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Reducing target E-field variability in repetitive TMS through online motion compensation.

Sarah Grosshagauer¹, Michael Woletz¹, Marlen Becher²

¹High Field MR Center, Medical University of Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria.

Brain Stimulation

|December 6, 2025

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This study quantifies motion during repetitive transcranial magnetic stimulation (rTMS) and introduces a novel method to adjust stimulation amplitude, significantly reducing electric field variability for more reliable major depressive disorder treatment.

Area of Science:

Neuroscience
Medical Physics

Background:

Repetitive transcranial magnetic stimulation (rTMS) effectiveness hinges on precise targeting and dosing for neurophysiological outcomes, especially in treating major depressive disorder (MDD).
Neuronavigation aids accurate coil placement, but minor coil deviations during extended rTMS protocols can substantially alter the induced electric field (E-field).
Motion-induced E-field variability poses a challenge to consistent rTMS treatment delivery.

Purpose of the Study:

To quantitatively analyze coil-target movement during rTMS sessions.
To introduce and evaluate a novel methodology for compensating motion-induced E-field variability.
To enhance the reliability of rTMS for clinical applications like MDD treatment.

Main Methods:

Analyzed coil-target movement (position, rotation) in 200 rTMS sessions across 20 adults with MDD.

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Simulated induced E-fields and quantified variability within and across sessions.

Developed a real-time algorithm adjusting stimulator output based on coil position and precomputed E-fields.

Main Results:

E-field variability was mainly driven by scalp-normal displacement and rotation, with lateral movement having a lesser impact.
The novel amplitude adjustment method significantly reduced target E-field variability.
Within-session E-field variability decreased by 41% (from 2.85% to 1.67%), and across-session variability decreased by 74% (from 6.77% to 1.73%).

Conclusions:

This study provides the first quantitative analysis of motion during rTMS treatment.
A practical, low-computational-cost method for compensating motion-induced E-field variability was developed.
The proposed approach is suitable for clinical implementation, improving rTMS treatment reliability, especially for patients prone to movement.