Programmable Transcranial Magnetic Stimulation: A Modulation Approach for the Generation of Controllable Magnetic Stimuli

Ultra-high frequency repetitive TMS at subthreshold intensity induces suprathreshold motor response via temporal summation

Objective.The transcranial magnetic stimulation (TMS) coil induces an electric field that diminishes rapidly upon entering the brain. This presents a challenge in achieving focal stimulation of a deep brain structure. Neuronal elements, including axons, dendrites, and cell bodies, exhibit specific time constants. When exposed to repetitive TMS pulses at a high frequency, there is a cumulative effect on neuronal membrane potentials, resulting in temporal summation. This study aims to determine whether TMS pulse train at high-frequency and subthreshold intensity could induce a suprathreshold response.Approach.As a proof of concept, we developed a TMS machine in-house that could consistently output pulses up to 250 Hz, and performed experiments on 22 awake rats to test whether temporal summation was detectable under pulse trains at 100, 166, or 250 Hz.Main results.Results revealed that TMS pulses at 55% maximum stimulator output (MSO, peak dI/dt= 68.5 A/μs at 100% MSO, pulse width = 48μs) did not induce motor responses with either single pulses or pulse trains. Similarly, a single TMS pulse at 65% MSO failed to evoke a motor response in rats; however, a train of TMS pulses at frequencies of 166 and 250 Hz, but not at 100 Hz, successfully triggered motor responses and MEP signals, suggesting a temporal summation effect dependent on both pulse intensities and pulse train frequencies.Significance.We propose that the temporal summation effect can be leveraged to design the next-generation focal TMS system: by sequentially driving multiple coils at high-frequency and subthreshold intensity, areas with the most significant overlapping E-fields undergo maximal temporal summation effects, resulting in a suprathreshold response.

The complex landscape of TMS devices: A brief overview

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.

xTMS: A Pulse Generator for Exploring Transcranial Magnetic Stimulation Therapies

A cascaded H-bridge based pulse generator for transcranial magnetic stimulation is introduced. The system demonstrates complete flexibility for producing different shape, duration, direction, and rate of repetition of stimulus pulses within its electrical limits, and can emulate all commercial and research systems available to-date in this application space. An offline model predictive control algorithm, used to generate pulses and sequences, shows superior performance compared to conventional carrier-based pulse width modulation. A fully functioning laboratory prototype delivers up to 1.5 kV, 6 kA pulses, and is ready to be used as a research tool for the exploration of transcranial magnetic stimulation therapies by leveraging the many degrees-of-freedom offered by the design.

Optimal Design of Array Coils for Multi-Target Adjustable Electromagnetic Brain Stimulation System

Temporal interference magnetic stimulation is a novel noninvasive deep brain neuromodulation technology that can solve the problem of balance between focus area and stimulation depth. However, at present, the stimulation target of this technology is relatively single, and it is difficult to realize the coordinated stimulation of multiple brain regions, which limits its application in the modulation of multiple nodes in the brain network. This paper first proposes a multi-target temporal interference magnetic stimulation system with array coils. The array coils are composed of seven coil units with an outer radius of 25 mm, and the spacing between coil units is 2 mm. Secondly, models of human tissue fluid and the human brain sphere are established. Finally, the relationship between the movement of the focus area and the amplitude ratio of the difference frequency excitation sources under time interference is discussed. The results show that in the case of a ratio of 1:5, the peak position of the amplitude modulation intensity of the induced electric field has moved 45 mm; that is, the movement of the focus area is related to the amplitude ratio of the difference frequency excitation sources. The conclusion is that multi-target temporal interference magnetic stimulation with array coils can simultaneously stimulate multiple network nodes in the brain region; rough positioning can be performed by controlling the conduction of different coils, fine-tuning the position by changing the current ratio of the conduction coils, and realizing accurate stimulation of multiple targets in the brain area.

A neurostimulator system for real, sham, and multi-target transcranial magnetic stimulation

Objective.Transcranial magnetic stimulation (TMS) is a clinically effective therapeutic instrument used to modulate neural activity. Despite three decades of research, two challenging issues remain, the possibility of changing the (a) stimulated spot and (b) stimulation type (real or sham) without physically moving the coil. In this study, a second-generation programmable TMS device with advanced stimulus shaping is introduced that uses a five-level cascaded H-bridge inverter and phase-shifted pulse-width modulation. The principal idea of this research is to obtain real, sham, and multi-locus stimulation using the same TMS system.Approach.We propose a two-channel modulation-based magnetic pulse generator and a novel coil arrangement, consisting of two circular coils with a physical distance of 20 mm between the coils and a control method for modifying the effective stimulus intensity, which leads to the live steerability of the target and type of stimulation.Main results.Based on the measured system performance, the stimulation profile can be steered ±20 mm along a line from the centroid of the coil locations by modifying the modulation index.Significance.The proposed system supports electronic control of the stimulation spot without physical coil movement, resulting in tunable modulation of targets, which is a crucial step towards automated TMS machines.

Modular multilevel TMS device with wide output range and ultrabrief pulse capability for sound reduction

Objective.This article presents a novel transcranial magnetic stimulation (TMS) pulse generator with a wide range of pulse shape, amplitude, and width.Approach.Based on a modular multilevel TMS (MM-TMS) topology we had proposed previously, we realized the first such device operating at full TMS energy levels. It consists of ten cascaded H-bridge modules, each implemented with insulated-gate bipolar transistors, enabling both novel high-amplitude ultrabrief pulses as well as pulses with conventional amplitude and duration. The MM-TMS device can output pulses including up to 21 voltage levels with a step size of up to 1100 V, allowing relatively flexible generation of various pulse waveforms and sequences. The circuit further allows charging the energy storage capacitor on each of the ten cascaded modules with a conventional TMS power supply.Main results. The MM-TMS device can output peak coil voltages and currents of 11 kV and 10 kA, respectively, enabling suprathreshold ultrabrief pulses (>8.25μs active electric field phase). Further, the MM-TMS device can generate a wide range of near-rectangular monophasic and biphasic pulses, as well as more complex staircase-approximated sinusoidal, polyphasic, and amplitude-modulated pulses. At matched estimated stimulation strength, briefer pulses emit less sound, which could enable quieter TMS. Finally, the MM-TMS device can instantaneously increase or decrease the amplitude from one pulse to the next in discrete steps by adding or removing modules in series, which enables rapid pulse sequences and paired-pulse protocols with variable pulse shapes and amplitudes.Significance.The MM-TMS device allows unprecedented control of the pulse characteristics which could enable novel protocols and quieter pulses.

Comparison between the modelled response of primary motor cortex neurons to pulse-width modulated and conventional TMS stimuli

In this study, the neural response to pulse-width modulated (PWM) transcranial magnetic stimulation (TMS) is estimated using a computational neural model which simulates the response of cortical neurons to TMS. The recently introduced programmable TMS uses PWM to approximate conventional resonance-based TMS pulses by fast switching between voltage levels. The effect of such stimulation on the six cortical layers is modelled by estimating the activation threshold of the neurons. Modelling results are compared between the novel device and that of conventional TMS stimuli generated by Magstim stimulators. The neural responses to the PWM pulses and the conventional stimuli show a high correlation, which validates the use of pulse-width modulated pulses in TMS.Clinical Relevance- This computational modelling study demonstrates an equivalent effect of PWM and conventional TMS pulses on the nervous system which paves the way to more flexibility in exploring and choosing stimulation parameters for TMS treatment.

Estimation of the Motor Threshold for Near-Rectangular Stimuli Using the Hodgkin-Huxley Model

The motor threshold measurement is a standard in preintervention probing in TMS experiments. We aim to predict the motor threshold for near-rectangular stimuli to efficiently determine the motor threshold size before any experiments take place. Estimating the behavior of large-scale networks requires dynamically accurate and efficient modeling. We utilized a Hodgkin-Huxley (HH) type model to evaluate motor threshold values and computationally validated its function with known true threshold data from 50 participants trials from state-of-the-art published datasets. For monophasic, bidirectional, and unidirectional rectangular stimuli in posterior-anterior or anterior-posterior directions as generated by the cTMS device, computational modeling of the HH model captured the experimentally measured population-averaged motor threshold values at high precision (maximum error ≤ 8%). The convergence of our biophysically based modeling study with experimental data in humans reveals that the effect of the stimulus shape is strongly correlated with the activation kinetics of the voltage-gated ion channels. The proposed method can reliably predict motor threshold size using the conductance-based neuronal models and could therefore be embedded in new generation neurostimulators. Advancements in neural modeling will make it possible to enhance treatment procedures by reducing the number of delivered magnetic stimuli to participants.

Paralleling insulated-gate bipolar transistors in the H-bridge structure to reduce current stress

In this study we present the new power electronic circuit implementation to create the arbitrary near-rectangular electromagnetic pulse. To this end, we develop a parallel- Insulated-gate bipolar transistors (IGBT)-based magnetic pulse generator utilizing the H-bridge architecture. This approach effectively reduces the current stress on the power switches while maintaining a simple structure using a single DC source and energy storage capacitor. Experimental results from the circuit characterization show that the proposed circuit is capable of repeatedly generating near-rectangular magnetic pulses and enables the generation of configurable and stable magnetic pulses without causing excessive device stresses. The introduced device enables the production of near-rectangular pulse trains for modulated magnetic stimuli. The maximum positive pulse width in the proposed neurostimulator is up to 600 µs, which is adjustable by the operator at the step resolution of 10 µs. The maximum transferred energy to the treatment coil was measured to be 100.4 J. The proposed transcranial magnetic stimulator (TMS) device enables more flexible magnetic stimulus shaping by H-bridge architecture and parallel IGBTs, which can effectively mitigate the current stress on power switches for repetitive treatment protocols.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42452-021-04420-y.