WO2016104411A1 - Système de stimulation magnétique transcrânienne - Google Patents

Système de stimulation magnétique transcrânienne Download PDF

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Publication number
WO2016104411A1
WO2016104411A1 PCT/JP2015/085647 JP2015085647W WO2016104411A1 WO 2016104411 A1 WO2016104411 A1 WO 2016104411A1 JP 2015085647 W JP2015085647 W JP 2015085647W WO 2016104411 A1 WO2016104411 A1 WO 2016104411A1
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WO
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Prior art keywords
subject
magnetic stimulation
transcranial magnetic
headrest
monitor
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Application number
PCT/JP2015/085647
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English (en)
Japanese (ja)
Inventor
勝志 藤本
宏記 竹島
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帝人ファーマ株式会社
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Filing date
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Application filed by 帝人ファーマ株式会社 filed Critical 帝人ファーマ株式会社
Publication of WO2016104411A1 publication Critical patent/WO2016104411A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/40—Applying electric fields by inductive or capacitive coupling ; Applying radio-frequency signals

Definitions

  • the present invention relates to a transcranial magnetic stimulation device, and more particularly to a transcranial magnetic stimulation device that reproduces a prescription position.
  • Repetitive transcranial magnetic stimulation is a technique that applies non-invasive magnetic stimulation to specific parts of the brain, such as intracerebral nerves, to cause neurological diseases such as pain after stroke, depression, and Alzheimer's. It is a treatment that can be used to treat or alleviate symptoms.
  • magnetic generating means such as an excitation coil is arranged at a specific position on the surface of the patient's scalp, and magnetic stimulation is performed from the magnetic generating means to a specific part of the patient's brain.
  • Patent Document 1 discloses that a current is passed through a coil placed on the surface of a patient's scalp, a small pulse magnetic field is generated locally, and an eddy current is generated in the skull using the principle of electromagnetic induction. It has been disclosed to stimulate the cerebral nerve directly under the coil by waking up.
  • Patent Document 1 discloses a technique in which the patient leans against a chair and fixes the occipital region and chin portion. .
  • Patent Document 1 describes that positioning is performed by bringing the occipital nodule into contact with the occipital rest, or using a monitor that displays a camera image that captures a predetermined reference point of the head.
  • these functions may not be used, so it is necessary to consider another aspect of the positioning method.
  • Patent Document 2 as a subject's head fixing means, a temporal head press supported so as to be openable and closable from a base portion of the apparatus is disposed so as to sandwich the subject's head, By providing a frontal head presser capable of supporting the head and back and forth, and by providing a chin rest for supporting the subject's chin on the base part, four points can be held.
  • Patent Document 3 either a forehead presser or a chin rest and a pair of opposing side presser pieces, a stretchable or flexible band is laid across the rear head presser means and the rear head presser means. Yes.
  • Patent Documents 2 and 3 require a certain space for treatment, and it may be difficult to perform treatment depending on the location.
  • An object of the present invention is to provide a transcranial magnetic stimulation device capable of easily and accurately positioning the head position.
  • the present invention relates to a transcranial magnetic stimulation apparatus that has an excitation coil and a coil drive power source for causing a current to flow through the excitation coil, generates a magnetic field in the excitation coil, and applies magnetic stimulation to the body of the subject.
  • the transcranial magnetic stimulation device is characterized in that a visual recognition device for performing the alignment is displayed, and a mark for aligning the specific position of the face of the subject is displayed on the visual recognition device.
  • the present invention is configured to contact a part or all of the forehead from the temple of the subject and to support the head of the subject, and a headrest configured to support the subject's chin and support the jaw. It is preferable to have a chin rest.
  • the present invention is a camera in which the visual recognition device projects a subject's face in real time and an image projected in the camera in real time, and a specific position of the subject's face is aligned with the monitor. It is preferable that a mark for displaying is displayed.
  • the mark displayed on the monitor is a cross line or a grid line for adjusting a horizontal line connecting the corners of the right and left eyes, the corners of the eyes, or the tragus of the subject and a vertical line passing through the center of the nose of the subject. It is preferable that Furthermore, in the present invention, it is preferable that an image displayed on the monitor can be enlarged and displayed. Further, in the present invention, it is preferable that the image projected on the monitor can display a real image and a mirror image, and can switch and display the real image and the mirror image. Furthermore, in the present invention, it is preferable that the screen of the monitor can be divided and displayed by changing the magnification of each screen.
  • the camera can be adjusted in position up and down, and the adjusted position can be recorded by a scale or an indicator.
  • the visual recognition device is a sight that serves as a guide for the subject's line of sight, and the position of the sight and the target can be adjusted to be in a straight line when tied to the eye position of the subject.
  • the mark for aligning the specific position of the face of the subject is preferably a dot site projected on the screen of the sight.
  • the headrest can be adjusted in the vertical direction and in the horizontal direction that is the front-rear direction of the subject, and the adjusted position can be recorded by a scale or an indicator.
  • the chin rest can be adjusted in the vertical direction and in the horizontal direction that is the front-rear direction of the subject, and the adjusted position can be recorded by a scale or an indicator.
  • this invention has a head strap which can wind a test subject's head from the said headrest so that a test subject's head may be pressed against the said headrest.
  • the headrest and the head strap are positioned in the same horizontal plane.
  • the chin rest and the headrest are directly or indirectly fixed to a support frame
  • the head strap is connected to the headrest
  • the camera, the sighting device and the target are perpendicular to the support frame. It is preferable to be connected to a lifting platform that is movable in
  • the transcranial magnetic stimulation device (hereinafter also referred to as “rTMS device”) of the present invention, accurate positioning can be easily performed.
  • the treatment time is shortened by improving the reproducibility of the treatment position, and the burden on the subject and the operator is reduced.
  • treatment is possible even in a narrow space compared to the conventional case. Since treatment can be performed in a forward leaning posture, a comfortable treatment can be provided for subjects including patients who can easily take a forward leaning posture.
  • transcranial magnetic stimulation system in this invention. It is the schematic of the head alignment part of the transcranial magnetic stimulation system in this invention. It is the top view seen from the test subject upper part of the headrest and the head strap. It is a figure reflected on the monitor at the time of head position alignment of the present invention. It is the schematic explaining the sighting device and target in this invention.
  • transcranial magnetic stimulation system according to an embodiment of the present invention will be described with reference to the accompanying drawings.
  • a transcranial magnetic stimulation system suitable for use in the medical field such as pain after stroke will be described.
  • the present invention describes other pains (especially intractable pain), depression, Alzheimer, etc. The same applies to medical fields such as neurosurgery and psychiatry.
  • FIG. 1 shows a schematic diagram of a transcranial magnetic stimulation system.
  • a transcranial magnetic stimulation system 10 (hereinafter simply referred to as “magnetic stimulation system 10”) has an excitation coil 7 (magnetic field generating means) and is electrically connected to a coil drive power supply 11 via a cable 9. Yes.
  • the coil drive power supply 11 is connected to an external power supply or the like and has a function of flowing power to the excitation coil 7.
  • the subject sits on the treatment chair 6 to fix the head, and places the excitation coil 7 at a specific position on the scalp surface useful for treatment. Treatment or the like is performed by applying a magnetic stimulus of a predetermined strength to the brain nerve of the subject from the excitation coil 7 arranged at this specific position.
  • the coil driving power source 11 controls the supply of current pulses to the exciting coil 7, and various types of conventionally known types can be used.
  • the operator can perform on / off (ON / OFF) operation of the coil drive power supply 11 and setting of the intensity and pulse waveform of a current pulse that determines the intensity and cycle of magnetic stimulation.
  • the exciting coil 7 is incorporated in an oval coil case, and the coil case is held in the coil unit 13.
  • the lower surface of the coil unit 13 (that is, the surface facing the subject's scalp surface) is formed in a concave curved surface corresponding to the subject's head shape. Thereby, the coil unit 13 can be smoothly moved along the subject's head surface.
  • the planar shape of the coil unit 13 (the shape of the coil unit when the entire coil unit is viewed from the lower surface) may be an ellipse including an oval shape or an oval shape, or an egg shape, and is not limited.
  • the optimal coil position and posture of the exciting coil 7 that can most reduce the subject's neuropathic pain are determined by using a dedicated positioning device during initial medical examination of the subject. From the next treatment, the magnetic stimulation system has a subject positioning function so that the optimum coil position and posture can be easily reproduced.
  • the magnetic stimulation system 10 includes a chin rest 1 for fixing a subject's head in a desired position, a headrest 2, a head strap 3, a camera 4, a monitor 5, and a chair 6.
  • the chin rest 1, the head rest 2, the head strap 3, and the camera 4 are supported directly or indirectly by the support frame 15.
  • the monitor 5 may also be connected to and supported by the support base 15.
  • the support frame 15 has a function of directly or indirectly supporting each element, whereby each element can be linked.
  • the support base 15 is not a base, but may be a support part that can support them, or the support base 15 may be integrated as shown in FIG. 1 or may be divided into a plurality of parts. Further, the support base 15 may be sized so as to be placed on a fixed base such as a desk without being installed from the floor as shown in FIG.
  • the support frame 15 may be connected to a lifting frame 16 that can move in a direction perpendicular to the support frame.
  • the chair 6 is preferably movable up and down in order to adjust the physique, and may be adjustable on the front-rear axis.
  • the upper body is tilted forward from the vertical, and the chest is placed with chestless 8 and the arm rest 12 is placed with the body like a wrist, thereby assisting in maintaining the posture of the subject under treatment.
  • the chestless 8 and the armrest 12 need only be able to hold each part of the patient, but are preferably supported by the support base 15 or the chair 6.
  • the camera 4 and the monitor 5 are connected to the lifting platform 16 and the monitor 5 to the support platform 15 in FIG.
  • the camera 4 and the monitor 5 correspond to the visual recognition device in the present invention.
  • the visual recognition device refers to a device that aligns or confirms the position of the subject's head by visual recognition. Examples of the visual recognition device include a camera and a monitor, an aiming device described later, and a mirror.
  • the subject first sits on the chair 6, adjusts the height of the chair 6 if necessary, and places it so that the chin rests on the chin rest 1.
  • the chin rest 1 is preferably fixed to the support frame 15.
  • the chin rest 1 is connected to the fixture 18, and the fixture 18 is further connected to the support frame 15 to be indirectly fixed to the support frame 15.
  • the chin rest 1 may be directly fixed to the support base 15 without the fixture 18.
  • the chin rest 1 holds the lower end of the head by placing the chin on the seating surface (chin receiving portion). Furthermore, you may give the positioning function of a head position lower end reference
  • the chin rest 1 may be adjustable in position on the vertical and horizontal axes (before and after the subject).
  • the vertical and horizontal axis positions of the chin rest are adjusted during prescription in a medical institution. Furthermore, the adjustment position at the time of prescription is recorded, and the position of the chin rest is adjusted to the recorded position at the next and subsequent treatments.
  • the shape of the chin rest 1 may be changed for each subject or for each subject's jaw shape so that the subject's jaw can be easily fixed. Furthermore, it may be a shape that fixes the position of the jaw by biting it with teeth or gums in the oral cavity or holding it in the mouth instead of the shape of placing the lower jaw as shown in the figure.
  • the headrest 2 is fixed to the support frame 15.
  • the headrest 2 is connected to the support member 19 connected to the fixture 18, so that the headrest 2 is indirectly fixed to the support base 15.
  • the head is supported by placing a forehead on the headrest 2.
  • the headrest 2 may have a function of positioning with respect to the front end direction and inclination of the head position.
  • the headrest 2 is preferably brought into contact with the forehead portion of the subject's temple, but even in a part of them, for example, only the forehead, a part of the forehead, or only the temple, the front end direction and inclination of the head position. What is necessary is just to be able to position about.
  • the position of the headrest 2 can be adjusted on the vertical and horizontal axes (before and after the subject). By adjusting this position, the vertical and horizontal axis positions of the headrest 2 are adjusted during prescription, similarly to the chin rest. It is preferable that the position adjustment of the headrest 2 can be adjusted independently of the chin rest 1. Furthermore, the adjustment position at the time of prescription is recorded, and the position of the headrest 2 is adjusted to the recorded position at the next and subsequent treatments.
  • a scale, an indicator, or the like is provided at the adjustment position of the chin rest 1 or the headrest 2, and the scale is recorded. Alternatively, a sensor or an electronic scale may be attached, measurement information may be taken into the control unit, and the information may be displayed.
  • the headrest 2 preferably has a curved surface that matches the subject's forehead so that the subject's forehead can be stably fixed, and can be exchanged for each subject or for each subject's forehead size. Also good.
  • the head strap 3 extends from the contact portion of the headrest 2 to the back of the subject's head so that the head position is pressed against the headrest 2 so that the head position aligned with the forehead and the like easily floats from the headrest 2 during treatment.
  • the movement to the back of the head is suppressed by winding and fixing.
  • the head strap 3 is preferably a flexible or elastic member so as to be pressed against the headrest 2, preferably a fiber such as cloth or rubber, and may be plastic, resin, metal or the like.
  • the position where the head strap 3 is provided is not specified as long as the head of the subject can be fixed.
  • the head strap 3 does not have to be installed at the same height as the headrest 2, but is preferably at the same height. Moreover, it is preferable that the head strap 3 exists in the position connected with the chin rest 1 and / or the head rest 2. In FIG. 2, the headrest 2 is connected.
  • FIG. 4 shows an image shown on the monitor 5.
  • a cross line 14 or a grid line is projected as a mark for alignment, and a real-time face facing the front of the subject is projected there.
  • the image displayed on the monitor can be switched to a mirror image (an image that is the same upside down and opposite to the left and right as shown in the mirror) so that the operator or subject can easily operate the image. In particular, when the subject sees, it is easy to operate if it is a mirror image.
  • a cross hair 14 is shown.
  • the test subject has the horizontal line of the cross or grid line reflected on the monitor 5 with the head fixed on the face of the test subject, such as the left and right eyes, the corners of the eyes, or the corners of the tragus (the part where the tragus protrudes).
  • the position does not change easily with facial expressions, etc., and the vertical line is aligned with a specific position where a horizontal line can be formed, and the vertical line is formed easily without changing the position with facial expressions etc. on the face of the subject such as the center of the nose Adjust to a specific position where possible.
  • an operator such as a medical staff may look at the monitor 5 and adjust the position of the subject's head.
  • the monitor 5 faces the operator side, but it can also be directed to the subject side, and is preferably moved to the front side of the subject so that the subject can easily align.
  • the camera 4 is fixed at a predetermined position when aligning. Thereby, positioning confirmation of the center, inclination, and height of a head position is attained, and a test subject's head positioning can be performed.
  • marking can be done by marking or pasting markers on the face without using the crosshairs 14 or grid lines.
  • the position may be aligned by aligning the position with the mark of a specific position displayed on the monitor. By this adjustment, the operator or the subject can confirm and finely adjust the tilt of the head position by matching the subject's face projected on the monitor 5 in real time with the cross cursor or grid line on the screen through the camera 4. it can.
  • the alignment needs to be adjusted in millimeters.
  • the position is adjusted and confirmed by the camera, it is easy to enlarge the screen imaged by the camera, and the alignment is possible on the enlarged screen. , The alignment accuracy is increased.
  • it is used together with a headrest or chin rest, and a use case in a forward leaning posture is disclosed.
  • the combination of the camera and the monitor is different from this embodiment, for example, in a backward leaning posture or a supine state. It can be used for positioning the head in transcranial magnetic stimulation.
  • the camera 4 is provided on the lifting platform 16 and can be adjusted up and down to the height at which the front of the subject is projected.
  • the height adjusted at the time of the prescription of the camera preferably has a scale and an indicator on the lifting platform 16 so that it can be recorded.
  • a sensor or an electronic scale may be attached to take measurement information into the control unit. Since the treatment unit 17 including the excitation coil 7 is a mechanism that is vertically adjusted integrally with the camera 4, the height is recorded with a scale, an indicator, and the like, and the position of the camera is prescribed at the time of the next treatment. When adjusted to the position, the height of the treatment device can be aligned.
  • the position of the treatment unit 17 can be adjusted in the vertical direction and / or the parallel direction with respect to the lifting platform 4, and the vertical distance between the camera 4 and the treatment unit 17 is set at the time of alignment.
  • the distance at the time of prescription and / or setting the angle between the camera 4 and the treatment unit 17 it is possible to align the treatment unit 17 at the time of treatment by matching the position of the camera. .
  • the treatment unit 17 can also be moved with respect to the lifting platform 4, it is possible to cope with a difference in face size and manufacturing position for each patient, and positioning becomes easy.
  • the height of the treatment unit 17 is also determined by adjusting the position of the camera by the lifting platform 16.
  • a sighting device 20 is provided instead of a monitor and a camera, and a mark for aligning a specific position of the face with the subject's own line of sight is displayed on the screen of the sighting device 20.
  • the head position, the lamp light and the target are aligned linearly.
  • the sight 20 in the present invention is positioned on a straight line of an arbitrary target 21 that is an alignment target with one eye of the subject, and a dot site display such as a cross, a dot, or a circle ( ⁇ ) shape is displayed on the sight 20. It is possible to reproduce the head position by adjusting the head position so as to match this with an arbitrary position on the target 21.
  • the target 21 may be a circle or a cross mark. It is desirable that the sighting device is fixed to the lifting platform 16 at a position 10 to 40 cm ahead of the eye position at a position where the line of sight of the subject can be matched (which may be either the left or right line of sight).
  • the target 21 is located at the tip of the line of sight connecting the eye of the subject and the sight, and is fixed to the lifting platform.
  • the aiming device 20 and the target 21 are set to predetermined positions when they are aligned with the subject's prescription position.
  • the sight 20 and the target 21 are fixed to the lifting platform 16 directly or indirectly.
  • the excitation coil 7 provided in the treatment unit 17 is aligned with the prescription position.
  • the treatment unit 17 is connected to the lifting platform 16 in FIG.
  • the treatment unit 17 can change its position in the horizontal direction and the vertical direction with respect to the lifting platform 16.
  • the position of the exciting coil 7 can be changed in the treatment unit 17.
  • the positions of the treatment unit and the excitation coil are set to positions determined by a medical institution, and the excitation coil is adjusted to the prescription position of the patient. After everything matches the prescription position, a voltage is applied to the exciting coil to generate a magnetic field and treatment is started.
  • the order of the alignment process is not limited to the above order, and the process may be different as long as it is finally adjusted to the position at the time of prescription.
  • the transcranial magnetic stimulation system is movable because a treatment place is not selected. Further, since the subject can be treated while sitting, the treatment space for the subject can be reduced. In particular, since it can take a forward leaning posture, it is a small space compared to a backward leaning or leaning position. It should be noted that it is preferable to be able to fix a support post such as a support base during treatment.

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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)
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Abstract

L'objet de la présente invention est de fournir un système de stimulation magnétique transcrânienne tel que le positionnement peut être obtenu facilement et de manière précise et le traitement peut être effectué même dans un espace étroit. Le système de stimulation magnétique transcrânienne est caractérisé en ce que : le système de stimulation magnétique transcrânienne comprend une caméra qui capture des images du visage d'un sujet d'examen et un moniteur qui projette en temps réel l'image capturée par la caméra ; et un repère, permettant d'aligner une position spécifique du visage du sujet d'examen, est affiché sur le moniteur.
PCT/JP2015/085647 2014-12-22 2015-12-21 Système de stimulation magnétique transcrânienne WO2016104411A1 (fr)

Applications Claiming Priority (2)

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JP2014-258544 2014-12-22
JP2014258544 2014-12-22

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WO2016104411A1 true WO2016104411A1 (fr) 2016-06-30

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106110507A (zh) * 2016-07-26 2016-11-16 沈阳爱锐宝科技有限公司 一种经颅磁刺激器的导航定位装置及定位方法
CN107263474A (zh) * 2017-06-20 2017-10-20 深圳市迈步机器人科技有限公司 一种控制机械臂移动的方法和装置
CN109480841A (zh) * 2017-09-13 2019-03-19 复旦大学 基于功能磁共振成像的异常脑区精准定位与矫正方法

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2003021859A (ja) * 2001-07-09 2003-01-24 Konica Corp 撮影用ガイド、人物写真撮影装置、人物写真プリント装置
JP2005148540A (ja) * 2003-11-18 2005-06-09 Moritex Corp 顔面撮像装置
JP2008171264A (ja) * 2007-01-12 2008-07-24 Noritsu Koki Co Ltd 顔撮影装置および顔撮影方法
JP2009009069A (ja) * 2007-06-29 2009-01-15 Noritsu Koki Co Ltd 顔撮影装置
WO2013062022A1 (fr) * 2011-10-24 2013-05-02 帝人ファーマ株式会社 Système de stimulation magnétique transcrânienne

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2003021859A (ja) * 2001-07-09 2003-01-24 Konica Corp 撮影用ガイド、人物写真撮影装置、人物写真プリント装置
JP2005148540A (ja) * 2003-11-18 2005-06-09 Moritex Corp 顔面撮像装置
JP2008171264A (ja) * 2007-01-12 2008-07-24 Noritsu Koki Co Ltd 顔撮影装置および顔撮影方法
JP2009009069A (ja) * 2007-06-29 2009-01-15 Noritsu Koki Co Ltd 顔撮影装置
WO2013062022A1 (fr) * 2011-10-24 2013-05-02 帝人ファーマ株式会社 Système de stimulation magnétique transcrânienne
WO2013062021A1 (fr) * 2011-10-24 2013-05-02 帝人ファーマ株式会社 Système de stimulation magnétique transcrânienne

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106110507A (zh) * 2016-07-26 2016-11-16 沈阳爱锐宝科技有限公司 一种经颅磁刺激器的导航定位装置及定位方法
CN107263474A (zh) * 2017-06-20 2017-10-20 深圳市迈步机器人科技有限公司 一种控制机械臂移动的方法和装置
CN109480841A (zh) * 2017-09-13 2019-03-19 复旦大学 基于功能磁共振成像的异常脑区精准定位与矫正方法

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