Magstim brochure 2012 by Acertys

The Leading Provider of Advanced Neurostimulation Products

Advanced Neurostimulation The Magstim range of magnetic stimulation systems provide a variety of high quality solutions for researchers and clinicians working within Neurology, Neuroscience, Psychiatry and Rehabilitation. Magstim has substantial expertise in magnetic stimulation, and is a leader in the field, offering a wide range of magnetic stimulators and stimulating coils to suit a variety of clinical and research applications.

Non-invasive Neuromodulation Magnetic stimulation is a non-invasive and painless method of stimulating human tissue using strong, time varying magnetic fields to induce small currents in nerve tissue. These are able to stimulate the human cortex, spinal roots and peripheral nerves. Depending on the application a variety of output waveforms may be used to excite or inhibit nerve response. These pulses can be either monophasic or biphasic, or a combination of the two. This brochure is intended for users of TMS equipment outside of the USA.

a leader in the field of magnetic stimulation Users of Magstim Transcranial Magnetic Stimulators in the USA please note: Caution - Investigational Device. Federal (or United States law) limits device to investigational use.

Magstim

Controlled Trains Magstim 2002 & BiStim2 - Monophasic Monophasic Systems Magstimproduce BiStim² offers the potentialsystems; to combine two Magstim two monophasic the Magstim

component clinical and research assessment techniques, Two ISI optionsofoffer maximum controllability: including: ● 1ms - 999ms in 1ms resolution Triple Stimulation Technique ● ● 1.0ms - 99.9ms in 0.1ms resolution coil. The ability to changemonophasic pulse intervals and to systems single pulse functionality, waveform ● Resting Motor Threshold BiStim² has the added advantage of being able to sum the 2 independently power 2level of each Magstim Magstim & the BiStim - Monophasic are favoured 200 for:control ● Active Motor Threshold two single pulses provided by the Magstim 2002 Magstim produce monophasic systems; the Magstim2002 allows fortwo precise sub- and supra-threshold ●200²Neurological research ● Central Conduction Time stimulators to produce a single high power pulse equal to and BiStim2, which are used extensively within the for fields of and test pulses. Thisresearch is invaluable the ●conditioning Cortical mapping and brain ● Motor Evoked Potential neurology and neurophysiology. For accurate single pulse functionality, 113% of a single Magstim 200². Inter-Cortical and Intra-Cortical ●investigation Functionalofassessment of central motor pathways ● Input-Output Curve monophasic waveform systems are favoured for: and Facilitation. ●Inhibition Early diagnosis, assessment and monitoring ● Cortical Silent Period l Neurological research of nervous diseases, such as Multiple inter-stimulus interval (ISI) of the two pulses is Magstim 200² offers complete flexibility and can be l The Cortical mapping and brain research Sclerosis and Motor Neurone Disease. l adjustable using either integral Functional assessment of the central motorstimulator pathways controls, interfaced with a wide range of commercially available l remote Early diagnosis, assessment and monitoring of nervous diseases, EMG systems. The monophasic waveform provides a high Single control pulsecoil or externally via triggering such as Multiple Sclerosis and Motor Neurone Disease. software offering complete user flexibility. degree of hemispheric accuracy, low noise and less coil Magstim 200² provides users with the ability to elicit heating than other Trains pulse waveforms. Controlled Single pulsepotentials, quickly and easily, as a routine cortical evoked 2 2 Magstim offers the potential to combine Magstim Magstim 200 provides users with the ability to elicit cortical The MagstimBiStim 200² is backward compatible with all two Magstim 2 200 units to provide fully programmable paired pulse stimulation evoked potentials, quickly and easily, as a routine component of clinical stimulating coils. Monophasic single pulse systems are favoured in neurological Magstim unitswhich to provide fullyextensively programmable 2002 and 200² BiStim2, are used within the applications due to the accuracy of the stimulation and the low heat paired stimulation through a single For stimulating fields of pulse neurology and neurophysiology. accurate output.

through a single stimulating coil. The ability to change pulse intervals and to independently control the power level of each Magstim 2002 allows for precise sub- and supra-threshold conditioning and test pulses. This is invaluable for the investigation of Inter-Cortical and Intra-Cortical Inhibition and Facilitation.

and research assessment techniques, including: l

Triple Stimulation Techniquev

Resting Motor Threshold

Active Motor Threshold

Central Conduction Time

l Motor

Evoked Potential

l Input-Output l Cortical l Motor

a worldThemarket leader in the field of inter-stimulus interval (ISI) of the two pulses is adjustable using either the integral stimulator controls, remote control coil or externally magnetic stimulation via triggering software offering complete user flexibility.

Curve

Two ISI options offer maximum controllability:

Silent Period

Mapping

l 1ms

- 999ms in 1ms resolution - 99.9ms in 0.1ms resolution

l 1.0ms

Magstim 2002 offers complete flexibility and can be interfaced with a wide range of commercially available EMG systems.The monophasic waveform provides a high degree of hemispheric accuracy, low noise and less coil heating than other pulse waveforms. The Magstim 2002 is backward compatible with all Magstim stimulating coils, via the coil adaptor.

BiStim2 has the added advantages of being able to sum the two single pulses provided by the Magstim 2002 stimulators to produce a single high power pulse equal to 113% of a single Magstim 2002, as well as having the functionality to connect two individual coils for interhemispheric stimulation.

Magstim 200²

Magstim BiStim²

Magstim Rapid²

Magstim Rapid² Plus¹

Monophasic

Monophasic Twin Pulse

Biphasic

2.80kV

2.50kV*

1.67kV

2.0s 3.0s 4.0s

Single PSU - 50Hz Dual PSU - 100Hz Single PSU - 30Hz Dual PSU - 50Hz Single PSU - 15Hz Dual PSU - 25Hz

100Hz 97Hz 41Hz

Minimum Inter Stimulus Interval

N/A

1.0ms

N/A

Minimum Inter Train Interval

N/A

4.0s

0.5s

Maximum voltage Maximum repetition rates (230V configuration)

30% 50% 100%

“

* Also available as 2.80kV

“

Output Type

Magstim

Magstim 2002 & BiStim2 - Monophasic Biphasic Systems Magstim Rapid2 - Biphasic 2002 and BiStim2, which are used extensively within the

component of clinical and research assessment techniques, including:

● Functional assessmentviof- in central motor pathways Cognitive Neuroscience the investigation of learningvii viii, ix x memory , speech , hearing, visual, perception and functional connection ● Early diagnosis, assessment and monitoring

●withTriple Stimulation Technique integral system acquisition software including latency and ●amplitude Restingmeasurements. Motor Threshold The dedicated touch screen user interface internal and external memory makes storage and retrieval ●withActive Motor Threshold of results straightforward. Connecting the optional thermal printer ● Central Conduction Time allows for the provision of hard copies. ● Motor Evoked Potential 2 can be usedCurve with other investigation tools such as fMRI, EMG, ●Rapid Input-Output EEG, tDCS, tACS and Image-guided TMS over a broad range of ● Cortical Silent Period

Magstim produce two monophasic systems; the Magstim

Magstim Rapid2 repetitive Transcranial Magnetic Stimulation (rTMS) fields of neurology and neurophysiology. For accurate devices are highly effective non-invasive biphasic magnetic stimulators single pulse functionality, monophasic waveform designed to meet the exacting needs of those involvedsystems at all levels of are favoured for: clinical and academic research. Highly efficient, short duration biphasic pulses makes it very well suited to bilateral cortical stimulation and is ● Neurological research used in many different areas of brain research, including: ● Cortical mapping and research

of nervous xidiseases, such as Multiple Psychiatry - to influence specific brain function within the Sclerosis and Motorcortex Neurone Disease. dorsolateral prefrontal Neurophysiology - used in the stimulation of the peripheral Single pulse and central nerve pathways

Magstim 200² provides users with the ability to elicit

Rehabilitation - used in the promotion of muscle recovery cortical evoked potentials, and the relief of nerve spasticityquickly and easily, as a routine The Magstim Rapid2 range of repetitive stimulators has been developed to maintain a consistent pulse amplitude/frequency during the delivery of stimulation trains through Single Pulse, Repetitive, Burst and Session modes of operation. Rapid2 stimulators offer frequencies of up to 100Hz, with a 0.1Hz frequency resolution for the first 30Hz.

Magstim Rapid2 has a unique in built two channel EMG amplifier

protocols and is fully compatible with existing Magstim coils through

Magstim 200² offers complete flexibility and can be customised hardware. 2 1 interfaced with a wide range of innovative commercially availableto the Magstim Rapid Plus is an enhancement 2 EMG Theonly monophasic provides ahigher high Rapidsystems. and is the system ablewaveform to offer a significantly repetition rate at stimulation output of 30% and higher. This degree of hemispheric accuracy, low noise and less coil is particularly applications using protocols such as Theta Burstxii, heating thanuseful otherinpulse waveforms. as the Magstim Rapid2 Plus1 is capable of up to 89% output at 50Hz.

The Magstim 200² is backward compatible with all Magstim With the addition of a Plus1 module a single PSU Rapid2 can be easily stimulating coils. upgraded to dual PSU performance, whereas the addition of the Plus1 module to a dual PSU Rapid2 make high powered protocols feasible. 100

Rapid2 Plus1

Dual PSU Rapid2

Single PSU Rapid2 (230v configurations)

Frequency (Hz)

70 60 50 40 30

Magstim Rapid2 is for single pulse and repetitive stimulation

20 10 0 0

100

Power (%)

Magstim Rapid2 Performance

100 90 80

Frequency (Hz)

70 60 50 40 30 20

“

10 0 0

Power (%)

Rapid2 Plus1 Dual PSU Rapid2 Single PSU Rapid2

Magstim

Magstim 2002 & BiStim2 - Monophasic component of clinical and research assessment techniques, Magstim produce two monophasic systems; the Magstim including: 2002 and BiStim2, which are used extensively within the fields of neurology and neurophysiology. For accurate ● Triple Stimulation Technique single pulse functionality, monophasic waveform systems ● Resting Motor Threshold are favoured for: ● Active Motor Threshold ● Neurological research ● Central Conduction Time ● Cortical mapping and brain research ● Motor Evoked Potential ● Functional assessment of central motor pathways ● Input-Output Curve As the original pioneers of TMS, Magstim are industry recognised ● Early diagnosis, assessment and monitoring ● Cortical Silent Period as world leaders in diagnostic, research and therapy solutions. of nervous diseases, such as Multiple Magstim 200² offers complete flexibility and can be rTMS (Repetitive Transcranial Sclerosis and Motor Neurone Disease. Magnetic Stimulation) is a treatment interfaced with a wide range of commercially available for patients that have not responded to pharmaceutical solutions - it is EMG systems. The monophasic waveform provides a high Single pulse estimated that up to 40% of patients do not beneﬁt from, or cannot degree of hemispheric accuracy, low noise and less coil tolerate, antidepressant medications – even after repeated attempts. Magstim 200² provides users with the ability to elicit heating than other pulse waveforms. evoked potentials, quickly that and easily, as ahas routine Acortical recent study has shown rTMS a 58% response rate and The Magstim 200² is backward compatible with all Magstim 37% remission rate and has shown eﬃcacy as a well-tolerated stimulating coils. 1 therapeutic option .

An eﬀective treatment where traditional medication has failed

Beneﬁts of rTMS ● Treatment with rTMS has a fast onset of action with signiﬁcant patient improvement2 ● Treatment is provided as an outpatient procedure ● Patients can return to normal activities after treatment ● No anaesthesia or sedation required ● 20-30 treatments over 4-6 weeks ● 37.5 minute treatment time

Is rTMS right for you? rTMS is a treatment that can be used as an adjunct with medication, or as a drug free treatment. This therapy avoids the side eﬀects associated with antidepressant medication. rTMS is the future for depressed patients who are proving resistant to traditional pharmaceutical solutions.

To request more information, please visit:

“

www.magstim.com/TMSclinical email: TMSclinical@magstim.com or Tel: +44 (0) 1994 240798

1 Carpenter. L, et al: Transcranial Magnetic Stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice (2012) 2 Rossini. D, et al: Transcranial magnetic stimulation in treatment-resistant depressed patients: A double-blind, placebo-controlled trial (2005)

Magstim

Magstim 2002 & BiStim2 - Monophasic Magstim produce two monophasic systems; the Magstim Part Coil Description 2002 and BiStim2, which are used extensively within the No. fields of neurology and neurophysiology. For accurate single pulse functionality, monophasic waveform systems are favoured for: 3192-00 90mm Standard Single High Power ● Neurological research Coil Remote ● Cortical mapping and brain research Control ● Functional assessment of central motor pathways ● Early diagnosis, assessment and monitoring of nervous diseases, such as Multiple 9784-00 Disease. 90mm Coil Sclerosis and Motor Neurone * Single High Power Coil 1st generation Single pulse Magstim 200² provides users with the ability to elicit cortical evoked potentials, quickly and easily, as a routine 1165-00 *

25mm Double Coil

Branding Iron Polyurethane 1st generation

Stimulator Compatibility

Clearance

● Triple Stimulation Technique ● Resting Motor Threshold Cortical ● Active Motor Threshold Stimulation ● Central Conduction Time Cervical nerve ● rootsMotor Evoked Potential ● Input-Output Curve Lumbosacral nerve ● rootsCortical Silent Period

Magstim 200² offers complete flexibility and can be Cortical a wide range of commercially available interfaced with Stimulation EMG systems. The monophasic waveform provides a high Cervical nerve degree roots of hemispheric accuracy, low noise and less coil Lumbosacral heating than other pulse waveforms. nerve roots The Magstim 200² is backward compatible with all Magstim stimulating coils. Facial nerve Median nerve Ulnar nerve Somatosensory evoked potentials F-Wave and reflexes

3190-00 70mm Double Coil

Remote Coil

Cortical Stimulation Spinal roots Peripheral nerves

3271-00 *

70mm Double Coil

Branding Iron Polyurethane 1st generation

Cortical Stimulation Femoral nerve Back and neck

3281-00 *

70mm Flat coil Double Polyurethane Coil 1st generation

Cortical Stimulation Femoral nerve Back and neck

Please refer to www.magstim.com for regular product updates. * Requires coil adapter

Regulatory

component of clinical and research assessment techniques, 2002 Bistim2 Rapid2 CE Mark FDA Application including:

“

Magstim

Magstim 2002 & BiStim2 - Monophasic Magstim produce two monophasic systems; the Magstim Part 2002 and BiStim2, which are usedCoil extensivelyDescription within the No. fields of neurology and neurophysiology. For accurate single pulse functionality, monophasic waveform systems are favoured for: High 4102-00 D702 Performance Double ● Neurological research Double Coil Coil ● Cortical mapping and brain research ● Functional assessment of central motor pathways ● Early diagnosis, assessment and monitoring of nervous diseases, such as Multiple Cone Coil 9902-00Disease. 110mm Sclerosis and Motor Neurone 1st generation * Double Coil Single pulse Magstim 200² provides users with the ability to elicit cortical evoked potentials, quickly and easily, as a routine 4150-00 Alpha 70mm Double Coil

Alpha Coil

3530-00 70mm Double Coil

Air Cooled Coil

3910-00 70mm Double Coil

3950-00 70mm Double Coil (Placebo)

Stimulator Compatibility

● Triple Stimulation Technique ● Resting Motor Threshold Cortical ● Active Motor Threshold Stimulation ● Central Conduction Time Spinal Roots ● Motor Evoked Potential Peripheral Nerves ● Input-Output Curve ● Cortical Silent Period

The Magstim 200² is backward compatible with all Magstim stimulating coils. Cortical Stimulation Spinal roots Peripheral nerves

Power intensive protocols Long duration protocols

Air Film Coil

Psychiatry Cognitive Neuroscience Neurology Neurophysiology Rehabilitation

Identical to the active coil (see above) other than the stimulating output. Suitable for double-blind trials

Cortical Stimulation Cervical nerve roots Lumbosacral nerve roots

“

FDA Clearance

Magstim 200² offers complete flexibility and can be Central motor interfaced with a wide range of commercially available disorders EMG systems. The monophasic waveform provides a high Spinal injuries Urology degree of hemispheric accuracy, low noise and less coil heating than other pulse waveforms.

Please refer to www.magstim.com for regular product updates. * Requires coil adapter

Regulatory

component of clinical and research assessment techniques, Application 2002 Bistim2 Rapid2 CE Mark including:

Magstim

Magstim 2002 & BiStim2 - Monophasic Magstim produce two monophasic systems; the Magstim 2002 and BiStim2, which are used extensively within the fields of neurology and neurophysiology. For accurate Distributor Information single pulse functionality, monophasic waveform systems are favoured for: ● Neurological research ● Cortical mapping and brain research ● Functional assessment of central motor pathways ● Early diagnosis, assessment and monitoring of nervous diseases, such as Multiple Sclerosis and Motor Neurone Disease.

Single pulse Magstim 200² provides users with the ability to elicit cortical evoked potentials, quickly and easily, as a routine References

component of clinical and research assessment techniques, including: ● Triple Stimulation Technique ● Resting Motor Threshold ● Active Motor Threshold ● Central Conduction Time ● Motor Evoked Potential The Magstim CompanyCurve Ltd ● Input-Output Spring ●Gardens, CorticalWhitland Silent Period Carmarthenshire, Magstim 200²SA34 offers0HR complete flexibility and can be

Wales, UK interfaced with a wide range of commercially available T: +44 (0)1994 240798 EMG systems. The monophasic waveform provides a high E: sales@magstim.com degree of hemispheric accuracy, low noise and less coil heating than other pulse waveforms. www.magstim.com The Magstim 200² is backward compatible with all Magstim stimulating coils.

i Combining TMS

and fMRI: From 'virtual lesions' to functional-network accounts of cognition. Ruff CC, Driver J, Bestmann S. Cortex. 2008 Dec 6. [Epub ahead of print]

ii Combining TMS and EEG to study cognitive function and cortico-cortico interactions. Taylor PC, Walsh V, Eimer M. Behav Brain Res. 2008 Aug 22;191(2):141-7. Epub 2008 Apr 1. iii Mapping of the human visual cortex using image-guided transcranial magnetic stimulation. Fernandez, E., Alfaro, A., Tormos, J.M., Climent, R., Martinez, M., Vilanova, H., Walsh, V., and Pascual-Leone, A. Brain Research Protocols 10:115-124, 2002. iv Complementary

localization and lateralization of orienting and motor attention. Rushworth, Matthew F.S., Ellison, Amanda, and Walsh, Vincent. Nature Neuroscience, 4(6), June 2001.

v Triple

stimulation technique (TST) in amyotrophic lateral sclerosis Leonid Komissarow, Jens D. Rollnik, Dessislava Bogdanova, Klaus Krampfl, F. A. Khabirov, Andon Kossev, Reinhard Dengler and Johannes Bufler Clinical Neurophysiology, Volume 115, Issue 2, Pages 356-360

vi Transcranial

magnetic stimulation and cognitive neuroscience Vincent Walsh and Alan Cowey Nature Reviews – Neuroscience, Volume 1, October 2000, 73-79

vii The Contribution of Primary Motor Cortex is Essential for Probabilistic Implicit Sequence Learning: Evidence from Theta Burst Magnetic Stimulation Leonora Wilkinson, James T. Teo, Ignacio Obeso, John C. Rothwell and Marjan Jahanshahi Journal of Cognitive Neuroscience viii Transcranial

magnetic stimulation can measure and modulate learning and memory J Grafman E Wassermann Neuropsychologia 37 (1999) 159-167

ix Contribution

of noninvasive cortical stimulation to the study of memory functions A. Floela, L.G. Cohen Brain Research Reviews 53 (2007) 250–259

x Stimulating

language: insights from TMS Joseph T. Devlin and Kate E. Watkins Brain 130, (2007) 610–622 xi Applications

of TMS to Therapy in Psychiatry. Lisanby, Sarah H.; Kinnunen, Leann H.; Crupain, Michael J. Journal of Clinical Neurophysiology. 19(4):344-360, August 2002.

xii Exploring Theta

Burst Stimulation as an intervention to improve motor recovery in chronic stroke P. Talelli, R. Greenwood, J. Rothwell Clinical Neurophysiology, Volume 118, Issue 2, Pages 333-342

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Users of Magstim Transcranial Magnetic Stimulators in the USA please note: Caution - Investigational Device. Federal (or United States law) limits device to investigational use. All standard products carry the mark, comply with the Medical Device Directive 93/42/EEC, and are manufactured under a Quality System certified to ISO 13485. © 2012 The Magstim Company Limited. Magstim®, and Air FilmTM are registered trademarks of The Magstim Company Limited. All specifications are subject to change. All material in this literature is produced in good faith

This brochure is intended for users outside the USA