9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 1 Development of Complex Curricula for Molecular Bionics and Infobionics Programs within a consortial* framework** Consortium leader PETER PAZMANY CATHOLIC UNIVERSITY Consortium members SEMMELWEIS UNIVERSITY, DIALOG CAMPUS PUBLISHER The Project has been realised with the support of the European Union and has been co-financed by the European Social Fund *** **Molekuláris bionika és Infobionika Szakok tananyagának komplex fejlesztése konzorciumi keretben ***A projekt az Európai Unió támogatásával, az Európai Szociális Alap társfinanszírozásával valósul meg. PETER PAZMANY CATHOLIC UNIVERSITY SEMMELWEIS UNIVERSITY sote_logo.jpg dk_fejlec.gif INFOBLOKK Peter Pazmany Catholic University Faculty of Information Technology www.itk.ppke.hu (Neurális interfészek és protézisek ) RICHÁRD CSERCSA and GYÖRGY KARMOS TRANSCRANIALMAGNETIC STIMULATION NEURALINTERFACESAND PROSTHESES LECTURE6 (Transzkraniálismágneses ingerlés) NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011 TÁMOP –4.1.2-08/2/A/KMR-2009-0006 3 AIMS: In this lecture, the student will become familiar with the principles and application techniques of transcranialmagnetic stimulation. They will also learn about the history of magnetic stimulation, the different types of magnetic stimulation devices, and examples of possible fields of application. www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 4 DEFINITION: Transcranialmagnetic stimulation (TMS) is a noninvasive method to cause depolarization in the neurons of the brain. TMS uses electromagnetic induction to induce weak electric currents using a rapidly changing magnetic field; this can cause activity in specific or general parts of the brain with minimal discomfort, allowing the functioning and interconnections of the brain to be studied. A variant of TMS, repetitive transcranialmagnetic stimulation (rTMS) has been tested as a treatment tool for various neurological and psychiatric disorders including migraines, strokes, Parkinson's disease, dystonia, tinnitus, depression and auditory hallucinations. (wikipedia) www.itk.ppke.hu PRINCIPLES www.itk.ppke.hu http://www.bem.fi/book/index.htm NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 5 www.itk.ppke.hu TMS uses electromagnetic induction to generate an electric current across the scalp and skull without physical contact. The charge amount of the charged heavy-duty condenser generates voltage of max. 2000 V and current of ~1000 A in the coil through the thyristor trigger in 100-200 µs. This produces a short-lasting magnetic field oriented orthogonally to the plane of the coil (Faraday-Henry law). The magnetic field passes unimpeded through the skin and skull, inducing an oppositely directed current in the brain that activates nearby nerve cells in much the same way as currents applied directly to the cortical surface. The magnetic field penetrates only to a maximum depth of three centimeters into the brain, in the area directly adjacent to the coil. (wikipedia) PRINCIPLES NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 6 www.itk.ppke.hu TIMING OF MAGNETIC STIMULATION Stimulating coil current ~ 8000 A Magnetic field pulse ~ 2.5 T Rate of change of magnetic field ~ 30 kT/s Induced electric field ~ 500 V/m Induced tissue current ~ 15 mA/cm2 Induced charge density ~ 1 µC/cm3 NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 7 1771 Luigi Galvani animal electricity 1819 Hans Christian Oersted (1777-1851) electromagnetism 1831 Michael Faraday (1791-1867) electromagnetic induction 1833 Duchennede Boulogne stimulation of muscles with surface electrodes 1853 Hermann von Helmholtz measurement of speed of nerve impulses with electrical stimulation and mechanical twitch recorder; pioneering discoveries in electromagnetism (reciprocity etc.) 1874 Bartholow excitability of the human brain while stimulating the exposed cortex in a patient with a large cranial defect 1896 Arsenne d'Arsonval "phosphenesand vertigo, and in some persons, syncope"when the subjects head was placed inside an induction coil www.itk.ppke.hu HISTORY NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 8 1902 191019111946 Beer Silvanus Thompson Dunlap Walsh visual sensations, i.e., magnetophosphenes:"a faint flickering illumination, colorless or a blush tint" 1911 Magnusson & Stevens "when the direct current was initiated, a luminous horizontal bar was perceived moving downward" 1947 Barlow & al. "as to the locus of excitation, we believe that this is retinal" 1959 Kolin first to stimulate magnetically nerves (a frog sciatic-nerve) 1965 Bickford & Fremming first to stimulate the humannerves magnetically using harmonic magnetic fields 1970 19701973 Maass& AsaIrwin P. A. öberg muscle twitches in animals and human subjects 1976 Polson,Barker, & Freeston stimulation with brief magnetic field pulses and first demonstration of peripheral nerve stimulation with simultaneous electromyographicrecordings www.itk.ppke.hu HISTORY NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 9 1980 Merton & Morton non-invasive brain stimulation with scalp electrodes 1985 Barker& al. non-invasive, painless, cortical stimulation with magnetic fields 1984 1988 David Cohen, Shoogo Ueno the idea and realization of the figure-of-eight coil 1989 RQ Cracco, VE Amassian, PJ Maccabee & JB Cracco recording of magnetically evoked cortical responses from the scalp with electrodes placed on the other side of the head 1987/88 Cadwell Laboratory Inc. repetitive stimulation with water-cooled coil http://www.biomag.hus.fi/tms/index.html Shoogo Ueno www.itk.ppke.hu HISTORY NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 10 Size matters. Early attempts to induce phosphenes by brain stimulation suffered from the difficulties of producing the requisite large, rapidly-changing electromagnetic fields. Here we see the arrangement of coils used by Magnusson and Stevens (1911). Coils were piled upon one another to create the increase in field strength. www.itk.ppke.hu THE BEGINNINGS NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 11 www.itk.ppke.hu STIMULATION PATTERNS Round coil Figure-8 (butterfly) coil G:\My Documents\oktatás\TÁMOP\2010\Csuhajképek_files\Kepek\P_circular_coil_01.jpg G:\My Documents\oktatás\TÁMOP\2010\Csuhajképek_files\Kepek\P_double_coil_01.jpg NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 12 current www.itk.ppke.hu BUTTERFLY COIL-INDUCED CURRENT IN ISOTROPIC CONDUCTOR NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 13 www.itk.ppke.hu G:\My Documents\oktatás\TÁMOP\2010\Csuhajképek_files\Kepek\L_bp_RGB.jpg MAGNETICSTIMULATIONDURINGEEGRECORDING NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 14 vectors www.itk.ppke.hu STIMULATION VECTOR DIRECTIONS IN MOTOR CORTEX MAGNETIC STIMULATION http://www.bem.fi/book/index.htm NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 15 2203 www.itk.ppke.hu DISTRIBUTION OF TMS COIL-INDUCED MAGNETIC FIELD AND STIMULATING CURRENT http://www.bem.fi/book/index.htm NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 16 2202 e2203 L = inductance of the coil [H] µ = permeability of the coil core [Vs/Am] N = number of turns on the coil r = coil radius [m] l = coil length [m] s = coil width [m] e2204 e2205 www.itk.ppke.hu TYPES OF COILS Multilayer cylinder coil Flat single layer coil Flat multilayer coil http://www.bem.fi/book/index.htm NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 17 2202 2,5 mm2copper wire, 19 turns R: 14 m.L: 169 µH 2,5 mm2copper wire, 10 turns R: 10 m.L: 6.67 µH www.itk.ppke.hu http://www.bem.fi/book/index.htm NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 18 http://www.musc.edu/tmsmirror/intro/field.gif www.itk.ppke.hu DISTANCE VS. CHANGE OF INDUCED ELECTRIC FIELD NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 19 e-field www.itk.ppke.hu INDUCED ELECTRIC FIELD ON MR IMAGE NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 20 8-4 magnetic stimulation electric stimulation www.itk.ppke.hu MOTOR POTENTIAL EVOKED BY STIMULATING MOTOR CORTEX NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 21 www.itk.ppke.hu SILENT PERIOD AFTER MOTOR POTENTIAL EVOKED BY TMS IN STROKE PATIENTS affectedside unaffectedside Byrneset al. BrainRes. 2001 NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 22 www.itk.ppke.hu SILENT PERIOD AFTER MOTOR POTENTIAL EVOKED BY TMS IN STROKE PATIENTS Byrneset al. BrainRes. 2001 TopographicMEPand SPmapsshowingshiftsontheaffectedsideintwoselectedstroke subjects. The pointof thebluearrowindicatestheexpectedpositionofthemap centre ontheaffectedside. NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 23 Advantages: .painless .central motor conduction time can be measured fast, without pain .suitable for surgical monitoring Contraindicated with: .pacemaker.focal epilepsy .metal in the brain www.itk.ppke.hu PROS AND CONS NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 24 Brainsight-Frameless System TMS_Head_2 Brainsight www.itk.ppke.hu MRI LOCALIZATION AIDED TMS NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 25 www.itk.ppke.hu MRI LOCALIZATION AIDED TMS NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 26 www.itk.ppke.hu TMS-EVOKED EEG RESPONSES Ilmoniemiet al. NeuroReport, 1997 NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 27 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 28 TMS-evoked averaged EEG responses. Minimum-norm estimates of the cortical activity areshown as color maps drawn on three-dimensional MRI.The EEG is displayed ascontour maps, with red lines indicating positive potential. The TMS coil position is indicated with a cross. (a) The response to left motor cortex stimulation. At latencies of 3 and 10 ms, the ipsilateralhemisphere shows prominent activation; at 24 ms, the contralateralactivity dominates (between 10 and 24 ms, the two hemispheres showed simultaneousstrong activation). The EEG contour spacing is 1 mV. (b) The response to visual-cortex TMS at 4, 7 and 28 ms post-stimulus; the contourspacing is 2 mV. www.itk.ppke.hu TMS-EVOKED EEG RESPONSES NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION Magnetic stimulation of the frontal eye field (FEF) induces local cerebral blood flow (CBF) change in the parietooccipital visual cortex (PO). www.itk.ppke.hu TMS-EVOKED DISTAL CBF RESPONSE (PET) NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 29 www.itk.ppke.hu fMRI RESPONSE OF MOTOR CORTEX MAGNETIC STIMULATION Bestmanet al. EurJ Neurosci2004 NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 30 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 31 Direct and remote neural effects of focal TMS. (a) Activity changes evoked by suprathresholdTMS (3 Hz, 10s) delivered over left sensorimotor cortex (M1/S1) during fMRI. Stimulation not only increased activity at the site of TMS but also in ipsilateraldorsal and ventral premotorcortex, contralateralventral premotorcortex, medial motor areas, including SMA and putative cingulatemotor area. (b) Importantly, remote activity increases during TMS also occurred in the motor thalamus ipsilateralto stimulation, even at subthresholdstimulation intensities. This excludes reafferentfeedback from evoked muscle responses as a contributing factor to these activity increases. Note also the additional activity increases in auditory cortex that are due to the noise generated at TMS pulse discharge. The yellow flash denotes the site of stimulation. Abbreviations: AUD, auditory cortex; PMd, dorsal premotor cortex; PMv, ventral premotor cortex; SMA, supplementary motor area; Thal, motor part of the thalamus. Adapted from Bestmannet al. fMRI RESPONSE OF MOTOR CORTEX MAGNETIC STIMULATION www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION www.itk.ppke.hu fMRIRESPONSEOF VOLITIONAL AND TMS-EVOKED HAND MOVEMENTIS SIMILAR http://www.magventure.com/default.aspx?pageid=245 NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 32 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 33 (a) rTMS-trains consisting of 10 stimuli applied every 200 ms were interleaved with the MR acquistion(b) Brain responses to rTMSstimulation. Shown is the group activation map for 5 subjects (threshold z=2.3 voxellevel, p=0.05 cluster level; FSL FLAME mixed effects analysis; MNI space) (c) Brain activation caused by volitional movements acoustically triggered by rTMStrains at low intensity (same threshold level) (d) overlapbetween rTMS-and movement-related activations. The rTMS-induced activations exhibit a robust spatial overlap with those obtained for volitional movement (c&d). Except for the control region in white matter, they show the expected BOLD shape. Taken together, the example demonstrates that fMRIcan be used to reliably access the responses to TMS in the stimulated and in connected brain areas. http://www.magventure.com/default.aspx?pageid=245 fMRI RESPONSE OF VOLITIONAL AND TMS-EVOKED HAND MOVEMENT IS SIMILAR www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION VISUAL SEARCH www.itk.ppke.hu EFFECT OF TMS ON COGNITIVE FUNCTIONS TMS applied to the parietal cortex.The dotted line at 1.0 on the ordinate indicates the control reaction time in the absence of TMS. The solid line that peaks at 100 msrepresents reaction time relative to control trials, when a target was present; the dashed line that peaks at 160 msrepresents reaction time relative to control trials when target was absent. Walshand Cowey, TrendsinCognitiveSci. 1998 NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 34 www.itk.ppke.hu EFFECT OF rTMS ON LETTER IDENTIFICATION Walshand Cowey, TrendsinCognitiveSci. 1998 The black line (ordinate on the leftrepresenting the number of letters correctly identified in trigrams) shows the effects of TMSonrecognition.The blue line (ordinate to the right showing the proportion ofletters correctly identified in the presence of a visual mask). NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 35 Ridding & Rothwell, Nature Revievs Neuroscience, 2007, 8: 559-567. www.itk.ppke.hu EFFECT OF rTMS ON MOTOR CORTEX EXCITABILITY NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 36 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 37 How repetitiveTMS affects excitability in the brain. a | Time course of changes in excitability of the motor cortex after 25 min repetitive transcranialmagnetic stimulation (rTMS; blue shading) at 1 Hz and an intensity of 90% resting threshold. Data reflect the amplitude of the electromyographicresponse to a single TMS pulse as a percentage of the amplitude before rTMS. The response is suppressed immediately after rTMSand this effect persists to a decreasing extent for the next 30 min. b | Brain images from a study that used positron emission tomography (PET) to measure metabolic activity. The colourcoding shows the areas in which activity after a 25 min session of real 1-Hz rTMSover the dorsal premotorcortex (PMd) is less than that seen after a sham rTMSsession. Numbers in the colourcode bar are Z-scores, which indicate the probability that the activation differs from the rest; Z>4 is highly significant. There are significant decreases in activity after real rTMSat the site of stimulation (outlined in red) as well as at many distant sites. L, left side of the brain. EFFECT OF rTMS ON MOTOR CORTEX EXCITABILITY www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION Pascual-Leone et al.Phil. Trans. R. Soc. Lond. B 1999 www.itk.ppke.hu BoldfMRIshowstheareaof activationofvisualstimulationwithdisplay of random motion(red), verticalmotion(green) orboth(yellow). The barsdepictsthesubject’s accuracyinthedetectionof directionofrandom motionduringTMStofivedifferentscalpposition. EFFECTOF TMSONDETECTIONACCURACY NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 38 Pascual-Leone et al. 1999 www.itk.ppke.hu EFFECT OF TMS ON BRAIN ACTIVATION DURING BRAILLE READING IN BLIND SUBJECTS ActivationonPETof thecontralateralsensorimotorcortexand theoccipitalcortexinan earlyblindsubjectduringBrailereading. Bars show significantincreaseinerrorsduringTMStothesensorimotorcortexinsitedcontrols. IncontrastoccipitopolarTMSinducedincreasedof errorsinearlyand congenitallyblindsubjects. Pascual-Leoneet al. Phil. Trans. R. Soc. Lond. B 1999 NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 39 Twin Coil The patient was oxygenated during anesthesia with 100 % O2. The motor activity of the right foot is assessed visually in order to track the duration of motor seizures, and bilateral frontal-mastoid EEG recordings is obtained by an EEG device. Treatments are delivered with a magnetic stimulator (MagVentureMagProMST) usingthehighly efficient “Twin Coil”. Stimulation repetition rate 100 pps. Number of pulses: 100-600 (duration 1-6s) www.itk.ppke.hu MAGNETIC SEIZURE THERAPY IN DEPRESSION NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 40 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 41 Stimulation amplitude 100%. During the stimulations, the center of the coil is placed at the vertex. The peak magnetic field induced above 2 Tesla at the coil surface. Seizures were elicited under general anesthesia (propofol). Two MST sessions per week. MAGNETIC SEIZURE THERAPY IN DEPRESSION www.itk.ppke.hu Twin Coil http://www.magventure.com/default.aspx?pageid=253 NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION www.itk.ppke.hu DEEP BRAIN rTMS http://www.brainsway.com NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 42 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 43 Dailyprefrontal rTMS(20 Hz, 2 sec on 20 sec off, for 20 minutes, i.e., 1680 stimuli) each day for 4 consecutive weeks (i.e. 20 treatment sessions), at 120% of the individual motor threshold. BrainswayInc. Treatment Resistant Major Depression 4499447983_Big DEEP BRAIN rTMS www.itk.ppke.hu http://www.brainsway.com NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION MS general term for magnetic stimulation, including TMS and stimulation of the peripheral nervous system TMS general term for all modes of transcranial magnetic stimulation rTMS repetitive transcranial magnetic stimulation single-pulse TMS non-repetitive TMS low-frequency TMSslow TMS repetition rate below 1 Hz high-frequency TMS rapid-rate TMS repetition rate above 1 Hz www.itk.ppke.hu ABBREVIATIONS NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 44 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 45 dual-pulse TMSpaired-pulse TMS stimulation with two distinct stimuli through the same coil at a range of different intervals; the intensities can be varied independently quadruple-pulse TMS as dual-pulse stimulation, but with 4 pulses double TMS stimulation with two stimulation coils applied to different cerebral loci; the timing and stimulus intensity are adjusted separately multichannel TMS TMS with multiple (say, 20-100) coils that are independently controlled TMS mapping performed by changing the coil position above the head while observing its effects ABBREVIATIONS www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 46 REFERENCES • MalmivuoJ., Plonsey, R.: Bioelectromagnetism, http://www.bem.fi/book/index.htm1995. • Pascual-Leone A, Davey NJ, RothwellJ, Wassermann EM, PuriBK, (eds.) Handbook of transcranialmagnetic stimulation. New York: Oxford UniversityPress; 2002. • Rossi S et al. Safety, ethical considerations, and application guidelines for the use of transcranialmagnetic stimulation inclinical practice and research. ClinNeurophysiol(2009), doi:10.1016/j.clinph.2009.08.016 • Hallett M, Wassermann EM, Pascual-LeoneA, Valls-SoléJ. Repetitivetranscranialmagnetic stimulation. Recommendations for the practice of clinicalneurophysiology: guidelines of the international federation of clinicalneurophysiology. In: DeuschlG, EisenA, editors. Electroencephalography andclinical neurophysiology, 2nd ed. (Suppl. 52); 1999. p. 105–113. • Ridding MC, RothwellJC. Is there a future for therapeutic use of transcranialmagneticstimulation? NatRevNeurosci2007;8:559–67. • http://www.magventure.com/interleaved-tms-fmri.aspx www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION 9/14/2011. TÁMOP –4.1.2-08/2/A/KMR-2009-0006 47 REVIEW QUESTIONS • What are the principles of transcranial magnetic stimulation? • Who and when applied non-invasive, painless cortical stimulation with magnetic fields for the first time? • What types of TMS devices do you know? • What are the advantages and disadvantages of TMS? • When is the application of TMS contraindicated? www.itk.ppke.hu NEURALINTERFACESAND PROSTHESESTRANSCRANIALMAGNETICSTIMULATION