IMAGE-GUIDED ROBOTICALLY-POSITIONED TMS SYSTEM

DESCRIPTION (provided by applicant): Interest in transcranial magnetic stimulation (IMS) has grown rapidly since its introduction in 1985, with clinicians and researchers worldwide now using IMS. Promising clinical applications include pre-surgical language mapping, and treatment of depression, Parkinson's disease, and Schizophrenia. Promising research applications include reversible-lesion mapping and connectivity analysis. An image-guided, robotically positioned TMS (irTMS) system that provides accurate and precise IMS for both research and clinical applications was developed at the UTHSCSA Research Imaging Center. This is the first system with fully integrated robotic control of IMS. This system additionally provides a full set of features for treatment planning, similar to modern radiation therapy treatment planning. A new irTMS system and robot intended for broader clinical use is now being evaluated. The initial target market for this irTMS system is for treatment of depression, and our specific aims therefore focus on clinical features important for such treatments, which are also unique to TMS/robotics. The aims of this Phase I proposal are to: 1) replicate prior validation studies using the new robot, 2) develop and evaluate single- session multi-site treatments, 3) develop and evaluate within-session head motion correction, and 4) develop and evaluate optimal TMS coil positioning using feedback from EMG. Concurrent with the performance of these aims we will be developing additional safety features and collecting data regarding safe use of the new robot. In Phase II, the irTMS system will be further refined for its first clinical use, TMS treatment of depression. Testing in this Phase I proposal is with a head phantom to simulate the patient, and testing in Phase II will include research in human subjects. This application is in response to the NIHM Topic B "Instrumentation for Basic and Clinical Neurosciences Research" in the omnibus solicitation.