Reciprocity Principle. Front Psychiatry 2016; 7:87. [PMID: 27303311 PMCID: PMC4882341 DOI: 10.3389/fpsyt.2016.00087] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/02/2016] [Indexed: 12/14/2022] Open
Abstract
A key challenge in multi-electrode transcranial electrical stimulation (TES) or transcranial direct current stimulation (tDCS) is to find a current injection pattern that delivers the necessary current density at a target and minimizes it in the rest of the head, which is mathematically modeled as an optimization problem. Such an optimization with the Least Squares (LS) or Linearly Constrained Minimum Variance (LCMV) algorithms is generally computationally expensive and requires multiple independent current sources. Based on the reciprocity principle in electroencephalography (EEG) and TES, it could be possible to find the optimal TES patterns quickly whenever the solution of the forward EEG problem is available for a brain region of interest. Here, we investigate the reciprocity principle as a guideline for finding optimal current injection patterns in TES that comply with safety constraints. We define four different trial cortical targets in a detailed seven-tissue finite element head model, and analyze the performance of the reciprocity family of TES methods in terms of electrode density, targeting error, focality, intensity, and directionality using the LS and LCMV solutions as the reference standards. It is found that the reciprocity algorithms show good performance comparable to the LCMV and LS solutions. Comparing the 128 and 256 electrode cases, we found that use of greater electrode density improves focality, directionality, and intensity parameters. The results show that reciprocity principle can be used to quickly determine optimal current injection patterns in TES and help to simplify TES protocols that are consistent with hardware and software availability and with safety constraints.
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Affiliation(s)
- Mariano Fernández-Corazza
- NeuroInformatics Center, University of Oregon, Eugene, OR, USA
- LEICI Instituto de Investigaciones en Electrónica, Control y Procesamiento de Señales, Universidad Nacional de La Plata (UNLP), CONICET, La Plata, Argentina
| | - Sergei Turovets
- NeuroInformatics Center, University of Oregon, Eugene, OR, USA
- Electrical Geodesics Inc., Eugene, OR, USA
| | - Phan Luu
- NeuroInformatics Center, University of Oregon, Eugene, OR, USA
- Electrical Geodesics Inc., Eugene, OR, USA
- Department of Psychology, University of Oregon, Eugene, OR, USA
| | | | - Don Tucker
- NeuroInformatics Center, University of Oregon, Eugene, OR, USA
- Electrical Geodesics Inc., Eugene, OR, USA
- Department of Psychology, University of Oregon, Eugene, OR, USA
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