DEVELOPMENT OF A NEW DEEP TMS DEVICE

The difficulty of an efficient activation of the deep structures of the brain, the way of depositing energy and the orientation of the target, are the fundamental elements that provoked the creation of a different way to stimulate brain tissue. The differences emerge from the physical properties and physiological aspects of interaction of TMS with the human brain, and that includes both the coil and the generator.

Without going into deep neuroanatomic aspects, the actions of EMT within a three-dimensional neural network must be considered in the brain. The cytoarchitecture not only varies between the areas of the same brain lobe, but between the lobes themselves.

Another circumstance arises with the orientation of the magnetic field in relation to cortical folds. The position of the coil in the primary motor cortex and, therefore, the orientation of the current flow change the amplitude of the motor evoked potential.

The same premises and conditions are applicable to the white substance. This means that the effects of brain stimulation correspond to the sum, or net effects, of axonal and neuronal stimulation.

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DESIGN OF H-COIL IN DEEP TMS

The way to reach the depth of the brain, up to more than 6 cm, is produced by activating magnetic fields at several points aimed at the same objective. While the field is aimed at the target, a similar effect could be produced on the amount of constructive interference that emanates from more than one point, and the “non-target” areas could experience an opposite field of reduced intensity, similar to the destructive intensity because of the opposite effect.

It is known that brain stimulation occurs when the magnitude of the electric field reaches a certain threshold. This threshold depends on the orientation of the induced field.

Physiological studies indicate that optimal activation occurs when the field is oriented in the same direction as nerve fibers. Therefore, in order to stimulate the deep regions of the brain, it is necessary to use coils with that orientation to activate the neuronal structures or axons of consideration. Building a deep TMS coil must meet the following principles:

  • Enough intensity of the electric field at the desired depth of the brain to exceed the threshold of neuronal activation.
  • High percentage of the electric field at the desired depth of the brain relative to the maximum intensity of the cortex.
  • Minimal undesirable effects such as pain, or activation of facial muscles.

With the development of a three-dimensional coil in the form of H, H-Coil, coupled to a helmet similar to that of a motorcyclist, and the modification of existing generators according to the exposed criteria, a team of researchers co-led by Yftach Roth and Abrahan Zangen, have created, after 11 years of clinical trials, an ingenious deep TMS device, which elevates and expands the category of this treatment modality considerably.

Patented single-structure-coil.

Deep Transcranial Magnetic Stimulation (Deep TMS) is based on its H-coil, which offers a unique new structure that enhances the electrical stimulation of deep brain regions. Unique features of the coil design include:

  • Tangential coil components to the head near the brain targets
  • Flexible base adaptable to the shape of the head
  • Convergence of numerous electrical pulses from various directions
  • Parallel coil components to direct the electric pulse beams
  • Location of the return paths of the electrical pulses at a distance from the target area

The effectiveness of deep TMS technology has been validated, among others, in the following indications:

  • Resistant Depression (FDA approved) – H1 Coil
  • Obsessive Compulsive Disorder (FDA approved) – H7 Coil
  • Bipolar disorder – H1 Coil
  • PTSD – H7 and H1
  • Autism spectrum disorders, Asperger syndrome – H1 Coil
  • Tobacco and alcohol Treatment for dependency – H7 Coil
  • Alzheimer´s disease – H1 Coil
  • Parkinson's disease – H1 Coil
  • Chronic pain – H10 Coil
  • Gait disorder – H10 Coil
  • Increase in the temporal permeability of the blood brain barrier – H1 Coil
  • Multiple sclerosis – H10 Coil
  • Stroke – H10 Coil
  • Migraine – H1 Coil

The two processes approved by the FDA to be treated with deep TMS are Major Depression Disorder (MDD - 2013) and Obsessive Compulsive Disorder (OCD - 2018).

Brain regions that have been safely stimulated using Deep TMS Brainsway

  • Lateral and medial prefrontal cortex
  • Orbitofrontal cortex
  • Insular cortex, left and right, and entorinal cortex
  • Anterior and posterior cingular cortex
  • Lateral and medial motor cortex, including the deep motor cortex of the leg
  • Premotor cortex
  • Supplementary motor area
  • Precuneus
  • Subgenual cortex
  • Structures of the right and left temporal cortex, the fusiform area of the face and the superior temporal groove
  • Regions of the parietal and occipital cortex
  • Auditory cortex
  • Visual cortex
  • Cerebellum

Specialties that benefit themselves from deep TMS:

  • Psychiatry
  • Neurology
  • Child neurology
  • Neurosurgery
  • Neuroradiology
  • Neurorehabilitation
  • Endocrinology
  • Ophthalmology
  • Urology

BrainsWay Research Network Includes

Important US Institutions:
  • National Institute of Neurological Disorders and Stroke
  • National Institute of Drug Abuse
  • Medical University of South Carolina
  • Harvard University
  • New York State Psychiatric Ins./ Columbia University
  • University of California
  • Duke medical Center
  • Johns Hopkins Hospital
  • Mount Sinai
International Institutes
  • Ludwig-Maximilians University, Germany
  • Charité University, Germany
  • Medical Center Hamburg-Eppendorf, Germany
  • University of Bonn, Germany
  • UCL Medical School, UK
  • CAMH, Toronto, Canada
  • Mc Gill University, Canada
  • San Raffaele Medical Center, Milan, Italia
  • Tel Aviv Medical Center, Israel
  • Ben-Gurion University, Israel
  • Hadassah Medical Institutes, Israel
  • Weizmann Institute, Israel Medical School
  • UT Southwestern Medical Center, Dallas
  • Greater Nashua Mental Health Center

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