Same dose, same location—every time.

How SmartFocusTM TMS works

Using an MRI head scan, Nexstim SmartFocus™ TMS  builds a 3D rendering of the patient’s brain. Peeling to a depth of 2-3 cm (1 in), reveals the patient’s cortical anatomy in detail. Using a published, science-based algorithm*, instead of the 5 cm rule-of-thumb technique, you can then determine the precise location of the left DLPFC (dorso-lateral pre-frontal cortex) target within the individual’s brain anatomy.

The Nexstim system displays the location and the orientation of the maximum induced E-field overlaid in the cortical anatomy. As you move, turn or tilt the coil—even slightly—the system screen displays the updated E-field strength and location, all in real-time.

Accurately marking the left DLPFC, just once, gives your patient the benefit of receiving therapy to the same, precise location over the entire course of their treatment—and later, visit after visit. SmartFocus™ TMS  operates with the same accuracy level as demanded by neurosurgeons using Nexstim’s navigated TMS for planning. In order to benefit from E-field navigation, the SmartFocus™ TMS  system only requires a short, one-time setup process. The system then guides a trained operator to deliver a series of personalized therapy sessions, reliably and precisely—all in just a few steps.

SmartFocusTM TMS — a new noninvasive, non-drug therapy for depression.

SmartFocus™ TMS workflow

Co-registering the MRI and the patient’s head

SmartFocus™ TMS creates a 3D model of the patient’s brain from an MRI head scan. With the patient comfortably seated, the MRI is co-registered to the patient’s head using the tracking system with Nexstim’s unique forehead tracker. When resting the coil against the patient’s head, the system now visualizes the coil and the E-field overlaid on the 3D model of the brain. As the coil is moved, the magnitude (V/m) and orientation of the E-field relative to the cortex are dynamically calculated and displayed in real time.

Determining the patient’s motor threshold

Place EMG electrodes over hand muscles. Using single-pulse TMS to accurately locate the thumb representation area in the primary motor cortex. The SmartFocus™ TMS software quickly guides the operator to determine an optimized intensity of TMS dose for the patient’s individual cortical excitability.

Localizing the left DLPFC

The published, science-based algorithm allows accurate and reliable identification of the left DLPFC (dorso-lateral prefrontal cortex) in the brain on the system screen. The left DLPFC is the validated target in the cortex for treating depression.

Dose delivery

The coil is aligned to the target and then locked in place for the treatment session. The system delivers the prescribed dose of TMS pulses while the system operator monitors treatment precision. The operator has on-screen visual feedback at all time—in real time.

Repeat sessions

The SmartFocus™ TMS system automatically stores the target-finding, dose-defining and other settings needed to personalize the TMS therapy for the patient in the future. In subsequent treatment session, SmartFocus™ TMS guidance software helps the system operator ensure the patient receives the same optimized dose at the same location and in the same orientation—every time.

*Mylius V, Ayache SS et al., Neuroimage. 2013 Sep;78:224-32