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Brainsight cTMS Brainsight cTMS (controllable pulse parameter TMS) is the latest innovation in transcranial magnetic stimulation technology, increasing the flexibility and functionality available to researchers investigating neurophysiology and brain connectivity. One of the strengths of cTMS is it's ability to generate new types of TMS pulses, beyond the limitations of traditional TMS monophasic and bipha-sic pulse shapes. The development of such technology has enabled rectangular pulses to be incorporated in single pulse and repetitive TMS protocols, which can be used to affect physiological and behavioural parameters to a greater extent than traditional TMS pulse shapes (Peterchev et al., 2013; Goetz et al, 2016). The cTMS system overcomes many of these limitations by using a completely different approach to traditional stimulator circuits, using two capacitors and a sophisticated switching circuit to manage the charging and discharging of energy between them. This allows the voltage on each capacitor to be inde pendently defined, providing more flexibility in controlling the positive and negative phases of the stimulator output pulse. The design is based on the novel work by Dr. Angel Peterchev at Duke University (formerly at Columbia University). For example, by setting a low negative voltage in one capacitor and a high positive voltage in the other capacitor and discharging from one to the other and back again, cTMS can generate a unidirectional (monophasic-like) pulse. This makes the negative phase at the start and end of the pulse longer and shallower than the positive phase, so while it is technically a biphasic pulse, the effective electric field (from the neuron's perspective) is monophasic. The result of this flexibility in defining novel waveforms is that the influence of pulse length and pulse direction on physiological or behavioural parameters can be probed using TMS. Recent research using Brainsight cTMS has revealed that the ability to vary pulse length enables a more selective affect of TMS on excitatory corticospinal inputs (D'Ostilio et al., 2015; Hannah et al., 2017; Hannah & Rothwell, 2017). The ability to specify the two phases of a TMS pulse in opposite directions has led to evidence that each phase of a TMS pulse may affect a separate population of excitatory interneurons, as evidenced by the effect of cTMS on MEP parameters (Sommer et al., 2018). Unidirectional pulses can be delivered in much the same way as traditional, single pulse TMS; however, repetitive cTMS is also achievable when a balanced, unidirectional pulse is configured. Balanced pulses are those where the end voltages of the capacitors are at or slightly below their original voltages. 1Hz rTMS protocols with unidirectional, rectangular pulse shapes

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have been shown to reduce motor evoked potential amplitude to a greater extent than conventional bipha-sic 1Hz rTMS, which produced no effect (Goetz et al., 2016). Brainsight cTMS benefits from the same, intuitive user interface design that is inherent of entire Brainsight family of products, including Brainsight TMS Navigation and Brainsight NIRS. The system offers seamless integration with MEP and Neuronavigation solutions and is capable of interfacing with other devices through a series of trigger input and output ports. Relevant publications that have used the Brainsight cTMS can be...

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