T022 Shaping the temporal characteristics of transcranial magnetic stimulation

Publication date: March 2017
Source:Clinical Neurophysiology, Volume 128, Issue 3
Author(s): A. Peterchev
The pulse waveform of transcranial magnetic stimulation (TMS) affects the degree to which various neuronal elements and populations are activated as well as the strength of neuromodulation resulting from repetitive TMS. Conventional TMS devices allow very limited pulse waveform adjustment; therefore we developed TMS devices with controllable pulse parameters (cTMS). So far cTMS has been used, by our and other groups, to study strength-duration curves in motor cortex and the associated neural membrane time constants; pulse-width dependence of motor input–output curves, cortical neuron recruitment, paired-pulse paradigms, and scalp sensation; and pulse-shape dependence of neuromodulatory effects. These studies show that changing the pulse width, shape, and/or direction may alter the neural elements that are preferentially activated in cortex, as evidenced by differences in motor evoked potential latencies and membrane time constants. These parameters also affect the changes of neural excitability resulting from 1Hz and intermittent theta burst stimulation. For the 1Hz protocol, the near rectangular cTMS pulses produced stronger inhibition than conventional sinusoidal pulses, with unidirectional cTMS pulses having the strongest effect. As well, cTMS has been used to optimize new repetitive paired-pulse stimulation protocols. cTMS was also used to show that the slope of motor input–output curves depends on pulse width via the same mechanism driving the strength-duration relationship of motor threshold. Finally, the pulse width affects the perceived scalp sensation of TMS, with briefer pulses feeling sharper and slightly more uncomfortable than longer pulses. In parallel with exploring the capabilities afforded by cTMS, we are developing a next generation ultraflexible TMS device called a modular pulse synthesizer (MPS) that would allow the generation of essentially any pulse shape and pulse sequence/train within the energy levels practical for TMS. The development and adoption of cTMS and MPS could enable expanded utilization of the temporal characteristics of TMS as a means of enhancing functional targeting, noninvasive biomarkers, neuromodulatory potency, and tolerability.



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