STIMBOY is a smart robotic platform for transcranial magnetic stimulation (TMS). TMS is a non-invasive and painless technique to stimulate the brain. A coil, placed outside the head upon the targeted cortex, generates a magnetic field that activates the neurons. Today, TMS has already a wide range of application in clinics for diagnostic, follow-up (e.g. in multiple sclerosis) and therapeutic purposes, as for drug-resistant depression. However, its employment is expected to grow strongly, for instance in 2025 the global market size will reach 2.5 billion € only for depression treatment. TMS is widely used in research as well, to investigate diseases (e.g. chronic pain, stroke, dementia) and the working principles of the healthy human brain, with more than a thousand papers per year indexed by PubMed.
Currently, TMS is carried out by expert operators who must manually hold the coil above the subjects’ scalp. However, the weight of coils and the long duration of sessions make TMS administration a strenuous task for operators who struggle to maintain the position and orientation required for an accurate stimulation. Errors in position and orientation produce a minor cumulative dose and wrong targeted functions, thus compromising the efficacy and reproducibility of the treatment.
The STIMBOY project developed an innovative, low-cost and high-performance robot-assisted TMS platform to automate the stimulation procedure, in order to improve the accuracy, repeatability and reproducibility of the stimulation and increase comfort in patients and operators.
STIMBOY project improved the robot-TMS platform developed within the ERC RESHAPE project to realize a modular system arrangeable in two main configurations. The clinical configuration mainly fulfills the need for automation and extreme easiness-of-use of TMS clinical end-users, and the research configuration that answers to the need for precision and flexibility of TMS scientists.
The platform is made of up to two robotic manipulators, an optical tracking system and ad-hoc management software. Additionally, different TMS stimulators and electrophysiological recording devices have been integrated. Compared to the platform developed within the ERC-RESHAPE project, from which it derives, novel features were added to STIMBOY. The physical platform has been optimized to be more compact and transportable. New algorithms have been developed and integrated to enhance the safety of the system and to integrate higher resolution lower-cost cameras. Moreover, further features have been developed specifically for each one of the two configurations. The clinical configuration has been endowed with algorithms for fast subject scalp reconstruction and for automatic identification of the stimulation points. The research configuration has been enriched with algorithms for synchronous control of two arms-two coils with conflict avoidance and for automation of functional mapping of motor areas.
The tests of the platform achieved promising results. In a preliminary phase, a mock-up head system, simulating basic and complex head motions, was used to assess the developed features and tools in the platform. STIMBOY was faster than a manual operator to deliver the same number of stimuli, achieving not worse positioning and rotation accuracy. After the positive outcomes of these first tests, the platform was evaluated in research environment by performing TMS neuromodulation experiments on healthy subjects during an active task. The neuromodulation was effective, coil position was still precise and both subjects and operators experience was reported as more comfortable.
STIMBOY innovative features have been acknowledged by all the worldwide TMS experts, to whom the platform has been presented. They highlighted that the few commercially-available alternatives to STIMBOY suffer several drawbacks, as the high cost and the need for high-trained personnel, which could be overcome by STIMBOY.
The STIMBOY platform will increase the number of patients who will benefit from TMS therapy, which will be made affordable by more clinical centers. The possibility to neuromodulate during active tasks implying patient’s head movement will make STIMBOY a key tool in neurorehabilitation.
Finally, all the innovative protocols enabled by the research configuration will allow to answer neuroscientific questions at system level in human, which at the present require animal studies, and will likely pave the routes for future therapeutic applications.
