A Guide to Magnetic Stimulation

Induced electric field profile of the double cone

coil. The colours yellow, red, blue and green
signify decreasing field strengths.

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 A Brief History of Magnetic Stimulation

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 Basic Principles

Magnetic stimuli are produced by passing strong electric

current pulses through a coil of wire.

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 The time varying magnetic field produces an electric field
surrounding the stimulating coil which in turn induces small eddy
currents in a conductive medium such as the human tissue.

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 Magnetic Stimulator Design

Magstim Model 200 shown

above is a magnetic stimulator
with a monophasic output
pulse. The unit weighs 17kg
with the heaviest items being
the storage capacitor,
transformers and thyristor.

Storage Capacitor Transformers Thyristor

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 The Magstim in the previous slide consists of a capacitor
charge/discharge system together with the associated control
and safety electronics.
• The capacitor is charged to a set level determined by controls up to a
maximum of 2,800 volts (2.8kV).
• When triggered the energy stored in the capacitor is discharged into the
stimulating coil. The stored energy is transferred to the coil and then
returned to the instrument to reduce coil heating.
• The thyristor is capable of switching large currents in a few
microseconds. Thyristors conduct current only in one direction and hence
the Magstim 200 produces a monophasic discharge current with no
current reversal.
• Monophasic discharge currents reduce heat dissipation in the coil,
discharge click noise, the stimulus artefact and increase stimulus
accuracy. In addition, the stable and well defined monophasic pulse
allows for a better understanding of the mechanisms involved in magnetic
nerve stimulation.

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 Waveforms produced by
the circular 70mm coil
showing a fast rise and
slow decay culminating in
induced charge which
depolarises the nerve.

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Mariluce Caetano Barbosa - [email protected] - IP: 179.73.189.191
 The previous slide shows the outputs of the main
types of magnetic stimulators.

• Conventional recharger and close interval pulse train units have

high output capability.
• Rapid-rate stimulators have medium output power at repetition
rates of 10-30Hz. It must be noted that rapid-rate trains of five or
more pulses applied cortically have been shown to induce seizures.
This is, of course not surprising as ECT is also capable of inducing
seizures using similar parameters. Single stimuli delivered at less
than 5Hz or pulse trains containing four or fewer pulses, on the
other hand are highly unlikely to induce a seizure.

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 The above diagram shows the three main types of magnetic field output
from stimulators together with their characteristics. Only one device
appears to utilise polyphasic output with the remainder using mono and
biphasic output in similar numbers. Some units have multiple output
types.

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 The 3D magnetic field profile is shown above for the 90mm coil. The
highest field strength occurs near the inner turn (2.0 Tesla peak field).

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 The 3D magnetic field profile is shown above for the double circular 70mm coil
showing the interaction between the two windings (2.2 Tesla peak field).

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 The induced
electric field
profile of single
and double coils
differ widely
because of their
geometry. The
induced electric
field of a circular
coil is zero directly
under its centre and
reaches maximum
approximately
under the mean
diameter. In the
case of double coils it is at a maximum
directly under the coil centre and has two
smaller characteristic peaks on either
side.

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 Clinical applications for the technique are for the
non-invasive stimulation of;

• Peripheral pathways
• Central motor pathways

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 Other uses include stimulation of

• Left and right prefrontal cortex

• Visual cortex
• Language centre
• Cerebellum
• Peripheral sensory nerves

These applications cover uses for diagnosis, prognosis,

monitoring and therapy.

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 Motor Evoked Potentials (MEPs)

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 The set-up shown previously allows the recording of motor evoked
potentials. The example responses shown on the right have all been
recorded over the left dorsal interosseous (FDI). From top to bottom:

• (a) Stimulation at Erb's point using the circular 40mm coil;

• (b) Stimulation at the neck with the 90mm circular coil centred
over C7;
• (c), (d), and (e) Stimulation of the motor cortex with the 90mm
coil placed centrally on the vertex - three superimposed responses
each. Responses (d) and (e) are facilitated by slight preactivication
of the target muscle.

Note that there is a silent period after the compound motor

potential lasting over 100ms.

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 Central Motor Conduction Time (CMCT)

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 The central motor conduction time (CMCT) is typically
measured by;

• first stimulating the motor cortex (bottom right)

• and then the relevant peripheral nerve as it exits the
spine (top right).

The difference is the time it takes for the impulse to

travel from the motor cortex to the spinal vertibral
foramen. This time is commonly referred to as the
CCMT. The responses shown above were obtained
from the first dorsal interosseous (FDI) muscle in the
hand.

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