KR20150023364A - Method and system for tms dose assessment and seizure detection - Google Patents

Abstract

A system and method for monitoring a patient's electroencephalogram (EEG) during Transcranial Magnetic Stimulation (TMS) is disclosed. The system includes a TMS device, when in an active state, for generating a plurality of magnetic pulses that may be applied to a patient's head as a burst comprising a plurality of pulses grouped together or as individual pulses, according to a TMS treatment protocol . The EEG system is provided to measure EEG data originating from the TMS therapy protocol applied to the patient. The system further comprises control means for communicating with the TMD device and the EEG system, wherein the control means is operable to monitor the therapeutic efficacy and to detect potential seizures, wherein the EEG data measurement is continuously applied or a magnetic pulse To activate the EEG system for periods of time when the TMS device is not generating pulses.

Description

[0001] METHOD AND SYSTEM FOR TMS DOSAGE AND SEISURE DETECTION [0002]

The present invention relates to methods and devices for TMS dose assessment and seizure detection.

Transcranial magnetic stimulation (TMS) is a noninvasive technique for stimulating the human brain. In particular, TMS causes depolarization or hyperpolarization in brain neurons. TMS uses electromagnetic induction to induce weak currents using a rapidly changing magnetic field, which can cause activity in specific or general parts of the brain with minimal discomfort, so that brain functions and interconnections are studied do. Thus, TMS uses the principle of inductance to obtain electrical energy across the skull and scalp without the pain of direct percutaneous electrical stimulation. This involves placing a wire coil on the scalp and passing a strong and rapidly varying current through the wire coil. This creates a magnetic field that passes through tissues of the head without being disturbed and relatively painless. Ultimately, this magnetic field induces much weaker currents in the brain. To induce enough current to depolarize the neurons in the brain, the current through the stimulation coil starts and stops within several hundreds of microseconds, or its direction is reversed.

TMS is currently used in several different forms. In a first form, the invoked single-pulse TMS, which is a single pulse of magnetic energy, is delivered from the coil to the patient. In another form, rTMS (repetitive TMS), the train of pulses is delivered in various frequency patterns for a specific time period. The frequency sequences upregulate cortical excitability, and in some diseases (e.g. depression), the use of these patterns is advantageous. However, high frequency patterns involve the risk of elevated seizure risk. Safety limits for stimulus intensity and frequency are available from international consensus papers (for example, Rossi et < RTI ID = 0.0 > al 2009, Wassermann et al 1996).

To monitor the safety and effectiveness of a TMS application, one known approach would be to visually monitor the status of the patient during and after the application. Thus, this subjective assessment for safety is available, which is usually based on questionnaires. However, online feedback on the efficacy of treatment is missing, and this protocol can not detect seizures in time.

A further known method of monitoring the safety and validity of a TMS application is to monitor the patient's EEG before the TMS session and after the TMS session.

EEG (electroencephalogram) is a record of the patient's specific EEG patterns. EEG systems allow recording of EEG patterns. The EEG system typically includes a plurality of conductive electrodes disposed on a scalp of a patient. These electrodes are typically metal and are connected to a preamplifier that processes the signals detected by the electrodes and provides the amplified signals to the EEG machine. The EEG machine includes hardware and software that interprets signals to provide a visual display of EEG activity detected by the electrodes. Such EEG activity is typically displayed on a strip chart recorder or a computer monitor.

Indeed, the use of an EEG involves the measurement of responses after the TMS session and before the TMS session, and then measuring the spontaneous EEG or non-magnetically induced EEG responses after the treatment session. However, the application of EEG measurements after a TMS treatment session can significantly extend the entire treatment session.

Yet another known method of monitoring the safety and effectiveness of a TMS application is to monitor a patient's EEG during a TMS session. However, monitoring the patient's EEG during the TMS pulse presents technical problems because the high-energy dynamic magnetic fields generated by the TMS device induce undesirable voltages in the EEG leads, resulting in a TMS-compatible EEG system Gt; EMS < / RTI > hardware that is not suitable for safe and effective monitoring of TMS therapy because it can not generally accommodate TMS measurements. In particular, at least the preamplifiers used in current EEG systems experience saturation caused by the magnetic field generated by the TMS system. Because the electrodes used to monitor the EEG are typically close to the TMS coil, the magnetic pulses induce a signal at one or more of the EEG electrodes causing the EEG preamplifiers to saturate. Conventional preamplifiers used in EEG systems take a relatively long time to recover after being saturated by the TMS pulse.

One known method of monitoring EEG during TMS includes amplifiers in an EEG system that use a sample-and-hold circuit to pin the amplifier to a constant level during TMS pulses. The amplifiers are said to be restored within 100 microseconds after the end of the TMS pulse. Although this system appears to allow monitoring of the EEG within a short time after the end of the TMS pulse, additional gating and synchronization circuitry is needed to control the operation of the EEG amplifiers with respect to the TMS system. Additional gating and sampling circuitry is undesirable because it can require additional circuitry and become complex.

An additional problem that arises when a patient's EEG is monitored during TMS is caused by the use of metal electrodes to sense EEG signals. Large eddy currents induced by TMS pulses or pulses at the metal electrodes can cause localized heating which can cause burns to the patient ' s scalp. This presents safety hazards.

US 2002/007128 A1 discloses yet another method of monitoring EEG during TMS. This prior art document discloses a system and method in which synchronization exists between the operational timing of the TMS system and the operational timing of the EEG system. Instead, the disclosure provides a controlling arrangement that monitors the signals provided by the EEG system during operation of the TMS system and halts operation of the TMS system when the EEG signals are in an undesirable state.

According to a first aspect of the present invention there is provided a system for monitoring a patient's electroencephalogram (EEG) during Transcranial Magnetic Stimulation (TMS), said system comprising, when in an active state, A TMS device for generating a plurality of magnetic pulses that may be applied as a burst comprising a plurality of pulses or as a separate pulse to a patient's head; An EEG system for measuring EEG data originating from a TMS therapy protocol applied to a patient; And control means for communicating with the TMD device and the EEG system, the control means comprising means for monitoring the therapeutic efficacy and for detecting potential seizures, wherein the EEG data measurements are continuously applied or the magnetic pulses generated according to the TMS therapy protocol To activate the EEG system for a period of time when the TMS device is not generating pulses.

In an embodiment, the TMS device is arranged to generate a signal when it is not active, and to send this signal to the control means, whereby the control means is adapted to control the operation of the EEG system when the TMS device is not active Trigger.

In an embodiment, the system comprises storage means for storing the measured EEG data.

In an embodiment, before the TMS device applies a plurality of pulses, the TMS device sends a ready signal to the EEG system, which is controlled by control means for triggering the recorder to record the EEG data in the storage means Is used.

In an embodiment, the system includes a seizure monitoring module for detecting or predicting a seizure of a patient.

In an embodiment, the seizure monitoring module measures the spectral characteristics of oscillatory brain activity when the TMS device is not generating pulses, and measures the resultant measurement results as illustrated or predicted to detect or predict a seizure of the patient I will compare it with the desired profile.

In an embodiment, the seizure monitoring module communicates with the control means to enable the control means to suspend the operation of the TMS device if a seizure is detected or predicted.

In an embodiment, the seizure monitoring module is arranged in the EEG system to be active for certain time periods when the TMS device is not generating pulses.

In an embodiment, the system includes a dose monitoring module to enable an operator to adjust the dosage of the pulses provided by the TMS device in a subsequent treatment protocol.

In this embodiment, the TMS device is arranged to apply a plurality of pulses during a waiting period, which is defined as time periods between bursts of pulses in accordance with a treatment protocol.

In an embodiment, the plurality of pulses are individual pulses generated at random intervals, and the control means deactivates the EEG system during transmission of these pulses and then activates the EEG system to monitor and measure the response of the patient immediately thereafter .

In an embodiment, prior to applying a plurality of individual pulses during the waiting period, the TMS device sends a ready signal to the EEG system via control means to enable the EEG system to activate its protection circuit.

In an embodiment, the control means is arranged to automatically adjust the profile of the pulses generated by the TMS device and / or to recommend a tailored profile of pulses to be generated by the TMS device in a subsequent therapy session.

In an embodiment, the TMS device includes a capacitor for generating a current and thereby a magnetic field to provide magnetic pulses, a coil or probe for delivering magnetic pulses, and a high voltage charging circuit for charging the capacitor.

In an embodiment, the TMS device is arranged to generate a signal to indicate when the TMS device is not in an active state for a period of time, if the TMS device is not charging the capacitor, and send it to the control means.

In an embodiment, the system includes a navigation system for assisting positioning of the TMS device.

In an embodiment, the system includes a patient-response device (typically embedded in an EEG system) for inducing visual, sensory, auditory or other types of stimulation when the TMS device is not generating pulses for subsequent measurements .

In an embodiment, the EEG system includes an amplifier and protection circuit designed to accept high voltages and current associated with the TMS device, and the control means is operable, prior to the TMS magnetic pulse, to apply a ready signal to the EEG system As shown in FIG.

According to a second aspect of the present invention there is provided a method of monitoring a patient's electroencephalogram (EEG) during Transcranial Magnetic Stimulation (TMS), the method comprising, in accordance with a TMS treatment protocol, a burst comprising a plurality of pulses grouped together Generating a plurality of magnetic pulses that may be applied to the patient's head as individual pulses or as a plurality of magnetic pulses; Measuring EEG data originating from a TMS therapy protocol applied to the patient, wherein the EEG data is used to continuously monitor the therapeutic efficacy and to detect potential seizures, Is measured for certain time periods when there are no generated magnetic pulses so that they are interleaved with the magnetic pulses generated according to < RTI ID = 0.0 >

In an embodiment, the method includes generating a signal when magnetic pulses are not being generated, which in turn triggers measurement of the EEG data.

In an embodiment, the method includes storing the measured EEG data.

In an embodiment, prior to the generation of magnetic pulses, the method comprises generating a ready signal, which in turn triggers the storage of the EEG data.

In an embodiment, the method includes measuring spectral characteristics of spontaneous oscillatory brain activity when the generated magnetic pulses are not present; And comparing the resultant measurement to an exemplified or desired profile for detecting or predicting the seizure of the patient.

In an embodiment, the method includes stopping generation of magnetic pulses if a seizure is detected or predicted.

In an embodiment, the method comprises applying a plurality of individual pulses at random intervals for a period of time when there are no magnetic pulses generated according to a treatment protocol; And measuring the resulting EEG data to enable the operator to adjust the dose of TMS pulses in a subsequent treatment protocol.

In this embodiment, the method includes the steps of: deactivating measurement of EEG data during application of a plurality of individual pulses at random intervals; And measuring EEG data immediately thereafter to monitor and measure the patient ' s response.

In this embodiment, the method includes automatically adjusting the profile of the pulses and / or recommending the adjusted profile of the pulses to be generated in a subsequent therapy session.

In an embodiment, the method includes inducing visual, sensory, auditory or other types of stimulation when there are no magnetic pulses generated according to a treatment protocol for subsequent EEG data measurements.

The invention will now be described, by way of example only, with reference to the accompanying drawings.
1 illustrates a high-level schematic diagram of a system for monitoring a patient's electroencephalogram (EEG) during Transcranial Magnetic Stimulation (TMS), in accordance with an embodiment of the present invention.
Figure 2 shows a time frame schematic of a TMS protocol for detecting a seizure of a patient and an adjacent EEG protocol, in accordance with an aspect of the present invention.
Figure 3 shows a time frame schematic of a TMS protocol for dose monitoring and an adjacent EEG protocol, according to a further aspect of the present invention.
Figure 4 shows a time frame schematic of a TMS protocol for dose monitoring using the intermediate random TMS pulses and an adjacent EEG protocol, according to a still further aspect of the present invention.
Figure 5 illustrates a high-level flow chart depicting a method of monitoring a patient's electroencephalogram (EEG) during Transcranial Magnetic Stimulation (TMS), in accordance with a further embodiment of the present invention.

Referring first to Figures 1-4, a system 10 for monitoring a patient's electroencephalogram (EEG) during Transcranial Magnetic Stimulation (TMS) is shown. The system 10 includes a TMS device 12 for generating a plurality of magnetic pulses when in an active state. The pulses may be used as bursts comprising a plurality of pulses grouped together, as indicated by arrows 14 in Figures 2 to 4, or as bursts, as indicated by arrows 16 in Figure 4, , And may be applied to the patient's head 18 as individual pulses.

Based on the established safety guidelines, the TMS treatment protocols often use active stimuli (corresponding to arrows 14 in FIGS. 2-4) in the middle of the in-between long pose (as indicated by arrows 20). As is clearly shown, the duration of these poses often exceeds the duration of the active stimulus. As will be described in further detail below, the waiting periods defined by poses are used to measure diagnostic data that can be interpreted in real time and will be used to guide the TMS therapy protocol. A typical treatment protocol used in the treatment of depression, using rTMS, is a burst of 40 pulses delivered at 10 Hz (arrows 14 in FIGS. 2-4), then repeated until 3000 pulses are delivered, And a waiting period of 26 seconds (the arrows 20 in Figs. 2 to 4).

The system 10 further includes an EEG system 22 for measuring spontaneous EEG data associated with a TMS treatment protocol applied to the patient. As will be described in further detail, the use of the EEG system 22 is to monitor the patient ' s brain activity to extract diagnostic information during the treatment protocol.

The system 10 further comprises control means 24 in communication with the TMS device 12 and the EEG system 22. The control means 24 activates the EEG system 22 for a period of time when the TMS device 12 is not generating pulses, as indicated by blocks 28 in Figures 2-4 And a controller (26). Thus, EEG data measurements are continually applied or interleaved with TMS therapy to monitor treatment efficacy and detect potential seizures.

In an embodiment, the TMS device 12 generates a signal when it is not active (i.e. corresponding to a "no-stimulus" event during a treatment protocol, i.e., arrow 20 in FIGS. And to transmit it to the control means 24. Thus, the control means 24 are arranged to trigger the operation of the EEG system 22 when the TMS device 12 is not active.

The system 10 may include storage means 30 for storing the measured EEG data. In an embodiment, before the TMS device 12 applies a plurality of pulses, the TMS device 12 sends a ready signal to the EEG system 22, which then sends EEG data to the storage means 30 Is used by the control means 24 to trigger the recorder 32 for recording.

In an embodiment, the system 10 includes a seizure monitoring module 34 (which may be implemented within the EEG system 22) for detecting or predicting a patient ' s seizure. The seizure monitoring module 34 may determine the spectral characteristics-frequency, burst suppression, and phase-locked oscillations of spontaneous oscillatory brain activity when the TMS device 12 is not generating pulses And compares the resulting measurement results with the expected or desired profile. In other words, the module 34 matches the measured spectral characteristics with the individual EEG characteristics (i.e., the patient's normal seizure activity) to determine the effects of the operation of the TMS device 12 on the patient .

The seizure monitoring module 34 communicates with the control means 24 so that the control means 24 can stop the operation of the TMS device 12 if a seizure is detected or predicted. In this application, the EEG system 22 quantifies the spectral characteristics of the measured EEG signals, records them in the storage means 30, and then compares this quantified data with the benchmark EEG. Typically, if a pre-seizure activity is detected, the operator is notified to decide whether to stop treatment. If a seizure activity is detected, the operator is notified to stop the treatment.

In an embodiment, the seizure monitoring module 34, like the EEG system 22, corresponds to blocks 20 of Figures 2 to 4 when the TMS device 12 is not generating pulses - Lt; / RTI > periods.

In a further application, the EEG system 10 includes an amplifier 36 for amplifying bioelectric potentials associated with the activity of neurons in the brain, enabling unipolar and bipolar EEG measurements, A protection circuit 38 designed to accommodate high voltages and current, and a control unit 40 for connecting to and controlling the components of the EEG system 22. [ The control means 24 can be arranged to transmit a ready signal to the EEG system 22 before the TMS magnetic pulse is generated to activate the protection circuit 38 and thereby prevent amplifier saturation.

In an embodiment, the TMS device 12 includes a capacitor 42 for generating an electric current and thereby inducing a magnetic field to provide magnetic pulses, a coil or probe 44 for delivering magnetic pulses, a capacitor 42, And a high voltage charging circuit 46 for charging the unit 48. The capacitor 42 is charged for a few seconds, and then the stored energy is released to the coil 44 as a single or multiple pulses.

In an embodiment, the TMS device 12 generates a signal to indicate when it is not in an active state for a period of time, if the TMS device 12 is not charging the capacitor 42, (24). This enables the EEG system 22 to operate in an environment that is typically free of known artifacts.

Thus, in use, in one embodiment, as shown in FIGS. 2-4, the system 10 may be configured to provide a continuous sequence of stimulations, e. G., 10 sec / 4 sec, with burst- Lt; / RTI > During stimulation, as indicated above, the EEG system 22 is turned off to prevent amplifier saturation. After stimulation, EEG monitoring is activated in response to the TMS device 12 sending a "non-stimulating" signal to the EEG system 22 corresponding to the beginning of the waiting period. If the TMS capacitor 42 does not need to be charged, the TMS device 12 sends a ready signal to the EEG system 22 to prevent writing during the charging procedure.

1, 2 and 4, the system 10 allows the operator to adjust the dose of the pulses provided by the TMS system 12 in a subsequent treatment protocol (50) - typically embedded in an EEG system (22). This dose monitoring capability can be performed in one of two ways, with reference to Figures 3 and 4, respectively.

First, referring to FIG. 3, the TMS treatment sequence is applied in a conventional manner and with a continuous stimulus of 10 Hz / 4 seconds, as described above, i.e. with burst-to-break intervals of 26 seconds And conventional treatments include 75 such sequences. In this application, the dose monitoring module 50 of the EEG system 22 enables acquisition of averaged EEG epochs with an appropriate signal-to-noise ratio and is capable of quantitative monitoring For example, spectrum, coherence, and connectivity).

Referring now to FIG. 4, the treatment sequence described above can be applied with a continuous stimulus of 10 Hz / 4 seconds, i.e. with burst-to-break intervals of 26 seconds. In addition, in this application, the TMS device 12 is arranged to apply a plurality of, e.g., three to seven, pulses of the individual pulses 16 at random intervals during the waiting period 20. As indicated above, the waiting period 20 is defined as being the time period between bursts 14 of pulses, with respect to the treatment protocol.

The control means 24 is operable to deactivate the EEG system 22 during the transmission of these pulses, as indicated by the rectangular blocks 52 in Figures 2 to 4, and then to monitor and measure the response of the patient , It is arranged to activate the EEG system 22 immediately thereafter, as indicated by the blocks 28.

As indicated above, before applying a plurality of individual pulses 16 during the waiting period 20, the TMS device 12 enables the EEG system 22 to activate its protection circuit 38 And sends a ready signal to the EEG system 22 via the control means 24.

In use, after each treatment sequence, the characteristics of the induced reactions may include local excitability (e.g., amplitude, latency, surface characteristics, etc.) and global connectivity (e.g., Such as inter-hemispheric conduction time, amplitude ratio, etc.). At the end of the treatment session, the resulting data is stored in the storage means 30 for comparison or trending purposes. Based on the information recorded during the treatment session, the operator can, if necessary, adjust the dosage.

In an embodiment, the control means 24 automatically adjusts the profile of the pulses generated by the TMS device 12 and / or adjusts the adjusted profile of the pulses to be generated by the TMS device 12 in a subsequent therapy session .

In an embodiment, the system 10 includes a navigation system to assist in precise positioning of the TMS device (i.e., positioning of the coil or probe 44).

In an embodiment, the system 10 includes a patient-response device 54 that is typically embedded in the EEG system 22 to induce visual, sensory, auditory or other types of stimulation. This stimulus is applied when the TMS device 12 is not generating pulses for subsequent measurements. Again, the results of the patient's responses to the induced stimulation are typically stored in the storage means 30.

Finally, referring to FIG. 5, a method 80 of monitoring a patient's EEG during TMS will now be described. The method includes generating a plurality of magnetic pulses, as indicated by block 82, that may be applied to a patient's head as a burst comprising a plurality of pulses grouped together or as individual pulses. This can be done according to the TMS treatment protocol.

The method 80 further comprises measuring EEG data originating from a TMS therapy protocol applied to the patient, as indicated by block 84. [ The EEG data may be used to monitor the therapeutic efficacy and to detect potential seizures, such that the phases of the EEG data measurement are interrupted with magnetic pulses that are continuously applied or generated according to the TMS therapy protocol, Time periods.

Thus, the present disclosure provides a configuration that enables artifact free measurement of spontaneous EEG and induced responses during a TMS therapy protocol that is organized into stimulus patterns. The embedding or interleaving of EEG measurements during TMS therapy enables personalization and optimization of the treatment sequence.

It should be understood that the embodiments of the present invention are not limited to the specific structures, process steps or materials disclosed herein, but rather extend to their equivalents as will be appreciated by those skilled in the art It will be understood. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting.

Reference throughout this specification to "one embodiment" or "an embodiment " means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment of the invention. Accordingly, the appearances of the phrases "in one embodiment" or "in an embodiment" in various places throughout this specification are not necessarily all referring to the same embodiment.

As used herein, a plurality of items, structural elements, configuration elements, and / or materials may conveniently be presented in a common list. However, these lists should be interpreted as if each member of the list is individually identified as a distinct member of the individual. Thus, no individual member of such a list should be construed as a de facto equivalent of any other member of the same list based solely on their presentation in a common group without the vice versa. In addition, various embodiments and examples of the present invention may be referred to herein, along with alternatives to their various components. It is to be understood that such embodiments, examples and alternatives will not be construed as substantially equivalent to each other, but will be considered as separate autonomous representations of the present invention.

In addition, the described features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. In the following description, numerous specific details are set forth, such as examples of lengths, widths, shapes, etc., in order to provide a thorough understanding of embodiments of the present invention. However, those skilled in the art will recognize that the invention may be practiced without one or more of the specific details of the invention or with other methods, components, materials, and the like. In other instances, well-known structures, materials, or operations are not shown or described in detail so as not to obscure aspects of the present invention.

While the above examples illustrate the principles of the present invention in one or more specific applications, many modifications of the form, use, and details of implementation are possible without the practice of the inventive faculty and with the principles of the present invention It will be apparent to those skilled in the art that various changes may be made without departing from the spirit and scope of the invention. Accordingly, the invention is not intended to be limited except as by the claims set forth below.

Claims (24)

A method of monitoring an electroencephalogram (EEG) of a subject during a Transcranial Magnetic Stimulation (TMS) session,
- after the stimulation pulse from the TMS coil, do not transmit any stimulus signal to the EEG device,
- activating the EEG device without being based on any stimulus signal
Measuring spontaneous EEG signals from said patient,
- comparing the spontaneous EEG signals with a predetermined EEG template,
- detecting pre-seizure and / or seizure activity in said comparison,
A method for monitoring a patient ' s EEG during a TMS session. The method according to claim 1,
Measuring spontaneous EEG signals from the patient prior to any stimulation pulses from the TMS coil, and
- generating a predetermined EEG template for the patient based on measured EEG signals before pre stimulation,
The generated predetermined EEG template is used for comparison of measured EEG signals after a stimulus pulse,
A method for monitoring a patient ' s EEG during a TMS session. 3. The method according to claim 1 or 2,
Wherein the predetermined EEG template comprises a known < RTI ID = 0.0 >
A method for monitoring a patient ' s EEG during a TMS session. 4. The method according to any one of claims 1 to 3,
- transmitting a stimulus signal to the EEG device before activation of the TMS coil, and
- deactivating the EEG device based on the stimulation signal,
A method for monitoring a patient ' s EEG during a TMS session. 5. The method according to any one of claims 1 to 4,
The capacitor or capacitor bank of the TMS device coupled to the TMS coil does not transmit any stimulus signal after charging after the stimulation pulse.
A method for monitoring a patient ' s EEG during a TMS session. 5. The method according to any one of claims 1 to 4,
After the step of not transmitting any stimulus signal to the EEG device, one or more capacitors of the TMS device connected to the TMS coil are charged after the stimulation pulse, or an additional signal indicating that the charge has been terminated, ; And
Further comprising activating the EEG device based at least on the additional signal that is not a stimulus signal.
A method for monitoring a patient ' s EEG during a TMS session. 7. The method according to any one of claims 1 to 6,
- notifying a user of the TMS coil of the presence and / or absence of a detected seizure activity,
A method for monitoring a patient ' s EEG during a TMS session. 8. The method according to any one of claims 1 to 7,
Sending a stop signal to the TMS coil device connected to the TMS coil, if a pre-seizure and / or seizure activity is determined, and
- preventing TMS stimulation from the TMS coil based on the stop signal.
A method for monitoring a patient ' s EEG during a TMS session. 9. The method according to any one of claims 1 to 8,
- sending a stimulus signal to the EEG device before the TMS stimulation pulse, and
- activating a compensation mechanism in the EEG device to prevent EEG saturations,
A method for monitoring a patient ' s EEG during a TMS session. 10. The method of claim 9,
The compensation mechanism is gated,
A method for monitoring a patient ' s EEG during a TMS session. A method for monitoring a patient's TMS (Transcranial Magnetic Stimulation) dose build-up,
- sending a ready signal to the EEG device during a waiting period after a predetermined sequence of TMS stimulation pulses,
- initiating recording and averaging of evoked EEG responses of the patient based on the ready signal,
- sending a stop signal to the EEG device before a subsequent predetermined sequence of TMS stimulation pulses,
Terminating recording and averaging of the patient ' s induced EEG responses based on the stop signal;
Determining local excitability and / or global connectivity based on the induced EEG responses recorded and averaged during the waiting period,
Storing the local excitability and / or overall connectivity determined during the waiting period,
Comparing the determined local excitability and / or overall connectivity stored during the waiting period to local excitability and / or overall connectivity determined during a previous waiting period,
Performing an adjustment on a predetermined sequence of TMS stimuli for a subsequent sequence of TMS stimuli based on the comparison, if it is determined that an adjustment should be made,
A method for monitoring TMS dose accumulation in a patient. 12. The method of claim 11,
Based on the ready signal, the EEG initiates a compensation mechanism to prevent EEG saturations,
A method for monitoring TMS dose accumulation in a patient. 13. The method of claim 12,
The compensation mechanism may be gated,
A method for monitoring TMS dose accumulation in a patient. 14. The method according to any one of claims 11 to 13,
The determined local excitability may include local amplitude (s), latency, surface characteristics, or combinations thereof.
A method for monitoring TMS dose accumulation in a patient. 15. The method according to any one of claims 11 to 14,
The determined local connectivity may include an overall conduction time, an interelectrode comparison of amplitudes, a latency or a combination thereof,
A method for monitoring TMS dose accumulation in a patient. 16. The method according to any one of claims 11 to 15,
- determining correct measures of local excitability and / or overall connectivity after a plurality of waiting periods, and
Further comprising performing an adjustment to a predetermined sequence of TMS stimuli for a set of TMS stimuli or a subsequent sequence based on determined accurate measurements of local excitability and / or overall connectivity,
A method for monitoring TMS dose accumulation in a patient. 17. The method of claim 16,
The determined accurate measurements of the local excitability may include amplitude, latency, signal power, area under curve properties, or combinations thereof.
A method for monitoring TMS dose accumulation in a patient. 18. The method according to claim 16 or 17,
Wherein the determined overall connectivity comprises an interhemispheric conduction time and / or amplitude ratio,
A method for monitoring TMS dose accumulation in a patient. 19. The method according to any one of claims 11 to 18,
Adjustments made to subsequent sequences of TMS stimuli may include adjusting the intensity, duration, frequency and / or number of stimulation pulses, or combinations thereof,
A method for monitoring TMS dose accumulation in a patient. 20. The method according to any one of claims 11 to 19,
Further comprising stimulating the patient at least once through the TMS coil for each waiting period.
A method for monitoring TMS dose accumulation in a patient. 21. The method of claim 20,
Further comprising, during each waiting period, stimulating the patient less than 20 times, preferably less than 10 times, and still more preferably 3-7 times.
A method for monitoring TMS dose accumulation in a patient. A temporary or non-transitory computer readable medium having stored thereon a set of computer readable instructions for performing the method of any one of claims 1 to 21. As a system,
- Transcranial Magnetic Stimulation (TMS) coil device,
An EEG (electroencephalogram) device having at least one compensation mechanism for preventing EEG saturations during stimulation from a TMS coil device, and
A TMS device having a processor and a capacitor in electrical communication with a non-transitory computer readable medium, the TMS device being coupled to the TMS coil and communicating with the EEG device,
system. 24. The method of claim 23,
The non-transient computer readable medium having stored thereon a set of computer readable instructions for performing the method of any one of claims 1 to 21,
system.

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