Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
  • A61N2/00—Magnetotherapy
  • A61N2/02—Magnetotherapy using magnetic fields produced by coils, including single turn loops or electromagnets

Definitions

• the present invention relates to the general technical field of transcranial magnetic stimulation (SMT) and more specifically to an apparatus for use in the context of a transcranial stimulation using a magnetic antenna.
• SMT transcranial magnetic stimulation
• the transcranial magnetic stimulation technique consists, after identifying a target zone of the brain, to emit, on this target area, a specific magnetic field using an antenna causing modifications of the neuronal activity.
• the magnetic stimulation technique has many medical applications where therapeutic effects are known notably in neurology for the treatment of motor disorders, in the algology for the treatment of pain or in psychiatry for the treatment of chronic depression, obsessive-compulsive disorders, post-traumatic stress, schizophrenia, etc.
• a device for providing transcranial stimulation generally comprises a generator connected to a transmitting antenna mounted on a gripping support so as to enable it to be positioned facing the target zone of the brain.
• the positioning of the magnetic stimulation antenna is carried out for example by neuronavigation, by functional response, with the aid of magnetic resonance imaging tracking equipment, etc. Maintaining the position of the antenna in relation to the target zone is often a delicate operation to carry out. For example, it is known to maintain the antenna in a rudimentary manner using, for example, a bracelet or an adhesive holding strip.
• GB 2 164 856 has proposed an adapter for defining the position of target structures of the brain.
• This adapter comprises a support support for the head of a patient composed of a nasal support and two ear supports. This support support is provided with a mounting foot to a supporting structure.
• Such an adapter is not adapted to be implemented in the context of a transcranial stimulation using a magnetic antenna since this adapter offers no solution for simply and accurately positioning the magnetic stimulation antenna while not causing inconvenience to the user.
• the present invention therefore aims to remedy the drawbacks of the state of the art by proposing a new apparatus that can be used in the context of a transcranial stimulation performed using a magnetic stimulation antenna, this apparatus being designed to enable to position the magnetic stimulating antenna in a simple and precise manner without causing any inconvenience to the patient.
• Another object of the invention is to provide an apparatus providing the possibility of positioning the magnetic stimulation antenna in a precise position and repeatedly.
• the present invention relates to an apparatus used in the context of a transcranial stimulation implementing a magnetic stimulation antenna.
• the apparatus comprises at least one holding instrument for the head of a person, comprising:
• this mounting structure being equipped with locking means for placing the antenna in a fixed position relative to the support support.
• the support support comprises at least one posterior support and anterior support for the head
• the support support comprises means for adjusting the relative position of the posterior support relative to the anterior support
• the means for adjusting the relative position of the anterior support relative to the posterior support comprise two rings mounted to rotate with respect to a body, on either side of the posterior support, each being traversed by a branch of a bow provided with the front support and able to slide relative to the rings, each ring being provided with a member ensuring the angular locking of the ring and the locking sliding of the bow,
• the arch is equipped on each of its branches with a temporal support member
• the fixing device comprises a flexible system allowing limited movements of the bearing support with respect to the support frame; the fixing device comprises, as a flexible system, a fastening tab extending from the body and whose rigidity is adapted to allow limited flexion of the support support in a sagittal plane and in a frontal plane.
• Another object of the invention is to provide an apparatus adapted to identify a zone or a target position of the patient's head with respect to which the stimulation antenna is to be positioned.
• the apparatus comprises a removable frame for locating a target position in the space with respect to which the stimulation antenna is to be positioned, this removable frame comprising: a base provided with a positioning system of the frame with respect to the head, equipped with at least one support member on the holding instrument,
• a movable structure mounted on the base and equipped with a marker element for the target position, this mobile structure being provided with locking means for placing the marker element in a fixed position.
• the removable frame can be implemented with one and / or the other of the following characteristics: the mobile structure is provided with graduations making it possible to know the position of the registration element with respect to the base,
• the mobile structure comprises: a semicircular arc mounted at each of its ends, pivoting on the base along a half-axis established in the frontal plane, a slide mounted movably sliding along the arc half circular, o a mounting platform of the locating element mounted movably on the slider, o and locking means in the position of the semicircular arc, - the positioning system of the frame comprises two insertion rods in the auditory ducts mounted coaxially to each other being adjustable in spacing-approximation relative to each other, the support member being slidably mounted in a direction perpendicular to the rods and being provided with a double anchor fork on the front support.
• Another object of the invention is to provide an apparatus adapted to locate with coordinates a zone or a target position of the brain of a patient.
• the apparatus comprises an imaging material comprising a U-shaped body provided with two mounting rods in the auditory ducts and an anterior support member, the U-shaped body being equipped with markers detectable by MRI.
• the apparatus also comprises a system for converting the coordinates of a target point determined using the co-ordinate locating material identifiable by the marker element carried by the movable structure of the removable frame mounted on the support support of the sustaining instrument.
• Figure 1 is a perspective view of a holding instrument according to the invention forming part of an apparatus used in the context of transcranial stimulation.
• Figure 2 is a perspective view of three A rear of the holding instrument shown in Fig. 1 and provided with a stimulation antenna.
• Figure 3 is a perspective of a removable locating frame forming part of an apparatus according to the invention.
• Figures 4 and 5 are perspective respectively of profile and top of the removable locating frame mounted on a holding instrument.
• Figure 6 is a perspective of imaging tracking equipment.
• the object of the invention relates to an apparatus 1 adapted for use in the context of a transcranial stimulation of a zone or a target point of the brain by implementing a magnetic stimulation antenna 2.
• the apparatus 1 comprises at least one instrument 3 ensuring the maintenance of the head of a person, but also the support of the magnetic stimulation antenna 2 in a precise position of the space according to the target area.
• the maintenance of a head is considered with respect to the frontal plane or front view F, sagittal plane S, that is to say the vertical plane perpendicular to the frontal plane F, to the transverse plane T, that is to say, the horizontal plane perpendicular to the sagittal and frontal planes.
• the holding instrument 3 comprises a support support 4 for the head of a person, adapted to maintain the head during the setting implementation of magnetic stimulation.
• the support support 4 allows maintenance of the head in at least two opposite sides of the head.
• the support support 4 comprises at least one posterior support 6 for the head and an anterior support 7 for the head.
• this holding instrument 3 comprises means 9 for adjusting the relative position of the anterior support 7 with respect to the posterior support 6 so as to allow the passage of the head and the adaptation of the this instrument of maintenance 3 to different sizes and shapes of people's heads.
• the posterior support 6 is in the form of a support cushion shaped diabolo to allow support for the neck of the patient.
• This posterior support 6 is carried by a body 10 made in the example illustrated in the form of a stirrup.
• the support cushion 6 is mounted between the retractor arms 10 being carried by a not shown shaft projecting from the support cushion 6 which is thus engaged between the two rear branches 10.
• the anterior support 7 is carried by a hoop 12 of generally U-shaped shape supported by the body 10.
• the hoop 12 thus has two branches 12i extending parallel to one another and connected by a connecting part of which the medium is provided with the anterior support 7.
• the anterior support 7 is intended to be positioned at the level of the crown of the patient's nose.
• this front support 7 has a diabolo shape being coated or not with a soft material in contact.
• the posterior support cushion 6 may be provided with a soft contact coating for the patient's head.
• the adjustment means 9 allow between the posterior support 6 and the front support 7 on the one hand a relative approximation and spacing and, on the other hand, an adjustable relative angulation.
• the two branches 12i of the arch 12 are engaged in rings 14 mounted on the axis protruding from the branches of the stirrup 10.
• the rings 14 are mounted free to rotate around the axis so as to allow the rotation of the arch in the sagittal plane S allowing the relative angulation between the supports.
• Each ring 14 is provided with a member 15 such as a clamping screw for ensuring the angular locking of the ring 14 and the sliding blocking of the bow 12.
• the holding instrument 3 also comprises a fixing device 17 of the support support 4 to a support frame 18 in the general sense such as an armchair or a bed for example.
• the fixing device 17 comprises a flexible system 20 allowing limited movements of the support support 4 relative to the support frame 18 to improve the comfort of the patient during the implementation of the technique of magnetic stimulation. This flexible system 20 thus allows movements on a limited stroke in one or more directions.
• the flexible system 20 allows the movements of the support support in at least two directions and with a limited amplitude in each of these directions.
• the flexible system 20 allows the bending of the support support 4 in the sagittal plane S and its rotation about its vertical axis Z allowing a rotation in the transverse plane T.
• the fastening device 17 ensures complete blocking of the head with the exception of a possibility of limited inclination from front to back of the head and rotation of the head from left to right and vice versa.
• these movements are limited to an angular amplitude at most equal to 15 °. This limited freedom of movement prevents the patient the phenomenon of stress attached to a complete blockage of the head.
• the flexible system 20 is made by a fixing lug fixed on the body 10.
• This fixing lug 20 has a rigidity adapted to ensure the fixed position of the support support 4 to the exception of the possibility of bending in the plane sagittal S and rotation about its longitudinal axis in limited amplitudes.
• This fixing lug 20 which has a generally elongate flat shape, comprises a series of holes 25 for adjusting its fixing position on the support frame 18 in the form of a tube in which the fixing lug 20 is engaged. .
• the locking in position of the lug 20 on the support frame 18 is provided for example by a clamping nut 26 blocking the lug 20 inside the tube 18.
• the holding instrument 3 also comprises a mounting structure 30 for the magnetic stimulation antenna 2.
• This structure 30 is supported by the support support 4 and makes it possible to adjust the positioning of the magnetic stimulation antenna 2 relative to at the head, that is to say relative to the support support 4.
• the mounting structure 30 comprises a rod 31 fixed on the body 10 with a ring 31i. This rod 31 extends from the body 10 in a direction opposite to that of extension of the hoop 12.
• This mounting structure 30 also comprises a ring 32 slidably mounted on the rod 31 and supporting a hinged compass 33 at the end of which is mounted a receiving member 34 of the magnetic stimulation antenna 2.
• the ring 32 can be locked in position. position along the rod 31 by a locking member 35, such as a clamping screw.
• the articulation of the compass 33 is provided with a locking element 36 enabling the magnetic stimulation antenna 2 to be locked in a fixed position with respect to the body 10.
• the receiving member 34 can in the illustrated example, the receiving member 34 is provided with a bore for receiving the handle 2i of the antenna which is blocked in by the locking device 37.
• the holding instrument 3 makes it possible to provide a function for holding the head of a person, combined with a support function for the body.
• antenna magnetic stimulation 2 is not supported by the patient, but by the body 10.
• the holding instrument 3 offers a possibility of limited movements to the head ensuring a relative comfort to the patient.
• the use of the holding instrument 3 according to the invention is relatively simple to carry out and follows from the foregoing description. After fixing the support support 4 to a frame 18 with the aid of the fixing device 17, the patient's head is placed in support, by its nape, on the posterior support 6. To facilitate this maneuver, the The hoop 12 is pivotally or retracted away from the support 10.
• the hoop 12 is then pivotally and / or slidably displaced so that the anterior support 7 comes into contact with the upper part of the nose.
• the locking of the clamping screws 15 makes it possible to obtain a good hold of the head in the clamped or pinched position between the posterior supports 6 and front 7, with the possibility of micromovements as explained above.
• the hoop 12 can be equipped on each of its branches, a temporal support member 38.
• each temporal support member 38 is mounted on a ring 39 slidably mounted on a leg of the hoop 12 and locked in position by a locking screw 39i.
• the mounting structure 30 After mounting the magnetic stimulation antenna 2 on the receiving member 34, the mounting structure 30 is adjusted so that the antenna 2 is positioned in relation to the target area of the brain.
• the positioning of the antenna 2 in relation to a target zone can be carried out in any appropriate manner.
• the mounting structure 30 is then locked to maintain the antenna 2 in its final position.
• the locking member 35, the locking member 36 and the locking button 37 are locked.
• the antenna 2 follows the micromovements of the body 10.
• the apparatus 1 comprises a removable frame 40 for locating a target position in the space with respect to which the magnetic stimulation antenna 2 is to be positioned.
• this removable frame 40 comprises a base 41 provided with a positioning system 42 of the frame 40 relative to the head.
• this positioning system 42 is provided with at least one support member 43 on the holding instrument 3 as it appears more specifically in FIGS. 4 and 5.
• the support member 43 is intended to come to rest at the level of the front support 7 of the support 4.
• the base 41 of generally triangular shape has two arms 41i interconnected in a central zone equipped with the support member 43.
• the support member 43 comprises a rod 44 mounted movably sliding on the base 41.
• the rod 44 is provided at one end with a double fork 45 intended to be anchored on the hoop 12 on either side of the front support 7 as shown in FIG. 5.
• the two arms 41i are provided, at each of their free end, with an insertion rod 46 in an auditory canal.
• the two insertion rods 46 are mounted coaxially to one another by being adjustable in spacing-approximation relative to each other.
• each insertion rod 46 slides inside bores arranged in two fingers 4I 2 extending from each end of the branches 41i.
• the two insertion rods 46 and the rod 44 extend in one plane.
• the rod 44 of the support member 43 slides in a direction perpendicular to the direction of the insertion rods 46.
• the rods 44, 46 are slidably adjustable to allow correct and precise positioning on the head.
• the rods 44, 46 are equipped with locking members to lock them in position after adjustment.
• the rods 44, 46 are provided with graduations to identify their position of extension relative to the base 41. It should be noted that the correct positioning of the frame 40 on the head is obtained when the two rods 46 ' extend projecting relative to the base 41 according to an identical value. In this position, the axis passing through the rod 44 of the support member 43 intersects the axis passing through the two rods 46, in the middle of the distance separating said rods 46.
• the removable frame 40 also comprises a movable structure 48 mounted on the base 41 and equipped with a locating element 49 of the target position.
• This mobile structure 48 is adapted to allow positioning of the locating element 49 at any point in the space corresponding to the target point of the brain.
• this mobile structure 48 comprises a semicircular arc 51 pivotally mounted at each of its ends, on the base 41 along a half-axis 52 carried by the base 41.
• the half-shafts 52 are mounted in a collinear manner in coincidence with the insertion rods 46.
• This semicircular arc 51 is pivotally mounted around the half-shafts 52, having as a center of rotation, the point d intersection of the axis passing through the rod 44 with the axis passing through the two rods 46.
• the movable structure 48 also comprises a slider 55 slidably mounted along the semicircular arc 51.
• the slider 55 is therefore able to be displaced in the plane of the semicircular axis 51 over an angular range of 1 order of 180 °.
• This slide 55 is provided with a mounting platform 56 on which the marking element 49 is mounted.
• the mounting platform 56 is mounted relative to the slide 55, with a possibility of movement to locate any target point of the brain.
• this mounting platform 56 allows the pivoting element 49 to pivot with respect to the slider 55 in the plane perpendicular to the plane containing the half circular arc 51.
• the platform 56 is provided with a pivot axis 57 parallel to the plane defined by the semicircular arc 51, and on which is articulated the locating element 49 (Figure 4).
• the angular position of the locating element 49 in the plane perpendicular to the plane defined by the semicircular arc 51 is marked by graduations arranged on a disk 60 carried by the platform 56 (FIG 3).
• the mounting platform 56 is rotatably mounted on the slide 55 according to a not shown axis being established perpendicularly to the plane defined by the semicircular arc 51. In this plane, the mounting platform 56 can rotate according to an angular range of 360 °. The angular position of the platform 56 in the plane defined by the semicircular arc 51 is marked by graduations made on the slider 55 (FIG 3).
• the removable frame 40 makes it possible to position a locating element 49 such as a laser beam in any of the locations of the brain likely to constitute a target zone.
• the mobile structure 48 is provided with graduations to know the position of the locating element 49 relative to the base 41.
• the half circular arc 51 has along its entire length graduations for locating the position of the slider 55 on the semicircular arc 51.
• the base 41 is provided with a graduated disc 61 to know the angular value of extension of the semicircular arc 51 relative to the base 41.
• the mounting platform 56 has graduations to know the angular orientation and inclination of the locating element 49 relative to at the slider 55.
• the removable frame 40 makes it possible to easily locate a target position on the head and consequently to also position the antenna 2 with respect to this target position.
• the removable frame 40 is adapted to the patient's head by the introduction of the rods 44, 46 in the ear canals and the fixation of the support member 43 on the arch 12 of the holding instrument 3
• the movable structure 48 is moved so that the locating element 49 can aim at the target point.
• the semicircular arc 51 is pivoted and locked in position.
• the slider 55 and the platform 56 are moved and positioned so that the registration element 49 occupies its aiming position of the target point. It should be noted that the slider 55 and the platform 56 are adapted to remain in position only because of the friction involved.
• the correct positioning of the antenna 2 with respect to the target position identified on the patient's head can be achieved. in any appropriate way. After the positioning of the antenna 2 relative to this target position, the frame 40 can be removed during the implementation of the transcranial stimulation.
• the frame 40 can be used again to locate the same target area using the settings (i.e. ticks) to place the registration element 49 in its aiming position.
• the antenna 2 can thus be positioned easily during the repeated sessions necessary for the implementation of the transcranial stimulation technique.
• the apparatus 1 comprises an imaging locating material 70 adapted to locate, that is to say, to determine the coordinates of the target zone of the brain in a reference frame. adapted, for example from Leksell.
• the marking material 70 comprises a U-shaped body 71 provided with two rods 72 for mounting in the auditory ducts extending opposite each other at a distance from one another and coaxially to each other. other.
• the body 71 is also provided with an anterior support member 73 whose axis intersects the axis passing through the two mounting rods 72.
• the two mounting rods 72 are slidably mounted and are provided with graduations so that in position correct mounting mounting material 70 on the head, the two rods 72 protrude from the body 71 by an identical value. These two rods are locked in position by locking members 74. In this symmetrical position of the rods, the axis passing through the anterior support member 73 intersects the axis passing through the two rods 72, in the middle of the distance separating the two rods 72.
• the body 71 is equipped with markers 75 detectable by MRI. In the illustrated example, these detectable marks 75 are made by two N-shaped bodies.
• the imaging locating material 70 allows initial identification of the target area of the brain to be treated:
• Talairach atlas Proportional atlas can find any areas of the brain by anatomical proportion
• the imaging registration material 70 must be used in association with a system (charts or software) ensuring the conversion of the coordinates of a target point determined using the marking material 70 into coordinates that can be identified on the removable frame 40 to place the marker element 49 in the position of said target point.

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• Health & Medical Sciences (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Radiology & Medical Imaging (AREA)
• Life Sciences & Earth Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
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• Veterinary Medicine (AREA)
• Magnetic Treatment Devices (AREA)

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• 2009
  • 2009-03-13 FR FR0951606A patent/FR2942968B1/fr not_active Expired - Fee Related
• 2010
  • 2010-03-11 WO PCT/FR2010/050420 patent/WO2010103242A1/fr active Application Filing
  • 2010-03-11 EP EP10716378A patent/EP2405971A1/de not_active Withdrawn

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