Determining stimulation levels for transcranial magnetic stimulation
First Claim
1. A system for determining a patient'"'"'s motor threshold level for stimulation of the patient'"'"'s motor cortex for use in transcranial magnetic stimulation of the patient, comprising:
- a stimulation magnet that generates transcranial magnetic stimulation (TMS) fields for application to the patient;
a transcranial magnetic stimulation (TMS) stimulator that outputs stimulation signals for causing said stimulation magnet to generate TMS fields;
a sensing device that detects a change in the patient'"'"'s condition indicative of motor threshold during application of the TMS fields and outputs sensed signals; and
a detector responsive to said stimulation signals and said sensed signals to determine if a detected change in the patient'"'"'s condition indicative of motor threshold is induced by a stimulation signal and to output a correlation signal indicative of correlation of the detected change and the stimulation signal.
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Accused Products
Abstract
Induced movement in a patient is detected and correlated with a TMS stimulating pulse so as to determine the patient'"'"'s motor threshold stimulation level. Direct visual or audible feedback is provided to the operator indicating that a valid stimulation has occurred so that the operator may adjust the stimulation accordingly. A search algorithm may be used to direct a convergence to the motor threshold stimulation level with or without operator intervention. A motion detector is used or, alternatively, the motion detector is replaced with a direct motor evoked potential (MEP) measurement device that measures induced neurological voltage and correlates the measured neurological change to the TMS stimulus. Other signals indicative of motor threshold may be detected and correlated to the TMS stimulus pulses. For example, left/right asymmetry changes in a narrow subset of EEG leads placed on the forehead of the patient or fast autonomic responses, such as skin conductivity, modulation of respiration, reflex responses, and the like, may be detected. The appropriate stimulation level for TMS studies are also determined using techniques other than motor cortex motor threshold methods. For example, a localized ultrasound probe may be used to determine the depth of cortical tissue at the treatment site. When considered along with neuronal excitability, the stimulation level for treatment may be determined. Alternatively, a localized impedance probe or coil and detection circuit whose Q factor changes with tissue loading may be used to detect cortical depth.
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Citations
43 Claims
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1. A system for determining a patient'"'"'s motor threshold level for stimulation of the patient'"'"'s motor cortex for use in transcranial magnetic stimulation of the patient, comprising:
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a stimulation magnet that generates transcranial magnetic stimulation (TMS) fields for application to the patient;
a transcranial magnetic stimulation (TMS) stimulator that outputs stimulation signals for causing said stimulation magnet to generate TMS fields;
a sensing device that detects a change in the patient'"'"'s condition indicative of motor threshold during application of the TMS fields and outputs sensed signals; and
a detector responsive to said stimulation signals and said sensed signals to determine if a detected change in the patient'"'"'s condition indicative of motor threshold is induced by a stimulation signal and to output a correlation signal indicative of correlation of the detected change and the stimulation signal. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14)
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15. A system for determining an appropriate stimulation location for transcranial magnetic stimulation of a patient, comprising:
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a stimulation magnet that generates transcranial magnetic stimulation (TMS) fields for application to the patient;
a transcranial magnetic stimulation (TMS) stimulator that outputs stimulation signals for causing said stimulation magnet to generate TMS fields;
a probe that measures depth of cortical tissue at a treatment site and outputs a measurement signal;
a detector responsive to said stimulation signals and said measurement signal to determine neuronal excitability; and
a processor that determines cortical depth at a therapy location and calculates a treatment stimulation level at the therapy location using a neuronal excitability and the measured cortical depth of cortical tissue. - View Dependent Claims (16, 17, 18, 19, 20)
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21. A method of determining a patient'"'"'s motor threshold of the patient'"'"'s motor cortex for use in transcranial magnetic stimulation of the patient, comprising the steps of:
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generating stimulation signals for causing a stimulation magnet to generate transcranial magnetic stimulation (TMS) fields;
generating TMS fields in response to said stimulation signals for application to the patient;
detecting a change in the patient'"'"'s condition indicative of motor threshold during application of the TMS fields and outputting sensed signals; and
determining if a detected change in the patient'"'"'s condition indicative of motor threshold is induced by a stimulation signal and outputting a correlation signal indicative of correlation of the detected change and the stimulation signal. - View Dependent Claims (22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33)
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34. A method of determining an appropriate stimulation level for transcranial magnetic stimulation of a patient, comprising the steps of:
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generating stimulation signals for causing a stimulation magnet to generate transcranial magnetic stimulation (TMS) fields;
generating TMS fields in response to said stimulation signals for application to the patient;
measuring a depth of cortical tissue at a treatment site and outputting a measurement signal; and
determining if a measured depth of cortical tissue at the treatment site correlates to a treatment level determined using motor threshold measurement at the motor cortex. - View Dependent Claims (35, 36, 37, 38, 39, 40, 41, 42, 43)
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Specification