A Magstim Super Rapid stimulator (Magstim Co. Ltd, Whitland, UK) with a figure-of-eight coil configuration was used for all patients. Size was recorded from the right first dorsal interosseous at rest by delivering 900 stimuli (90% of resting motor threshold, RMT) at 1 Hz for 15 min. The RMT was calculated by applying single-pulse TMS stimulation using a TMS stimulator attached to an electromyography machine. Motor evoked potential was recorded from the first dorsal interosseous muscle using Ag-AgCl surface electrodes placed over the muscle in a belly tendon arrangement. The RMT determined the lowest intensity that produced motor evoked potentials of >50 lV in at least five out of 10 trials. These were applied tangentially to the scalp with the handle pointing backwards and laterally at an approximate angle of 45°to the mid-sagittal line, and perpendicular to the presumed direction of the central sulcus.
Super rapid stimulator
Manufactured by Magstim
Sourced in United Kingdom
The Magstim Super Rapid stimulator is a non-invasive brain stimulation device. It generates magnetic pulses to stimulate specific areas of the brain. The device is designed to be used in research and clinical settings.
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20 protocols using super rapid stimulator
1
Resting Motor Threshold Determination
2
Repetitive Transcranial Magnetic Stimulation of Pre-SMA
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rTMS treatments were administered using a MAGSTIM super-rapid stimulator (Magstim Company, Ltd., Whitland, UK) with a focal 8-shaped, 70-mm coil. Stimulation parameters were 1-Hz, 20 min trains (1,200 pulses/day) at 100% of the resting motor threshold (MT), once per day, 5 days per week, for 4 weeks. For determining the MT level, we used the thumb-movement visualization method by stimulating the left primary motor cortex. The coil was positioned over the pre-SMA, which we targeted using the International 10–20 EEG System. The pre-SMA was defined as 15% of the distance between the inion and nasion on the anterior plane to the Cz (vertex) on the sagittal midline. The coil was placed with the handle along the sagittal midline, pointing toward the occiput for bilaterally and simultaneously stimulating the pre-SMA. The sham treatment targeted using the International 10–20 EEG System. The sham treatment was performed using the Neurosoft sham coil, wherein a metal plate placed inside the coil prevents the magnetic field from stimulating the cortex. This coil looks and sounds like an active one; however, it does not feel the same when receiving active rTMS, which generates a tapping sensation on the scalp. Therefore, for maintaining patient blinding we excluded all those who had, for any reason, experienced active rTMS.)
3
Focal Cortical Suppression and Cerebellar rTMS
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A Magstim super‐rapid stimulator (The Magstim Company) was used to deliver trains of stimuli through a figure‐of‐eight coil with a 70 mm outer diameter and a maximal output of 1.8 Tesla. To induce focal cortical suppression (the ‘virtual lesion’), 600 pulses of 1 Hz rTMS at 120% of pharyngeal resting motor threshold (RMT) were performed over the hemisphere with the largest PMEP as previously described (Mistry et al. 2007 ). High frequency stimulatory cerebellar rTMS was delivered as described by Vasant et al. (2015 ), consisting of 250 pulses of 10 Hz rTMS at 90% of thenar RMT delivered over the cerebellar hemispheres.
4
cTBS Modulation of Right FDI Cortical Excitability
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In Experiment 1, an air-cooled figure-of-eight coil connected to a Magstim Super Rapid stimulator (Magstim Company, Dyfed, UK) was used to apply cTBS with a biphasic pulse waveform (current direction PA-AP) to the optimal site for stimulating the right FDI. The cTBS protocol consisted of 600 pulses applied in bursts of three pulses at 50Hz, repeated at 5Hz for a total of 40 seconds [3] . The intensity of stimulation was set to 70% RMT [25, 26] , assessed prior to cTBS application using the rTMS coil.
5
Inducing Cortical Plasticity with Spaced cTBS
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Spaced continuous theta burst stimulation (cTBS) was used to induce plasticity within the left motor cortex. cTBS produces a transient reduction in corticospinal excitability that is thought to reflect an early form of long-term depression synaptic plasticity [14 (link)]. The application of a spaced cTBS protocol consists of two cTBS protocols applied 10 min apart and has been shown to induce a longer-lasting and more robust plasticity response [22 (link),23 (link),24 (link)]. cTBS was applied to the left motor cortex using an air-cooled figure-of-eight coil connected to a Magstim Super Rapid stimulator (Magstim, Whitland, Dyfed, UK). Each cTBS protocol consisted of three stimuli delivered at 50 Hz presented every 200 ms during a period of 40 s, delivered in a continuous manner (a total of 600 stimuli) [25 (link)]. Similar to in previous studies, the intensity of stimulation was set up to 70% of RMT-biphasic, which was determined using the same Magstim Super Rapid and air-cooled coil as used for the delivery of cTBS [22 (link)]. Participants remained relaxed during all neurophysiological experimental procedures, and the EMG was visually monitored to ensure that muscles were at rest.
6
Interleaved TMS/BOLD Imaging of cTBS Effects
7
High-Frequency rTMS for Depression
8
Anterior SMA rTMS Protocol for Neuromodulation
9
Targeting Ventrolateral Anterior Temporal Lobe with TMS
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A MagStim Super Rapid stimulator (The MagStim Company, Whitland, UK) was used to deliver stimulation with a figure of eight coil (70 mm). Resting motor threshold (RMT) was defined as a minimal intensity of stimulation inducing twitches in the contralateral first dorsal interosseous muscle of the right hand in at least 5 of 10 stimulations at rest. The average RMT intensity was 60.7% ± 7.2 in the experiment.
The target site [MNI: Montreal Neurological Institute, −57 −15 −35] was selected from previous fMRI and TMS studies (Jung and Lambon Ralph, 2016 (link); Visser et al., 2012 (link)). The coordinate was located on the ventrolateral ATL (Fig. 1 C) and transformed to each participant's native space. Statistical Parametric Mapping software (SPM8, Wellcome Trust Centre for Neuroimaging, London, UK) was used to normalize participants’ MRI scan against the MNI template and to convert the target coordinate to the untransformed individual native space coordinate using the inverse of each resulting transformation. These native space coordinates guided the frameless stereotaxy, via a Brainsight TMS-MRI co-registration system (Rogue Research, Montreal, Canada).
The target site [MNI: Montreal Neurological Institute, −57 −15 −35] was selected from previous fMRI and TMS studies (Jung and Lambon Ralph, 2016 (link); Visser et al., 2012 (link)). The coordinate was located on the ventrolateral ATL (
10
Transcranial Magnetic Stimulation of Prefrontal Cortex
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Participants’ heads were co-registered with their T1 MRI images using BrainSight™ frameless stereotaxic software (Rogue Research, Montreal, QC, Canada) to confirm the anatomical locus of stimulation. A Magstim Super-Rapid Stimulator (Magstim Co., Whitland, Dyfed, UK) was used to deliver the magnetic stimulation. TMS sessions corresponded to two targeted areas: (1) left MFG (center of BA 9); and (2) right MFG (center of BA 9).
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