Webinars and Talks on the Latest Advancements on nTMS

Nexstim Podium

Nexstim Webinars

We are bringing renowned speakers to you free of charge, pulling together some of the most exciting talks from the past few months and offering researchers and clinicians a virtual podium to showcase their most recent work live.

Join Our Next Live Webinar!

Register here for our next live webinar on Tuesday 27 October 2020 at 5 pm (GMT) / 1pm (EDT):

TMS for Presurgical Mapping of Tumours in Eloquent Areas
Francesco Vergani, MD, PhD, FRCS (SN)

Consultant Neurosurgeon
King's College Hospital
London (UK)

Find here more information about Dr. Vergani

Webinars and Talks On-Demand

Dr. Anastasia Shulga, MD

Potential novel therapy for spinal cord injury patients — PAS with high-frequency PNS and E-field guided high-intensity TMS: success stories and future directions

Dr. Anastasia Shulga, MD, tells in this webinar about the use of PAS with high-frequency PNS and E-field guided high-intensity TMS for potential novel therapy for spinal cord injury patients:

  • Watch before and after videos of multiple SCI cases, demonstrating restoration of upper and lower limb motor function after PAS with nTMS

  • See how nTMS can allow one to target precisely defined motor cortex areas with corresponding nerves

  • Get a sneak peek at current and future projects, including a sham-controlled double-blind randomized clinical trial

Please note that Nexstim nTMS Systems do not have an FDA clearance nor a CE mark for spinal cord injury rehabilitation. Helsinki University Hospital is utilizing the Nexstim NBS System for chronic spinal cord injury therapy as a research utility only.

 

 

Dr. Alexander Rotenberg, MD:

TMS and Motor Mapping Fundamentals

Dr. Alexander Rotenberg, MD, tells in this webinar about TMS Motor Mapping:

  • History and fundamentals of motor mapping, including an overview of stimulation protocols and the neurophysiological basis for TMS evoked electric potentials

  • Discussion includes unique advantages of nTMS over other mapping techniques with regard to the pediatric community

  • Using TMS as a quantitative measure for target engagement in pharmacological evaluation studies

 

Dr. Shalini Narayana:

TMS Language Mapping in Children: Challenges and Opportunities

Dr. Shalini Narayana tells in this webinar about TMS language mapping in children:

  • Learn how nTMS language mapping plays a critical role in the presurgical evaluation process for young children.

  • See case examples and demonstrations that present how nTMS language mapping can be tailored to meet the needs of children.

  • Understand why the “negative predictive value” of nTMS language mapping is key for presurgical evaluation.

  • Click here for Speaker’s recent paper comparing MEG vs nTMS and here for additional literature on Nexstim language mapping.

     

 

Dr. James Wheless, MD:

Integrating TMS into Clinical Practice

Professor James Wheless, MD, tells in this webinar about the integration of TMS into clinical practice.

  • Compares the pre-surgical evaluation process for children with epilepsy, with and without nTMS

  • See case studies demonstrating where nTMS can validate surgical treatment when MEG and fMRI results remain inconclusive

  • Learn how nTMS graphical data can assist with risk/benefit discussions during patient family consultations

  • See examples of how the passive nature of nTMS motor mapping facilitates consistent and reliable results in young children

 

Professor Peter Vajkoczy, MD:

nTMS in Academic Neurosurgical Center - 10 year's experience

Professor Peter Vajkoczy, MD tells about their experiences on using nTMS at Charité – Universitätsmedizin Berlin:

  • Enabling safer and more aggressive approaches for neurosurgical and radiotherapy treatments
  • New indications explored, including neurovascular and degenerative cervical myelopathy cases
  • Take a glance at new methods for nTMS-seeded DTI for speech mapping
 

Professor Sujit Prabhu, MD:

Validation of Pre-Operative Language Mapping Modalities

Professor Sujit Prabhu, MD from MD Anderson Cancer Center tells about validation of pre-operative language mapping modalities:

  • See case studies comparing fMRI, nTMS, and DCS for language mapping
  • Is it safe to resect? A look into the value of negative predictive value
 

Dr. Selja Vaalto, MD:

nTMS in Pain Therapy: Who to treat and best practice protocols

Dr. Selja Vaalto tells how nTMS is used in pain therapy in Helsinki University Hospital, Finland:

  • See the profiles of patients who responded to rTMS therapy for chronic neuropathic pain
  • Learn about primary and secondary targets
  • See how stimulation parameters vary depending on type of pain
 

Navigated Transcranial Magnetic Stimulation in Neurosurgery

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Terms and conditions for collecting the data

Indications for Use

Nexstim NBS: Indications for use

The Nexstim Navigated Brain Stimulation (NBS) System 5 is indicated for non-invasive mapping of the primary motor cortex of the brain to its cortical gyrus. The Nexstim NBS System 5 provides information that may be used in the assessment of the primary motor cortex for pre-procedural planning.

Nexstim NexSpeech®, when used together with the NBS System 5, is indicated for non-invasive localization of cortical areas that do not contain essential speech function. NexSpeech® provides information that may be used in pre-surgical planning in patients undergoing brain surgery. Intra-operatively, the localization information provided by NexSpeech® is intended to be verified by direct cortical stimulation.

The Nexstim NBS System 5 and NBS System 5 with NexSpeech® are not intended to be used during a surgical procedure.

The Nexstim NBS System 5 and NBS System 5 with NexSpeech® are intended to be used by trained clinical professionals.

 

Nexstim NBT in Depression Therapy: Indication for Use

INDICATIONS FOR USE

FDA IFU: Nexstim Navigated Brain Therapy (NBT) System 2 is indicated for the treatment of Major Depressive Disorder in adult patients who have failed to achieve satisfactory improvement from prior antidepressant medication in the current episode.

CE mark : Nexstim Navigated Brain Therapy System for depression is intended to be used for treatment of major depressive disorder (MDD) by targeting and delivering noninvasive repetitive TMS stimulation to the patient's dorsolateral prefrontal cortex.

NBT THERAPY SHOULD NOT BE GIVEN TO

  1. Patients with non-removable conductive, ferromagnetic, or other magnetic-sensitive metal anywhere in the head or within 30 cm (12 in) of the stimulation coil. Examples include cochlear implants, implanted electrodes or stimulators, aneurysm clips or coils, stents, bullet fragments, ocular implants, and stents.
  2. Patients who have an active or inactive implanted device (including device leads), including deep brain stimulators, cochlear implants, cardiac pacemakers, and vagus nerve stimulators. Contraindicated use could result in serious injury or death.
  3. Patients with increased intracranial pressure or patients with intracardiac lines, intravenous pumps, or dose calculators. 

Failure to follow these restrictions could result in serious injury or death.

RISKS AND SIDE EFFECTS

Seizures (convulsions): Cortical magnetic stimulation runs the risk of inducing seizures; although they are rare. Under ordinary clinical use, the estimated risk of seizure is approximately 1 in 30 000 treatments (0.003%) or 1 in 1000 patients (0.1%). 

Headache: The most common side effects reported during clinical trials are mild headache (~50% of TMS treatment group) and scalp pain or discomfort (35.8%). In general, headache and pain on the stimulation site have been generally mild to moderate and occurring less frequently after the first week of treatment. The reason for headache may be the tension of scalp and neck muscles due to an uncomfortable and stressful situation.

Muscle Twitching:  You may feel twitches in the muscles of your arm, leg or face during the magnetic stimulation. This is a common sensation but not hazardous. The twitches will stop when the magnetic stimulation stops.

Skin Irritation:  There is a small risk of mild skin irritation at the location where the muscle electrode sensors have been placed, but this usually consists of minor redness that will go away quickly after they are removed.

Changes in hearing:  The loud “click” produced by the TMS stimulator can cause temporary hearing changes following treatment.  This is prevented by wearing soft foam ear plugs during treatment. No problems with hearing due to TMS have ever occurred when earplugs have been properly worn

INEFFECTIVE TREATMENT

There is no evidence that single therapy sessions would improve mood.  rTMS treatment effects in reducing depression are temporary, and patients may need to continue other forms of depression therapy. Relapse into depression is likely without follow-up treatment. Notify your doctor in case of worsening depression or suicidality. 

CAUTION: SPECIAL POPULATIONS

All patients must be screened for the characteristics listed in this section and excluded without clear benefit or compelling clinical reason.
The safety and effectiveness of Nexstim TMS treatment has not been established in the following patient populations:

  • Younger than 22 years or older than 70 years
  • Suicide plan or recent suicide attempt
  • History of concurrent use of electroconvulsive therapy (ECT) or vagus nerve stimulation (VNS)
  • Depression secondary to a general medical condition or substance-induced
  • Seasonal affective disorder
  • History of substance abuse, obsessive compulsive disorder, or post-traumatic stress disorder
  • A psychotic disorder, including schizoaffective disorder, bipolar disorder, or major depression with psychotic features
  • History of increased intracranial pressure or head trauma
  • Cardiac pacemakers, implantable cardioverter defibrillators, ocular implants, deep brain stimulators, vagus nerve stimulators, implanted medication pumps, intracardiac lines, or significant cardiac disease
  • Pregnant or nursing

Nexstim NBT in Chronic Pain therapy: Indications for use (CE mark) and patient safety

Nexstim Navigated Brain Therapy (NBT) System 2 is not approved by the Food and Drug Administration for commercial use of the treatment of chronic pain in the United States, for this application NBT System 2 is available to select physician for investigational use only.

CE mark Intended use

Nexstim Navigated Brain Therapy System is intended to be used for localization and assessment of the primary motor cortex for pre-procedural planning purposes. In adult patients suffering from chronic unilateral neuropathic pain, Nexstim NBT System is intended to provide electric field navigated noninvasive repetitive TMS stimulation as therapy to alleviate pain.

CE mark Indications for use

Nexstim MRI-Guided and E-Field Navigated Brain Therapy System (Nexstim NBT® System) is indicated for noninvasive mapping of the primary motor cortex of the brain to its cortical gyrus. Nexstim NBT System is indicated for MRI-guided and electric field (or E-field) navigated, noninvasive, repetitive TMS stimulation (rTMS) of the motor cortex as therapy to alleviate chronic unilateral neuropathic pain in adult patients. 

Nexstim NBT® System is intended to be used by trained clinical professionals.

SAFETY

NBT THERAPY SHOULD NOT BE GIVEN TO

  1. Patients with non-removable conductive, ferromagnetic, or other magnetic-sensitive metal anywhere in the head or within 30 cm (12 in) of the stimulation coil. Examples include cochlear implants, implanted electrodes or stimulators, aneurysm clips or coils, stents, bullet fragments, ocular implants, and stents.
  2. Patients who have an active or inactive implanted device (including device leads), including deep brain stimulators, cochlear implants, cardiac pacemakers, and vagus nerve stimulators. Contraindicated use could result in serious injury or death.
  3. Patients with increased intracranial pressure or patients with intracardiac lines, intravenous pumps, or dose calculators. 

Failure to follow these restrictions could result in serious injury or death.

RISKS AND SIDE EFFECTS

Seizures (Convulsions): Cortical magnetic stimulation runs the risk of inducing seizures;  although they are rare.

The most common side effects reported during clinical studies (Lefaucheur et al., Nurmikko et al.) are: mild headache (25% of the TMS treatment group), sleepiness (38 %), and dizziness (15 %).

No severe adverse events were reported. Specifically, no seizures occurred.

In some patients with chronic neuropathic pain, the pain may transiently worsen after rTMS stimulation. The increase in pain sensation may last up to 1-2 days.

No adverse effects on hearing have occurred when ear protection has been properly worn.

No effects on cognitive function has been reported.

Clinical studies have reported no deaths in rTMS therapy. (Nurmikko et al.)