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外2013经颅磁刺激的自定义机器人:健康受试者的第一次评估
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A Custom Robot for Transcranial Magnetic Stimulation: First Assessment on Healthy Subjects R. Ginhoux1, P. Renaud2, L. Zorn2, L. Goffi n2, B. Bayle2, J. Foucher2, J. Lamy2, J.P. Armspach2 and M. de Mathelin2 Abstract— In this paper, a custom robotic system for Tran- scranial Magnetic Stimulation is assessed in clinical conditions on healthy subjects. A motor cortex mapping is performed using the robotic system with comparison to a manual approach using a neuronavigation system. Stimulation accuracy, repeatability are evaluated as well as the feeling of the system operator and the subject in terms of comfort, tiredness, stress level, ease-of- use. Very encouraging results are obtained on all these aspects, which strengthens the idea of developing robotic assistance for TMS. I. INTRODUCTION Transcranial Magnetic Stimulation (TMS) is a noninvasive stimulation technique of the cortex. The stimulation results from a rapidly changing magnetic fi eld generated with an external coil (Fig. 1) which is applied onto the skull to locally induce electric currents in the brain. The fi rst TMS device was created more than 25 years ago [1]. Single pulse and repetitive TMS have been applied in clinical research for the treatment of neurological and psychiatric diseases. The effi ciency of TMS has been demonstrated in the case of severe depression for patients whose drug medication has failed [2] and has been approved for clinical treatment in the US, Canada and Israel. Its effect on several other patholo- gies, such as the auditory hallucinations of schizophrenia or chronic neuropathic pain has shown promising results [9], [10]. However, TMS is not yet widely accepted because its effi ciency varies substantially between subjects. The variability is partially due to how the stimulation gesture is performed [3]. Up to now [4], [5], the most accurate method has been to position the coil manually with the help of a neuronavigation software [6], [7]. This tool combines preoperative MR images and peroperative data from an optical localizer (Fig. 4) in order to display in a graphical interface the actual position of the coil with respect to the subject’s brain. Even with such an assistance, it remains diffi cult to obtain an accuracy of a few millimeters in a repeatable manner. The main reason is that each procedure lasts more than 30 minutes with a coil that weighs more than 2 kg. A static positioning system is sometimes used to hold the coil. In such a case, it is not possible to follow continuous trajectories nor to compensate for involuntary motions of the subject during the session. 1R. Ginhoux is with Axilum Robotics, Strasbourg, France romuald.ginhoux@axilumrobotics.com 2ICube, Universit e de Strasbourg, CNRS, INSA de Strasbourg,France {pierre.renaud, lucile.zorn, lgoffin, bernard.bayle, jack.foucher, lamy, jparmspach, demathelin}@unistra.fr Fig. 1. Close-up view of a stimulation coil with a fi gure-of-eight shape. Fig. 2. The custom robotic system: the robotic device on the left, the software for the operator in the middle and the optical localizer on the right. A custom robotic system was previously proposed in [8], with details on its design and control. Its accuracy was then only tested on a phantom, in lab experiments. The purpose of this paper is to present the fi rst results of a clinical study with healthy subjects. The objective is to assess the level of performance of the robotic device in a standard TMS procedure and to evaluate the feeling of the user and the subject when interacting with the robot. The main features of the proposed robotic system to improve safety, comfort for the subject, and the ease-of-use for the operator are outlined in section II. The design of the experimental assessment is then introduced in section III, before detailing and discussing the results in section IV. Conclusion on the interest of the use of a custom robotic system for TMS are fi nally derived from the experimental results, and future work is outlined. II. MAIN FEATURES OF THE ROBOTIC SYSTEM A. Hardware features The robotic system is composed of a custom-designed robot, an external magnetic stimulation system, and an optical localizer (Fig. 2). The stimulation is delivered using a custom Magstim coil (The Magstim Company Ltd, Whitland, South West Wales) connected to a Magstim Super Rapid stimulator. The coil 35th Annual International Conference of the IEEE EMBS Osaka, Japan, 3 - 7 July, 2013 978-1-4577-0216-7/13/$26.00 2013 IEEE 5352

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