Neuro-MSX Transcranial Magnetic Stimulator

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  • Highlights
  • Features
  • Specifications
  • Standard Set
  • Warranty
  • Downloads
  • TMS ● rTMS ● Neuronavigation ● TMS-EEG ● TMS-EMG



Neuro-MSX is a Class II medical device, authorized by Health Canada. 

Authorization Reference Number 336230.  Issue Date: 2022-10-26.


Key features

· Stimulation frequency up to 100 Hz

· Five pre-defined treatment protocols, including Theta-burst stimulation (3 minute) treatment protocol

· New-generation ergonomic coils with inductor handles with built-in controls

· Deep integration and optimization with Neural Navigator

· Optimized with Neuron-Spectrum-63, 64, 65 for rTMS-EEG

· Lower Motor Threshold

· Advanced liquid coil-cooling technology

· Multifunctional color display

· Intuitive interface and easy control

· Free-use arrangement, no pay-per-use licence required

· Wi-Fi controls

· Optional Electrical Stimulator, e.g. for placebo studies

· Optional EMG Unit for TMS-EMG, e.g. for more precise, automatic motor threshold determination

· Easy to learn

· Easy to use

· Efficient clinically and economically

Up to 100 Hz stimulation frequency

Neuro-MSX Magnetic Stimulator’s main unit allows performing stimulation at up to 100 Hz frequency while peak induction is ensured at the frequency of 13-15 Hz.

Extra power supply unit allows increasing stimulation frequency, up to 25-30 Hz, at which peak induction is reached, and the system assures 60% intensity at just 50 Hz frequency. This is clinically important because, with the use of Neuro-MSX stimulators, the motor threshold in most patients is 45% MSO and less even for lower extremities.

This means that these patients can be stimulated with up to 50Hz frequency and with theta-burst stimulation (TBS) protocols without any stimulus decay.

New generation of cooled coils

Repetitive magnetic stimulation usually performed during TMS therapy implies that thousands of pulses are delivered within the treatment session. This may result in coil overheating and explains the need to use cooled coils.

Thanks to the breakthrough cooling system implemented in Neuro-MSX coils eliminates overheating during any treatment, and a variety of coil shapes enables achieving positive outcomes in various individual cases.

Flexible software for smooth performance

The supplied Neuro-MS.NET software allows keeping the patient database, managing treatment sessions, and detecting motor threshold.

Stimulation can be performed using preset protocols that can be customized to create custom protocols.

The advanced therapeutic configuration of Neuro-MSX features high-frequency protocol – up to 100 Hz frequency and theta-burst stimulation protocol – up to 2000 Hz!

Configuration options to fit different clinical needs

There are four Neuro-MSX configurations:

· Diagnostic

· Therapeutic

· Advanced Therapeutic I – with extra-power Irbis Cooling Unit

· Advanced Therapeutic II

 The two advanced therapeutic configuration options of Neuro-MSX include:

· A conventional cooling unit for robust everyday operation, or

· High-performance Irbis cooling unit for operation in rooms with higher ambient temperature, at higher intensity, and higher frequency.

Besides, for clinics with low patient flow and that do not use maximum intensity and frequency stimulation protocols, a cost-effective Slim configuration is available. It includes all 3 units, but employs a conventional cooling system, second-generation coils and does not include computer and software.

Hardware features

High stimulation frequency

The main unit of Neuro-MSX magnetic stimulator allows performing stimulation at up to 100 Hz frequency while peak induction is ensured at the frequency of 13-15 Hz.

Extra power supply unit allows increasing stimulation frequency, up to 25-30 Hz, at which peak induction is reached, and the system assures 60% intensity at 50 Hz frequency. This is clinically important because when using our stimulators motor threshold in most patients is 45% MSO and lower. It means that these patients can be stimulated with up to 50 Hz frequency and with TBS protocols without any stimulus decay.

Innovative liquid cooling system

The cooling system allows avoiding coil overheating during long-term rTMS sessions. The advanced method of active coil component cooling is implemented in Neuro-MSX magnetic stimulators.

The cooling liquid does not fill the whole coil, instead, it runs inside the winding and therefore, neutralizes the heat on the very site where heating appears.

Besides, the less liquid is inside the coil, the easier and more comfortable it is to use.

Reliable coil connector

The special industrial-quality connector made of high-strength materials ensures safe coil attachment to the Main Unit and long-lasting functioning without pin burning, a common problem with other connectors.

Flexible arm for coil positioning

During the entire treatment session, it is very important to keep the coil in the same position relative to the patient’s head. Any coil motion can impact negatively the therapy ef­ficiency.

To ensure reliable and accurate coil placement above the target area, the special flexible arm for coil positioning was designed. The arm enables easy and fast coil positioning in desired location.

Intuitive controls

DISPLAY:  The multifunctional display of the main unit shows stimulation parameters, state of the coil, and the unit itself.

“TRIGGER” BUTTON:  When the stimulator is in “Armed” state, pressing the “Trigger” button starts single pulse or repetitive stimulation depending on the current operating mode.

New generation of cooled coils

Figure-Of-Eight Coil FEC-03-100-C:  Focused cortical and peripheral nerve stimulation, gold standard for TMS.

Ring Coil RC-03-125-C:  Cortical and peripheral nerve stimulation (cervical, lumbosacral nerve roots, pudendal nerve). Designed for stimulation of deep-lying nerves.

Angulated-Figure-Of-Eight Coil AFEC-03-100-C:  Deep cortical stimulation, accurate focusing.  Anatomic shape being congruent to head shape ensures closer fitting to the patient’s head.

Double Cone Coil DCC-03-125-C:  Deepest stimulation including cortex representations of lower limb and pelvic floor muscles, cerebellum and DMPFC.

Coil features:

· Positioning grid for precise coil placement.

· Buttons to increase/decrease stimulus intensity.

· “Trigger” button.

· Handle with enhanced ergonomics.

Pre-defined treatment protocols

Neuro-MSX can store 5 pre-defined treatment protocols in built-in memory.

Pre-defined Depression treatment protocols include:

· Depression 37 min

· Depression 19 min

· Depression 3 min – Theta-burst stimulation (TBS)

Protocols can be edited when necessary, using the controls on the front panel or via Wi-Fi.

Integration with Neural Navigator

Hardware and software of Neuro-MSX and Neural Navigator are deeply integrated and optimized with each other.  Therefore, the best performance of Neural Navigator is achieved with Neuro-MSX.


Neuro-MSX is the industry-first TMS system with Wi-Fi interface.  It can be wirelessly controlled using standard browser app of any gadget: iOS or Android phone, tablet, etc. The web interface allows the following:

· Editing treatment protocol parameters;

· Selecting stimulation mode;

· Monitoring stimulation status (stimulation progress, intensity, parameters, coil temperature).

NEURO-MS.NET software

The Neuro-MSX stimulator can be controlled by the Windows-based computer with installed Neuro-MS.NET software. Computer interfaces with the main unit via a single USB port.

Neuro-MS.NET software comprises:

· Patient database

· Treatment protocol library and editor, and

· Controller of the TMS machine.

The software guides the user through regular routine workfl ow such as creating a new patient record, selecting the pre-defined protocol from the library, generating or editing new treatment protocol, running and completing stimulation session, displaying the detailed history of each treatment on the screen, and printing treatment report.

Pre-defined protocols

The software offers a large number of pre-defined treatment/rehabilitation protocols. The user can always create new protocols or edit any parameter of existing ones.

MT determination and brain mapping tools

Motor threshold (MT) is the way to determine the “dosage” of rTMS treatment. It is an important measure for most rTMS protocols. The accuracy of MT measurement is the key to achieve the effectiveness and safety of the treatment.

Together with treatment location mapping, MT determination must be performed quickly but accurately. Neuro-MS.NET software offers a battery of tools both for MT determination and for brain mapping: automatic MT determination using EMG amplifier, semiautomatic MT determination using STEP algorithms, F3 locator, and visual help.

Automatic MT Determination

Motor threshold can be determined automatically using a compatible EMG amplifier (optional). In this mode, the software automatically delivers the series of pulses with random intervals. Specially designed sophisticated algorithm gradually increases or decreases pulse intensity depending on the amplitude of a particular EMG response. In just a few steps, the algorithm finds the MT value automatically.

Semiautomatic MT Determination

In Semiautomatic Mode, the software also delivers a series of pulses, automatically increases and decreases stimulus intensity depending on the response whereas the user observes muscle twitch visually and clicks “Yes” or “No” in the software respectively the response. MT is usually found in just 6-8 steps/stimuli. This approach streamlines MT determination and ensures high accuracy and speed.

F3 Locator

Once MT is determined, it is important to posi­tion the coil correctly over the stimulated area. The conventional protocol for depression treat­ment implies stimulation of the left dorsolateral prefrontal cortex (DLPFC), which corresponds to the F3 point in the 10-20 system.

Manual location of F3 requires many measure­ments and calculations. Neuro-MS.NET software has an implemented algorithm for F3 location using just 3 measurements:

· Tragus-to-tragus distance

· Nasion-to-inion distance

· Head circumference

Once the measurements are entered in the interface, the software will calculate precisely the target F3 point.

For more precise brain mapping, Neuro-MSX can be upgraded with MRI-guided neuronavigational system.

“Soft Start” mode

Some treatment protocols employ stimulation at 110% or 120% MT. Such intensity can induce involuntary head movements in patients unfamiliar with this technique. To avoid such response and prepare a patient to the procedure, the “Soft Start” mode, implemented in the software, can be used. It allows starting stimulation at a low intensity and gradually increasing it automatically up to the required value.


Upon the treatment session completion, the software automatically generates printable treatment report which includes patient demographics, treatment parameter description and all treatment session history.

Treatment history

The treatment history keeps the data obtained during MT determination (including traces), data on performed treatment sessions, time when session started, the actual number of stimuli delivered during each session, and other data.

Patient database

The patient database contains the list of all patients and history of all treatments.

Software compatibility

Neuro-MSX software enables highly efficient operation – saving both capital and operating costs – through a number of compatibility features:

Multiple computers:  Although only one computer can be used for diagnostic test data recording, each Software License allows using software on an unlimited number of computers.  Thus, the data can be recorded on one computer, and then, the data can be shared, analyzed, reviewed on other computers – with no additional Software Licenses.

Other applications:  The software can operate on a computer with Microsoft Office applications – Word, Excel, Outlook, PowerPoint, Access, Project, as well as Adobe and accounting software.  This is particularly efficient in smaller clinics.

Internet:  Computers with the Software installed can be connected to the Internet.  In an unlikely and rare event that a Microsoft Operating System update affects a software component, it can be restored by software re-installation, with no loss of data. 

Information system integration

Most clinics, networks and research institutions are equipped with information systems to store and process their data.  HL7 (Health Level 7) is the most commonly used interface engine for exchange, integration, sharing and retrieval of electronic data.

HL7-compatibility allows integrating Neuro-MSX into the information system of a clinic, hospital network, or research institution.

Main specifications

Stimulus parameters

Pulse waveform biphasic


Pulse duration range

240…410 μs

Peak magnetic field

2.5 T

Rated energy stored on the main unit capacitor at the set amplitude of 100%

320 J

Stimulation mode

· Single pulse

· Train

· Burst

· Ramp

· Sweep frequency

Maximum frequency

100 Hz

Maximum pulse frequency in burst

2000 Hz

Coil surface temperature enabling automatic stimulation stop

(39 ± 2) °С

Connection to PC


Power Supply

Input voltage *)

(220 ± 22)/(230 ± 23)/(240 ± 24) V

Input frequency

50/60 Hz

Power consumption during the stimulation:

· main unit

· extra power supply unit

· Irbis cooling unit

· cooling unit


≤ 3000 VA

≤ 3000 VA

≤ 1000 VA

≤ 190 VA





Wireless Connection with PC   


Wi-Fi, IEEE 802.11b/g/n standard

Stimulation parameters

Pulse amplitude

0 – 100%

Adjustment step for pulse amplitude


Intensity in % of MT

0 – 150%

Adjustment step for intensity in % of MT

1 %

Automatic stimulator discharge time

1 – 60 min

Adjustment step for automatic stimulator discharge time

1 min

Train mode

Pulse frequency in train

· 0.1 – 30 Hz

· 0.1 – 100 Hz (option)

Permissible relative deviation of intertrain interval


Adjustment step for intertrain interval:

· in the range 0 – 30 s

· in the range 30 – 600 s


0.1 s

1 s

Number of bursts in train

Number of bursts in train 1 – 2000

Adjustment step for the number of bursts in train


Number of trains in session

1 – 1000

Adjustment step for the number of trains in session


Maximum train duration

6000 s (calculated automatically

Ramp Mode

Ramp up time

0.1 – 60 s

Adjustment step for ramp up time:

· in the range 0.1 – 1 s

· in the range 1 – 60 s


0.1 – 1 s

1 s

Ramp down time

0.1 – 60 s

Adjustment step for ramp down time:

· in the range 0.1 – 1 s

· in the range 1 – 60 s


0.1 s

1 s

Plateau time (pulses are delivered with the same amplitude)

1 – 600 s

Adjustment step for plateau time

1 s

Pulse frequency in train

· 1 – 30 Hz

· 1 – 100 Hz (option)

Permissible relative deviation of pulse frequency in train ± 5%

± 5%

Adjustment step for pulse frequency in train:

· in the range 1 – 30 Hz

· in the range 30 – 100 Hz


0.1 Hz

1 Hz

Intertrain interval

0 – 600 s

Permissible relative deviation of intertrain interval

± 5%

Adjustment step for intertrain interval:

· in the range 0 – 30 s

· in the range 30 – 600 s


0.1 s

1 s

Number of trains per session

from 1 to 1000

Adjustment step for the number of trains per session


Sweep Mode

Maximum pulse frequency in train

· 1 – 30 Hz

· 1 – 100 Hz (option)

Permissible relative deviation of the maximum pulse

frequency in train

± 5%

Adjustment step for the maximum pulse frequency in train:

· in the range 1 – 30 Hz

· in the range 30 – 100 Hz


0.1 Hz

1 Hz

Start frequency in train

· 1 – 30 Hz

· 1 – 100 Hz (option)

Permissible relative deviation of the minimum pulse frequency in train

± 5%

Adjustment step for the minimum pulse frequency in train:

· in the range 1 – 30 Hz

· in the range 30 – 100 Hz


0.1 Hz

1 Hz

Sweep up time

0.1 – 60 s

Adjustment step for sweep up time:

· in the range 0.1 – 1 s

· in the range 1 – 60 s


0.1 Hz

1 Hz

Sweep down time

0.1 – 60 s

Adjustment step for sweep down time:

· in the range 0.1 – 1 s

· in the range 1 – 60 s


0.1 Hz

1 Hz

Plateau time (pulses are delivered with the same frequency)

0 – 600 s

Permissible relative deviation of intertrain interval

± 5%

Adjustment step for intertrain interval:

· in the range 0 – 30 s

· in the range 30 – 600 s


0.1 s

1 s

Number of trains in session

1 – 1000

Adjustment step for the number of trains in session


Electrical Stimulator

Number of channels


Pulse type

Electrical current

Pulse waveform

Rectangular (monophasic, biphasic)

Pulse polarity

Positive, negative

Pulse amplitude

0 – 100 mА

Permissible relative deviation of pulse amplitude

± 5%

Adjustment step for pulse amplitude

0.1 mА

Output voltage limit

(425 ± 25) V

Pulse duration

50 – 5000 μs

Permissible relative deviation of pulse duration

± 10%

Adjustment step for pulse duration

10 μs

Stimulation type

Single pulse, train

Stimulation frequency

0.1 – 100 Hz

Permissible relative deviation of stimulation frequency

± 5%

Adjustment step for stimulation frequency:

· in the range 0.1 – 1 Hz

· in the range 1 – 100 Hz


0.05 Hz

1 Hz

Number of pulses in train

2 – 200

Interpulse interval

2 – 10 ms

Permissible relative deviation of interpulse interval

± 5%

Adjustment step for interpulse interval

0.08 ms

Pulse energy with load resistance 1000 Ω

≤ 50 mJ

EMG Unit (Electromyography)


Number of channels


Sampling rate

200 Hz – 80 kHz

Input voltage

0.2 – 100 mV

Permissible relative deviation of input voltage:

· in the range 20 – 100 μV

· in the range 0.1 – 50 mV


± 15%

± 5%

Input impedance

≥ 200 MΩ

Input capacitance

≤ 30 pF

Input noise level in the bandwidth 20 – 10000 Hz (rms value)

≤ 5 μV (≤ 0.8 μV)

Patient leakage current

≤ 0.1 μA

Bandpass flatness:

· in the bandwidth 0.02 – 0.05 Hz and 5 – 10 kHz

· in the bandwidth 0.05 Hz – 5 kHz


– 30 to + 5 %

– 10 to + 5 %

Lower bandwidth limit

0.02; 0.05; 0.1; 0.2; 0.3; 0.5; 1; 2; 3; 5; 10; 20; 30; 50; 100; 200; 300; 500 Hz;

1; 2; 3; 5 kHz

ON/OFF notch filter 50 or 60 Hz

≥ 40 dB

Common mode rejection ratio at 50 Hz

≥ 100 dB

Upper bandwidth limit

10 – 10000 Hz


0,05; 0,1; 0,2; 0,5; 1; 2; 5; 10; 20; 50; 100; 200; 500 μV/div;

1; 2; 5; 10; 20; 50 mV/div

Permissible relative deviation of sensitivity

± 5%

Sweep speed

1; 2; 5; 10; 20; 50; 100; 200;

500 ms/div;

1 s/div

Permissible relative deviation of sweep speed

± 1%

Electrode impedance measurement range

0.5 – 500 kΩ

Permissible relative deviation of electrode impedance

± 10%


Connection to PC, power source


Input voltage (electronic unit)

(5 ± 0.25) V (DC)

Power consumption

≤ 2.5 V·А

Cooling Unit

Volume of the tank when it is filled up to the “max”

2.5 l

Cooling agent

PDMS-5 (polymethylsiloxane of 5 сST viscosity)

Pressure of cooling agent in cooling system (cooled coil — cooling unit)

≤ 0.35 MPa

Synchronization – Trigger input/output specifications – Trigger input

Number of trigger inputs


Connector type


High level input

3.85 to 5.5 V

Low level input

0 to 1.65 V

Input impedance

≥ 47 kΩ

Minimum input pulse duration

≥ 100 μs

Pulse delay relatively trig-in signal

0 – 100 ms

Permissible relative deviation of pulse delay relatively trigging signal

± 10%

Adjustment step for pulse delay relatively trig-in signal accuracy:

· in the range 0 – 10 ms

· in the range 10 – 100 ms


0.1 ms

1 ms


*) NOTE:   Neuro-MSX operates at the power line voltage of 240V.  Hospital-grade receptacles rated 250V, 15A are required to ensure the device operation with the indicated specifications.  Please consult a licensed electrician servicing your clinic on the availability, or the possibility to install, of such receptacles in the area of the device operation.

Detailed specifications are provided in Annex 1 of the Neuro-MSX User Manual.

Neuro-MSX main unit

1 pc.

Irbis Neuro-MSX cooling unit

1 pc.

Neuro-MSX extra power supply unit

1 pc.

AFEC-03-100-C cooled angulated figure-of-eight coil, 100 mm

1 pc.

HV cable for extra power supply unit connection, high-voltage

1 pc.

Control cable for Neuro-MSX cooling unit

1 pc.

End cap for Neuro-MSX

1 pc.

High-voltage coil connector

1 pc.

Patient cap, size 37-42

10 pc.

Patient cap, size 42-54

10 pcs.

Patient cap, size 54-66

10 pcs.

AFEC-03-100-C coil positioning tool

1 pc.

Silicone oil, canister, 3 l

1 pc.

Equipotential cable

2 pcs.

CEE 7/7–IEC C19 mains supply cord

2 pc.

SCZ-1 mains supply cord

1 pc.

USB cable, A-B

1 pc.

K-3 flexible arm for coil positioning

1 pc.

К-8 coil holder, trolley/wall mounted

1 pc.

T-4/A trolley

1 pc.


1 pc.

Key for hex drive

1 pc.

Measuring reel

1 pc.

Marker pen

1 pc.

Patient button

1 pc.

Treatment chair

1 pc.

Neuro-MSX Technical Manual

1 pc.

Warranty certificate

1 pc.

Technical Manual Coils for Magnetic Stimulators

1 pc.

Neuro-MSX Workflow for Depression Treatment Using rTMS

1 pc.

Neuro-MSX Patient and Relatives Manual

1 pc.

User manual Neuro-MS.NET, ver.2

1 pc.

Unit package

1 pc.

Package set for Neuro-MSX main unit and cooling unit

2 pcs.

Transcranial Magnetic Stimulation handbook by Moacyr Alexandro Rosa and Marina Odebrecht Rosa

1 pc.


1 pc.

License for Neuron-Spectrum.NET software

1 pc.

Equipment cover

1 pc.

The manufacturer guarantees the magnetic stimulator quality conformance, if the rules of operation, storage, transportation and mounting are observed.

Warranty period for the magnetic stimulator is 24 months from the delivery date to the customer. The delivery date is the date of waybill or other document for the stimulator.

Warranty period for the coils included into the stimulator delivery set is specified in the technical manual for the coils.

There is no warranty for consumables.

Warranty period can be prolonged for the period from reclamation submission up to repair completion (see section 9 “Reclamations”).

Warranty storage period is not less than 6 months.

Warranty is voided in the following cases:

· if the rules of operation, storage, transportation, assembly and maintenance established in the technical documentation are not observed;

· when the warranty period is expired;

· if a user breaks the seal without permission of the manufacturer.

The manufacturer is obliged to repair the stimulator in case of its failure within the warranty period free of charge.

Transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS)


What is Transcranial Magnetic Stimulation (TMS)?

The principle of therapeutic transcranial magnetic stimulation (TMS) is based on presenting a series of short-duration magnetic pulses of magnetic field to the subject’s cranium. As the pulses are repeated in multiple cycles, the method is also called repetitive TMS (rTMS).

The induce high-intensity electromagnetic field penetrates through clothes, cranium bones and soft tissues, and impacts the brain.

If compared to electrical stimulation, magnetic stimulation does not cause painful sensations that usually occur due to the activation of skin receptors under the electrode, and does not require additional preparation time.

How does Repetitive Transcranial Magnetic Stimulation (rTMS) work?

Magnetic pulses alter the firing patterns of neurons and their networks in the brain, involved in a disorder such as depression, thus changing the dysfunctional neural brain patterns.

During the treatment session, the patient sits comfortably in an armchair and remains awake, as no medication or anesthesia is required, and returns to normal daily activities following the treatment.

A treatment session ranges between five minutes and 60 minutes. A typical treatment course ranges from four to six weeks.

Quick facts about TMS

· TMS is for patients who failed to receive improvement (so-called treatment-resistent)

· TMS should be provided alongside medication or ERP as an add-on therapy.

· TMS can be used to treat several mental health disorders, but effective MDD treatment involves TMS “recipes” that combine specific techniques that studies have found to be helpful.

What is it Like to Receive TMS Therapy?

TMS is intended to be an add-on therapy that patients receive alongside other MDD treatments like, for example, medication.

TMS treatment is typically provided in an office setting on an outpatient basis. During each treatment, the patient will sit in a chair and wear ear plugs. The patient is awake during the treatment. The machine will turn on, and during the treatment the patient will hear loud clicking sound and feel a “tapping” sensation on the scalp.

Some patients have reported feeling some mild discomfort during and shortly after the treatment, including scalp pain. Once the treatment is completed, the patient is free to continue with daily activities.

Since 1985, research has been conducted with TMS to understand and treat a number of neurological conditions (i.e. migraine, Parkinson’s disease, tinnitus) and psychiatric conditions (i.e. depression and auditory hallucinations in individuals with schizophrenia). Most recently, researchers have been focusing on the use of repetitive TMS pulses (rTMS) as a treatment option for major depressive disorder, auditory hallucinations in schizophrenia, cognitive disorders, obsessive-compulsive disorder and posttraumatic stress disorder.

Application in COVID-19 patients

As Dr. Jonathan Downar, MD, PhD, FRCPC, put it, “rTMS has emerged as a treatment that has swiftly evolved to be both more potent and more rapid-acting than conventional medication treatments, while offering superior safety, tolerability and remission rates.

The need for more effective treatment options for depression and anxiety has become substantially more pressing since the onset of the COVID-19 pandemic. COVID-19 is recognized to have direct biological effects on the brain driving depression and anxiety through inflammatory and autoimmune processes, as well as indirect effects through the psychosocial stresses of health risks, social isolation, worker and caregiver burnout, loss of livelihood, and financial insecurity. A survey published by the Canadian Psychological Association in 2021 has found a 4-fold increase (from 5% to 20%) in the percentage of Canadians with severe anxiety and a more than 2-fold increase (from 4% to 10%) in the percentage of Canadians with severe depression since the onset of the pandemic, with a disproportionate burden of illness falling upon low-income and marginalized communities, paralleling similar findings published by the Journal of the American Medical Association last year. Canadians with depression and anxiety have also reported greater difficulty accessing effective treatment during the pandemic, underscoring the need for a wider range of options.”

Neural Navigation – MRI-navigated rTMS for precise coil placement

Over recent years, many studies have been conducted to use MRI scans for more precise navigation for more precise coil placement and thus, more precise targeting of rTMS stimulation.


Neuronavigation technology in TMS, also called neuronavigational TMS (nTMS), enables more precise and accurate TMS positioning, resulting in the intended stimulation intensities at the targeted cortical level (Caulfield K, et. al., 2022).

A study findings suggested that the neuronavigation-guided high-dose rTMS may be a novel method to rapidly reduce suicidal ideation and mitigate depressive symptoms (Pan F, et. al., 2020).

The Neural Navigator makes more precise positioning the TMS coil over a specified target based on an individual’s MRI – 4 mm or better.  Desired brain targets can be identified by manually selecting them or by combining with functional MRI (fMRI) determined regions of activity in real time. 

It can target brain areas indicated on an MRI scan with a precision of 4 mm or better. It can load and visualize individual MRI scans, tissue maps (e.g. gray matter), fMRI activation maps and craniotopic facial markers. This allows seeing exactly which area is targeted.  

Pre-set neuroanatomical target markers can be pinpointed accurately. The virtual camera can also be linked to the TMS coil center to obtain a birds-eye view of the brain as if one is looking down along the TMS pulse, with a cross-hair to aid targeting of the brain region of interest.

Electromagnetic tracking

During neuronavigation, the 3D positions and angles of the TMS coil, a digitizing stylus and the head of the patient typically must be known at all times. Position tracking of coil, head and stylus can be performed either by using optical position tracking with large cameras on a stand, or by electromagnetic (EM) position tracking based on a DC-pulsed magnetic field emitted by a small box.

EM tracking offers several advantages, and is currently popular in neurosurgical navigation applications requiring high precision and reliability.  The main advantage of EM tracking is its immunity to line-of-sight occlusion (LOS), or avoiding the inability to track and navigate when the camera view is blocked. Another important advantage is the compact nature of EM-tracking, no camera stand is needed, and sensors are much smaller as well.

The DC-pulsed EM navigation is used in the Neural Navigator.  It is very robust, as it does not cause distortions. The materials used in a TMS coil also do not pose any problem for EM-position tracking based on DC pulses.

This allows seamless position tracking of coil and head even during high-frequency rTMS and even Theta-burst TMS protocols.

Proven technology

With MRI navigated TMS, fewer participants are needed in a research project for meaningful results.  TMS treatments are more efficient and achieve higher benefits for the patient. The Neural Navigator has been successfully used in several laboratories and clinics around the world for years. It is easy to use, lightweight, and mobile.


The entire Neural Navigator system, including head support, fits in a small carrying case.

Integration with Neuro-MSX

Hardware and software of Neuro-MSX and Neural Navigator are deeply integrated and optimized with each other.  Therefore, the best performance of Neural Navigator is achieved with Neuro-MSX.

Available in Canada

Neural Navigator is a product of Brain Science Tools and distributed in Canada by Soterix Medical.



Concurrent TMS and electroencephalography (TMS-EEG) is an emerging tool to non-invasively study the neurophysiologic biomarkers of psychiatric disorders, assessment of several cortical properties such as excitability and connectivity.

TMS-EEG helps accurately selecting cortical areas, targeting them, and adjusting the stimulation parameters based on some relevant anatomical priors. Together with visualization tools to perform a check of TMS-evoked potentials (TEPs) in real-time during TMS-EEG data acquisition, enhances the impact of the TMS pulse on the cortex and ensures highly reproducible measurements within sessions and across subjects (Cao KX et. al., 2021).

Storing stimulation parameters in the neuronavigation system can help replicating the stimulation parameters within and across experimental sessions and sharing them across research centers. Systematic employment of neuronavigation in TMS–EEG studies also helps standardizing measurements in clinical populations in search for reliable diagnostic and prognostic TMS–EEG-based biomarkers for neurological and psychiatric disorders (Tremblay S, 2019, Lioumis P, Rosanova M, 2022).

Corlier J, et. al. (2019) showed that the initial rTMS treatment session produced robust changes in brain functional connectivity (FC) which were significant predictors of clinical outcome of a full course of treatment for Major Depression Disorder (MDD).

Some studies found that the individual alpha frequency (IAF), as well as the absolute difference between IAF and 10 Hz stimulation frequency (IAF-prox), is related to TMS treatment outcome (Corlier J, et. al., 2019; Roelofs CL, 2021).

TMS-EEG can be optimally performed with Neuro-MSX and the sixth-generation of EEG instruments, Neuron-Spectrum-6G, as their hardware and software are optimized for such studies.  The systems provide simple and easy feedback on impedance quality with lead connector turning green for good and red for bad. Th flexibility of connector allows using EEG caps from various manufacturers.

The systems were designed and tested to deal with electromagnetic artifacts seen in EEG as a result of electric field induced by TMS stimulus pulses.  Particularly, the amplifiers were developed to not only ensure low-noise performance, but to recover as fast as possible from the TMS pulse.  Thus, they provide outstanding immunity to TMS-induced artifacts and ensure that the measured EEG signals have actually originated in the brain.

For convenience of TMS-EEG studies, the systems provide continuous impedance monitoring during acquisition with one-button operation mode switch between EEG monitoring and acquisition.

Neuron-Spectrum-63 is sufficient for routine TMS-EEG studies in most settings.

Neuron-Spectrum-64 offers more EEG channels and is optimized for video-EEG combined with TMS.

Neuron-Spectrum-65 is a powerful 39-channel EEG instrument, with each channel capable of working in both AC and DC modes, well suited for various research studies.

Neuron-Spectrum EEG instruments with TMS were used in a number of studies (e.g. Lui TK, et. al., 2020;  Voytenkov VB, et. al., 2022)



Combination of combination of Transcranial Magnetic Stimulation (TMS) with electromyography (EMG) is non-invasive technique for assessing the duration of silent period (SP) of electromyography (EMG).  It results from the application of magnetic or electrical stimulation to the motor cortex in a tonically active peripheral muscle ()Farzan F, et. al., 2013).

Studies show that TMS has clinical diagnostic utility in a broad range of neurological diseases, the results of motor evoked potential measurements in the early stage of stroke are predictive of the long-term motor outcome.  Particularly, short-interval intracortical inhibition (SICI), central motor conduction time (CMCT), and rest motor threshold are useful measurements to monitor extent of clinical disability. (Chen R, et. al., 2021).

The optional EMG Unit of Neuro-MSX is optimized for precise measurement of motor threshold (MT) in rTMS studies, and thus is a preferred tool rather than using separate EMG instruments.



TMS / rTMS methodology


Simone Rossi, Andrea Antal, Sven Bestmann, et. al. Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clinical Neurophysiology, Volume 132, Issue 1, January 2021, Pages 269-306.  Available from:


Wanalee Klomjai, Rose Katz, Alexandra Lackmy-Vallée. Basic principles of transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS). Annals of Physical and Rehabilitation Medicine, Volume 58, Issue 4, September 2015, Pages 208-213.  Available from:


Jean-Pascal Lefaucheur, André Aleman, Chris Baeken, et. al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018). Clinical Neurophysiology,

Volume 131, Issue 2, February 2020, Pages 474-528.  Available from:


Blumberger DM, Vila-Rodriguez F, Thorpe KE, Feffer K, Noda Y, Giacobbe P, Knyahnytska Y, Kennedy SH, Lam RW, Daskalakis ZJ, Downar J. Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. Lancet. 2018 Apr 28;391(10131):1683-1692. doi: 10.1016/S0140-6736(18)30295-2. Epub 2018 Apr 26. Erratum in: Lancet. 2018 Jun 23;391(10139):e24. PMID: 29726344.  Available from:


Giacobbe P, Mithani K, Meng Y, Vila-Rodriguez F, Daskalakis ZJ, Downar J, Blumberger DM. Evaluation of the effects of rTMS on self-reported quality of life and disability in treatment-resistant depression: A THREE-D study. J Affect Disord. 2020 May 1;268:127-133. doi: 10.1016/j.jad.2020.03.002. Epub 2020 Mar 3. PMID: 32174470.  Available from:


Konstantinou GN, Trevizol AP, Goldbloom D, Downar J, Daskalakis ZJ, Blumberger DM. Successful treatment of depression with psychotic features using accelerated intermittent theta burst stimulation. J Affect Disord. 2021 Jan 15; 279:17-19. doi: 10.1016/j.jad.2020.09.114. Epub 2020 Sep 30. PMID: 33038696.  Available from:


Cole EJ, Stimpson KH, Bentzley BS, Gulser M, Cherian K, Tischler C, Nejad R, Pankow H, Choi E, Aaron H, Espil FM, Pannu J, Xiao X, Duvio D, Solvason HB, Hawkins J, Guerra A, Jo B, Raj KS, Phillips AL, Barmak F, Bishop JH, Coetzee JP, DeBattista C, Keller J, Schatzberg AF, Sudheimer KD, Williams NR. Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression. Am J Psychiatry. 2020 Aug 1;177(8):716-726. doi: 10.1176/appi.ajp.2019.19070720. Epub 2020 Apr 7. PMID: 32252538.  Available from:


Cole EJ, Phillips AL, Bentzley BS, Stimpson KH, Nejad R, Barmak F, Veerapal C, Khan N, Cherian K, Felber E, Brown R, Choi E, King S, Pankow H, Bishop JH, Azeez A, Coetzee J, Rapier R, Odenwald N, Carreon D, Hawkins J, Chang M, Keller J, Raj K, DeBattista C, Jo B, Espil FM, Schatzberg AF, Sudheimer KD, Williams NR. Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. Am J Psychiatry. 2022 Feb;179(2):132-141. doi: 10.1176/appi.ajp.2021.20101429. Epub 2021 Oct 29. PMID: 34711062.  Available from:


TMS Neuronavigation

Kevin A. Caulfield, Holly H. Fleischmann, Claire E. Cox, Julia P. Wolf, Mark S. George, Lisa M. McTeague. Neuronavigation maximizes accuracy and precision in TMS positioning: Evidence from 11,230 distance, angle, and electric field modeling measurements. Brain Stimulation, Volume 15, Issue 5, 2022, Pages 1192-1205,

ISSN 1935-861X,  Available from:


Sparing R, Hesse MD, Fink GR. Neuronavigation for transcranial magnetic stimulation (TMS): where we are and where we are going. Cortex. 2010 Jan;46(1):118-20. doi: 10.1016/j.cortex.2009.02.018. Epub 2009 Mar 12. PMID: 19371865.  Available at:


Pan F, Shen Z, Jiao J, Chen J, Li S, Lu J, Duan J, Wei N, Shang D, Hu S, Xu Y, Huang M. Neuronavigation-Guided rTMS for the Treatment of Depressive Patients With Suicidal Ideation: A Double-Blind, Randomized, Sham-Controlled Trial. Clin Pharmacol Ther. 2020 Oct;108(4):826-832. doi: 10.1002/cpt.1858. Epub 2020 Jun 4. PMID: 32319673.  Available at:


Caulfield KA, Fleischmann HH, Cox CE, Wolf JP, George MS, McTeague LM. Neuronavigation maximizes accuracy and precision in TMS positioning: Evidence from 11,230 distance, angle, and electric field modeling measurements. Brain Stimul. 2022 Sep-Oct;15(5):1192-1205. doi: 10.1016/j.brs.2022.08.013. Epub 2022 Aug 27. PMID: 36031059.  Available at:


TMS Neuronavigation Systems Market Report with suitable set of assumptions and methodologies, Forecasted to 2022-2028.  Available at:


Kim WJ, Hahn SJ, Kim WS, Paik NJ. Neuronavigation-guided Repetitive Transcranial Magnetic Stimulation for Aphasia. J Vis Exp. 2016 May 6;(111):53345. doi: 10.3791/53345. PMID: 27214154; PMCID: PMC4942051. 



Cao KX, Ma ML, Wang CZ, Iqbal J, Si JJ, Xue YX, Yang JL. TMS-EEG: An emerging tool to study the neurophysiologic biomarkers of psychiatric disorders. Neuropharmacology. 2021 Oct 1;197:108574. doi: 10.1016/j.neuropharm.2021.108574. Epub 2021 Apr 22. PMID: 33894219.  Available from:


Tremblay S, Rogasch NC, Premoli I, Blumberger DM, Casarotto S, Chen R, Di Lazzaro V, Farzan F, Ferrarelli F, Fitzgerald PB, Hui J, Ilmoniemi RJ, Kimiskidis VK, Kugiumtzis D, Lioumis P, Pascual-Leone A, Pellicciari MC, Rajji T, Thut G, Zomorrodi R, Ziemann U, Daskalakis ZJ. Clinical utility and prospective of TMS-EEG. Clin Neurophysiol. 2019 May;130(5):802-844. doi: 10.1016/j.clinph.2019.01.001. Epub 2019 Jan 19. PMID: 30772238.  Available at:


Corlier J, Wilson A, Hunter AM, Vince-Cruz N, Krantz D, Levitt J, Minzenberg MJ, Ginder N, Cook IA, Leuchter AF. Changes in Functional Connectivity Predict Outcome of Repetitive Transcranial Magnetic Stimulation Treatment of Major Depressive Disorder. Cereb Cortex. 2019 Dec 17;29(12):4958-4967. doi: 10.1093/cercor/bhz035. PMID: 30953441; PMCID: PMC7305800.  Available at:,rTMS%20and%20explain%20the%20variability%20in%20clinical%20outcome.


Corlier J, Carpenter LL, Wilson AC, Tirrell E, Gobin AP, Kavanaugh B, Leuchter AF. The relationship between individual alpha peak frequency and clinical outcome with repetitive Transcranial Magnetic Stimulation (rTMS) treatment of Major Depressive Disorder (MDD). Brain Stimul. 2019 Nov-Dec;12(6):1572-1578. doi: 10.1016/j.brs.2019.07.018. Epub 2019 Jul 25. PMID: 31378603.  Available at:


Roelofs CL, Krepel N, Corlier J, Carpenter LL, Fitzgerald PB, Daskalakis ZJ, Tendolkar I, Wilson A, Downar J, Bailey NW, Blumberger DM, Vila-Rodriguez F, Leuchter AF, Arns M. Individual alpha frequency proximity associated with repetitive transcranial magnetic stimulation outcome: An independent replication study from the ICON-DB consortium. Clin Neurophysiol. 2021 Feb;132(2):643-649. doi: 10.1016/j.clinph.2020.10.017. Epub 2020 Nov 10. PMID: 33243617.  Available at:


Voytenkov, V.B., Vilnitz, A.A., Skripchenko, N.V. et al. Quantitative Electroencephalography Indicators in Children with Acute Purulent Meningitis. Neurosci Behav Physi 52, 315–318 (2022).  Available at:


Lui TK, Shum YH, Xiao XZ, Wang Y, Cheung AT, Chan SS, Neggers SFW, Tse CY. The critical role of the inferior frontal cortex in establishing a prediction model for generating subsequent mismatch negativity (MMN): A TMS-EEG study. Brain Stimul. 2021 Jan-Feb;14(1):161-169. doi: 10.1016/j.brs.2020.12.005. Epub 2020 Dec 17. PMID: 33346067.  Available at:


Liburkina, S.P., Vasilyev, A.N., Yakovlev, L.V. et al. A Motor Imagery-Based Brain–Computer Interface with Vibrotactile Stimuli. Neurosci Behav Physi 48, 1067–1077 (2018).  Availabel at:




Farzan F, Barr MS, Hoppenbrouwers SS, Fitzgerald PB, Chen R, Pascual-Leone A, Daskalakis ZJ. The EEG correlates of the TMS-induced EMG silent period in humans. Neuroimage. 2013 Dec;83:120-34. doi: 10.1016/j.neuroimage.2013.06.059. Epub 2013 Jun 22. PMID: 23800790; PMCID: PMC4211432.  Available at:


Chen, Robert, and Kai-Hsiang Stanley Chen. Clinical Utility of TMS-EMG Measures, in Eric M. Wassermann and others (eds), The Oxford Handbook of Transcranial Stimulation, Second Edition, 2nd edn (online edn, Oxford Academic, 10 Feb. 2021).  Available at:


Application in COVID-19 patients

Konstantinou GN, Downar J, Daskalakis ZJ, Blumberger DM. Accelerated Intermittent Theta Burst Stimulation in Late-Life Depression: A Possible Option for Older Depressed Adults in Need of ECT During the COVID-19 Pandemic. Am J Geriatr Psychiatry. 2020 Oct;28(10):1025-1029. doi: 10.1016/j.jagp.2020.07.007. Epub 2020 Jul 15. PMID: 32753340; PMCID: PMC7362844.  Available from:


Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I, Melloni EMT, Furlan R, Ciceri F, Rovere-Querini P; COVID-19 BioB Outpatient Clinic Study group, Benedetti F. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun. 2020 Oct;89:594-600. doi: 10.1016/j.bbi.2020.07.037. Epub 2020 Jul 30. PMID: 32738287; PMCID: PMC7390748.  Available from:


Dozois, D. J. A., & Mental Health Research Canada. (2021). Anxiety and depression in Canada during the COVID-19 pandemic: A national survey. Canadian Psychology / Psychologie canadienne, 62(1), 136–142.  Available from:


Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA Netw Open. 2020 Sep 1;3(9):e2019686. doi: 10.1001/jamanetworkopen.2020.19686. PMID: 32876685; PMCID: PMC7489837.  Available from:


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Repetitive Transcranial Magnetic Stimulation (rTMS)

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