Described herein are Transcranial Magnetic Stimulation (TMS) methods, devices and systems. In particular, TMS coils that are adjustable to a patient's head are described. Systems may include TMS electromagnets with a pair of coils that are adjustable so that the angle between the coils can be changed and held in selected positions.
Typical transcranial magnetic stimulation (TMS) electromagnets may include multiple fixed coils forming the body of the magnet. Such TMS coil designs have usually been designed for either high focality or deep penetration, and are not specifically configured either to target a specific brain region of to target this brain region even when applied to different users.
For example, the TMS coils described in the patent applications listed below are directed to deep brain TMS methods, including electromagnets. These TMS electromagnets include different designs: U.S. patent application Ser. No. 12/669,882, titled “DEVICE AND METHOD FOR TREATING HYPERTENSION VIA NON-INVASIVE NEUROMODULATION,” and filed on Jun. 2, 2010; U.S. patent application Ser. No. 12/671,260, titled “GANTRY AND SWITCHES FOR POSITION-BASED TRIGGERING OF TMS PULSES IN MOVING COILS”, and filed on Jun. 17, 2010; U.S. patent application Ser. No. 12/670,938, titled “FIRING PATTERNS FOR DEEP BRAIN TRANSCRANIAL MAGNETIC STIMULATION,” and filed on Jun. 17, 2010; U.S. patent application Ser. No. 12/677,220, titled “FOCUSED MAGNETIC FIELDS,” and filed on Sep. 16, 2010; U.S. patent application Ser. No. 12/679,960, titled “DISPLAY OF MODELED MAGNETIC FIELDS,” and filed on Sep. 15, 2010; U.S. patent application Ser. No. 12/680,749, titled “INTRA-SESSION CONTROL OF TRANSCRANIAL MAGNETIC STIMULATION,” and filed on Jul. 14, 2010; U.S. patent application Ser. No. 12/680,912, titled “TRANSCRANIAL MAGNETIC STIMULATION WITH PROTECTION OF MAGNET-ADJACENT STRUCTURES,” and filed on Jul. 14, 2010; U.S. patent application Ser. No. 12/324,227, titled “TRANSCRANIAL MAGNETIC STIMULATION OF DEEP BRAIN TARGETS,” and filed on Nov. 26, 2008; U.S. patent application Ser. No. 12/990,235, titled “TRANSCRANIAL MAGNETIC STIMULATION BY ENHANCED MAGNETIC FIELD PERTURBATIONS,” and filed on Nov. 30, 2010; U.S. patent application Ser. No. 12/185,544, titled “MONOPHASIC MULTI-COIL ARRAYS FOR TRANSCRANIAL MAGNETIC STIMULATION,” and filed on Aug. 4, 2008; U.S. patent application Ser. No. 12/701,395, titled “CONTROL AND COORDINATION OF TRANSCRANIAL MAGNETIC STIMULATION ELECTROMAGNETS FOR MODULATION OF DEEP BRAIN TARGETS,” and filed on Feb. 5, 2010; U.S. patent application Ser. No. 13/141,100, titled “SHAPED COILS FOR TRANSCRANIAL MAGNETIC STIMULATION,” and filed on Aug. 1, 2011; U.S. patent application Ser. No. 12/838,299, titled “TRANSCRANIAL MAGNETIC STIMULATION FIELD SHAPING,” and filed on Jul. 16, 2010; U.S. patent application Ser. No. 12/912,650, titled “SUB-MOTOR-THRESHOLD STIMULATION OF DEEP BRAIN TARGETS USING TRANSCRANIAL MAGNETIC STIMULATION,” and filed on Oct. 26, 2010; and U.S. patent application Ser. No. 13/169,967, titled “ENHANCED SPATIAL SUMMATION FOR DEEP-BRAIN TRANSCRANIAL MAGNETIC STIMULATION,” and filed on Jun. 27, 2011.
The inventors herein suggest, based on ongoing experimental data, that there may be clinical efficacy in deliberately steering the direction of induced current to a particular brain region, and in particular, directing induced current across a distance that may traverse two or more structures involved in a targeted brain circuit.
However, the fixed-coil TMS electromagnets currently available are not configured to produce an elongated path of induced electrical current along a pre-defined trajectory while adapting to differences in the curvature of each patient's head. For example, even the more physically flexible, large-coil designs currently available stimulate too much brain tissue lateral to the targeted strip, and thereby raise safety concerns. Thus, there is a need for TMS electromagnets (“coils”) that stimulate along an extended linear trajectory while conforming to the unique curvature of each patient's head.
Described herein are TMS electromagnets and methods of using them to treat patients that may address the concerns raised above.
In general, described herein are TMS electromagnets that are configured to target specifically and exclusively a predefined target brain region, even when applied to patients having different head shapes. Thus, the TMS electromagnets may be configured to adjust to different patient head geometries, while targeting the same specific brain region (and not substantially targeting other brain regions. Also described herein are methods of using such TMS electromagnetic devices.
For example, described herein are TMS electromagnet device(s) that are configured to provide transcranial magnetic stimulation to a specified area of the brain, wherein the specific area of the brain is a longitudinal strip extending from the left dorsolateral prefrontal cortex to the medial frontal cortex overlying the dorsal anterior cingulate gyrus; these TMS electromagnets may target this same region a variety of head sizes and shapes using the same coil apparatus. This TMS electromagnet (coil apparatus) may therefore be adjustable to different head sizes while maintaining the same brain target region(s).
In some variations a Transcranial Magnetic Stimulation (TMS) electromagnet device may include: an adjustable head frame that is configured to be worn on the patient's head and holds at least one TMS electromagnet that is (or can be) oriented to stimulate a predetermined target brain region without substantially stimulating more laterally positioned regions; and a TMS electromagnet that is adjustably connected to the adjustable head frame, wherein the TMS electromagnet comprises a first TMS coil and a second TMS coil that are adjustably and electrically connected to each other so that the angle between the first and second TMS coils may be adjusted.
In general, a TMS electromagnet device as described herein may also include a second (or third, fourth, fifth, etc.) TMS electromagnet that is adjustably connected to the adjustable head frame, wherein the second TMS electromagnet comprises a third TMS coil and a fourth TMS coil that are adjustably and electrically connected to each other so that the angle between the third and fourth TMS coils may be adjusted. Each of the pair of TMS coils may include multiple windings of a material used to form the TMS electromagnet, and the two coils may be connected so that the windings of each are electrically connected (and continuous), so that the TMS electromagnet functions as a unit. As shown and descried in greater detail herein, these TMS electromagnets (which may be referred, for convenience, as “hinged TMS electromagnets” or “angle adjustable TMS electromagnets”) typically include a region between each coil that permits the two coils to be adjusted relative to each other. For example, the first coil may be bent, twisted, rotated, angled, etc. The adjustment may be along a line (e.g., hinged motion) or a point (e.g., pivoting), so that the planes of each coil move relative to each other.
For example, the TMS electromagnet may be configured so that the angle between the plane of the first TMS coil and the plane of the second TMS coil may be adjusted from a hinge region between the first TMS coil and the second TMS coil. In some variations, the TMS electromagnet is configured so that the angle between the plane of the first TMS coil and the plane of the second TMS coil may be adjusted from a pivot point between the first TMS coil and the second TMS coil.
In some variations, the TMS device includes a lock, holder, or other securement that is configured to hold the angle between the first TMS coil and the second TMS coil of the TMS electromagnet once it has been adjusted. The lock/holder may be released and re-secured, or in some variations it may be permanent. The lock may be secured by screwing, or otherwise engaging a member, pin, clasp, etc.
The adjustable head frame devices may be configured to target any appropriate brain region. For example, the devices may be configured to aim TMS at a predetermined brain region such as the left dorsolateral prefrontal cortex to medial frontal cortex overlapping the dorsal anterior cingulate gyrus. The adjustable head frame may include an adjustable headband. The
TMS electromagnets may be held to the adjustable head frame by one or more holders that retain the TMS electromagnet(s) on the head frame, but allows it to be adjusted so that the shape of the TMS electromagnets may be conformed to the subject's head. The holder(s) may be configured so that they generally aim the TMS electromagnets to a predetermined target, but allow just enough movement of the TMS electromagnets so that they can conform to the head.
Thus also generally described herein are adjustable Transcranial Magnetic Stimulation (TMS) electromagnets (adjustable TMS electromagnet devices), that may include: a first TMS coil comprising multiple coil windings; a second TMS coil comprising multiple coil windings; an adjustable connecting region between the first TMS coil and the second TMS coil, wherein the adjustable connecting region is configured so that the angle between the first and second TMS coils may be adjusted; and a lock configured to hold the adjustable connecting region in a predetermined position, wherein the first TMS coil and the second TMS coil are electrically connected through the adjustable connecting region so that current flows between the first TMS coil and the second TMS coil. Although TMS electromagnets having two coils are described and shown herein, it should be understood that these devices may include three, four, or more coils; these coils may be connected at a single connecting region or multiple adjustable connecting regions may be included.
As mentioned, any of these devices may include a hold or lock configured to lock the angle between the coils (e.g., the first TMS coil and the second TMS coil) of the TMS electromagnet once it has been adjusted.
In some variations, the adjustable connecting region may comprise a hinge region configured so that the angle between a plane of the first TMS coil and a plane of the second TMS coil may be adjusted from the hinge region. In some variations, the adjustable connecting region comprises a pivot region (which may be a pivot point) configured, e.g., so that the angle between the plane of the first TMS coil and the plane of the second TMS coil may be adjusted from the pivot region.
Also described herein are coil devices for Transcranial Magnetic Stimulation (TMS), the device comprising: a curved undersurface configured to approximate the curvature of a human skull; an outwardly extending portion for either drawing or returning current to/from the curved undersurface; an inwardly extending region for either drawing or returning current to/from curved undersurface. In some variations the inwardly and outwardly portions are joined in electrical contact. In some variations, the curved undersurface comprises a flexible conductive material that conforms to the shape of patient's skull when in the specified position.
In general, the devices described herein include one or more TMS electromagnets that are configured to be worn on a patients head to induce current in a specific target region of the patient's brain (e.g., the left dorsolateral prefrontal cortex overlaying the dorsal anterior cingulate gyrus). The devices maybe configured to stimulate this region specifically (and without substantially stimulating non-target regions) in a variety of head sizes and shapes using the same device.
In some variations this device includes a head mount holding the TMS electromagnet, which may be configured as a hat, helmet, headband, or the like. The position or orientation of the TMS electromagnets (which may include two or more TMS electromagnets or coils) may be fixed, while various subcomponents of the TMS electromagnets may be adjustable.
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The positive side 1052 of curved undersurface 1005 is placed approximately over the F3 (EEG 10-20 nomenclature), or the left dorsolateral prefrontal cortex, Brodmann's Area 9/46. The negative side 1054 of curved undersurface 1005 is placed over medial frontal cortex, anterior to C7 (1015), but posterior to F2 (1016). In this manner, conventional electrical current flows within the curved undersurface 605 from the left side of the head.
Although the description above is broken into parts and includes specific examples of variations of suture passers, any of the features or elements described in any particular example or section may be incorporated into any of the other embodiments. Although the foregoing invention has been described in some detail by way of illustration and example for purposes of clarity of understanding, it is readily apparent to those of ordinary skill in the art in light of the teachings of this invention that certain changes and modifications may be made thereto without departing from the spirit or scope of the appended claims.
This patent application claims priority to provisional patent application No. 61/642,290, filed on May 3, 2012. This provisional patent application is herein incorporated by reference in its entirety. All publications and patent applications mentioned in this specification are herein incorporated by reference in their entirety to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference.
Filing Document | Filing Date | Country | Kind |
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PCT/US2013/039537 | 5/3/2013 | WO | 00 |
Number | Date | Country | |
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61642290 | May 2012 | US |