MAGSTIM 200 2 User manual

MAGSTIM®
2002
P/N 3001-23-04
OPERATING MANUAL
LUMENIS EX1091
Page 1

Magstim 2002
TABLE OF CONTENTS
Page Numbers
Guarantee 1
Section 1: Description
1.1 Introduction
1.2 Contraindications
1.3 Indications for Use
2
2
2
2
Section 2: Warnings and Precautions 3
Section 3: Front Panel Description 5
Section 4: Rear Panel Description 10
Section 5: Preparations for Use 12
Section 6: System Status Codes 15
Section 7: Using the Magstim 2002
7.1 Description of the Coil
7.2 Coil Positioning
7.3 Discharging the Magstim
7.4 Recording of Evoked Responses
17
17
17
19
19
Section 8: Safety Features
8.1 Coil Temperature Protection
8.2 Coil Disconnection
8.3 Other Safety Measures
21
21
21
21
Section 9: Maintenance and Servicing:
9.1 Voltage Selection and Fuse Rating
9.2 User Maintenance
9.3 Technical Maintenance
9.4 Cleaning and Disinfecting
9.5 Servicing
9.6 Device Lifetime
9.7 Disposal
22
22
23
23
23
24
25
25
Section 10: Specifications:
General Specifications
10.1 Power
10.2 Ambient Temperature Requirements
10.3 Capacitor Life Expectancy
10.4 Output
10.5 Rear Panel
10.6 General
10.7 Handling
10.8 Packing Instructions
26
26
27
27
27
27
28
28
29
29
Section 11: EMC Emissions and Immunity 30
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Magstim 2002
The Magstim Company Limited 3001-23-04 1 18th March 2005
GUARANTEE
Equipment manufactured by the Magstim Company Limited is fully guaranteed covering
materials and workmanship for a period of one year from the date of shipment. The capacitor is
guaranteed for one year, or 200,000 discharges, which ever comes first. The Magstim Company
Limited reserves the right to perform guarantee services in its factory, at an authorised repair
station, or at the customer's installation.
The Magstim Company's obligations under this guarantee are limited to repairs or, at the
company's option, replacement of any defective parts of our equipment, except batteries, without
charge if said defects occur during normal service.
Claims for damages during shipment must be filed promptly with the transportation company.
All correspondence concerning the equipment must specify both model name and/ or number
and serial number, as it appears on the invoice for said equipment.
Improper use, mishandling, tampering with, or operation of the equipment without following
specific operating instructions will void this guarantee and release the Magstim Company from
any further guarantee obligations.
The Magstim Company will only accept responsibility for the effects on safety, reliability and
performance of the equipment if:
i modifications or repairs are carried out by persons authorised by The Magstim Company.
ii the electrical installation of the relevant room complies with local regulations, and
iii the equipment is used in accordance with the instructions for use.
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Magstim 2002
The Magstim Company Limited 3001-23-04 2 18th March 2005
SECTION 1: DESCRIPTION
1.1 INTRODUCTION
This manual is written for users of the Magstim 2002, an instrument used
in the magnetic stimulation of neuromuscular tissue.
The Magstim 2002is a device capable of stimulating neuromuscular tissue
by inducing small currents in the tissue using a brief pulse of electromagnetic
energy.
This method of stimulation enables deep, and otherwise inaccessible,
nerves to be stimulated easily and relatively painlessly. In addition, no skin
preparation is required and stimulation can be achieved through clothing.
INDICATIONS FOR USE
The Magstim 2002is a magnetic nerve stimulator intended for the
stimulation of neuromuscular tissue. The Magstim 200² system is for use
by, or under the supervision of a medical practitioner only.
CAUTION
Federal law restricts this device to sale by or on the order of a practitioner
licensed by the law of the State in which he/she practices to use or order the
use of the device.
CONTRAINDICATIONS
Magstim 2002and its accessories should not be used on or in the vicinity of
patients or users with cardiac demand pacemakers, implanted defibrillators
and/or implanted neurostimulators.
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Magstim 2002
The Magstim Company Limited 3001-23-04 3 18th March 2005
SECTION 2: WARNINGS AND PRECAUTIONS
USA Only
CAUTION: Magnetic Stimulators have not been cleared by the FDA for
cortical stimulation. Investigational human uses require that the user complies
with the FDA regulations regarding Investigational Devices. Please visit
www.fda.gov/cdrh or www.magstim-us.com for more information.
CAUTION: In the USA, Federal Law restricts this device to sale by or on
the order of a practitioner licensed by the law of the State in which he/ she
practices to use or order the use of the device.
Attention: Consult accompanying documentation before using the Magstim
2002.
CAUTION: The Magstim 2002and its stimulating coils must not be used on,
or in the vicinity of, patients or subjects with cardiac demand pacemakers,
implanted defibrillators, or other electronic implants.
The Magstim 2002, its coils and accessories generate high intensity magnetic
pulses. The induced eddy current is of sufficient magnitude to stimulate nerves
and muscle.
The strong magnetic pulses generated by stimulating coils induce eddy currents
in any conductive medium such as the human body, nearby metallic objects or
electronic devices.
NB Particular care must be taken to ensure that leads connected directly to the
patient, or other equipment, are not in a position where the stimulating coil can
couple resulting in currents being induced in them.
Do not discharge the Magstim with the stimulating coil in the vicinity of
metallic objects or these may be projected, moved and/or damaged.
The Magstim 2002must not be used in an explosive atmosphere or in the
presence of flammable anaesthetics.
When the magnetic pulse is delivered, a discharge click is produced by the
Magstim 2002and its stimulating coil. This discharge click may startle.
Where possible avoid the use of the stimulating coil near the ears. The use of
ear plugs is recommended.
High voltages are present within this instrument. Do not remove covers. Refer
servicing to qualified personnel.
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Magstim 2002
The Magstim Company Limited 3001-23-04 4 18th March 2005
The Magstim 2002, its stimulating coil and accessories must not be used if there
are any signs of external damage or if any parts are damp or wet.
Cortical magnetic stimulation runs the risk of inducing seizures.
Do not discharge the Stimulating Coil in the vicinity of objects sensitive to
magnetic fields. Examples are credit cards, floppy disks and computer screens.
Trigger input/output – only equipment that meets EN 60601-1 ( IEC 601-1 ),
and configured in compliance with EN 60601-1-1, should be connected to this
input.
Protection circuits in the Magstim Magnetic Stimulator disable the equipment
if the surface temperature of the Coil exceeds to set limit. The 90mm Coil is
intended for transient use, the surface temperature limits for which, being 50oC.
If it is intended that the coil be used for more prolonged contact, the proposed
protocol must be run, prior to its application on a patient, to ensure that the
surface temperature does not rise above 41oC during operation.
Coils must not be immersed in water, put in an ice bucket, or refrigerated. Not
even if placed within a plastic bag. The coils do not have any specialised
protection against the ingress of liquids, therefore conditions where ingress of
liquid, or the forming of condensation within the coil, can occur must be
avoided as the electrical insulation will be compromised. Cooling must only be
performed by using a flow of cool air from a fan or air conditioning unit.
Due to thermal lag, the surface temperature of the Stimulating Coil will
continue to rise following the coil over-temp activating and forcing the main
unit into a standby condition. Therefore, the Coil must be removed from the
patient as soon as the replace coil symbol is illuminated.
There are currently few medical papers available regarding the effects of
magnetic stimulation on the unborn child/ foetus or the expectant mother. As a
result of this, we are unable to verify the safety of the Coil's use on, or by,
pregnant women. We recommend that anyone wishing to use the Coil on a
pregnant woman, or use it whilst pregnant, should contact the Magstim
Company Ltd. for more information as new medical papers become available.
On no account must the Magstim 2002and its accessories be used
in environmental conditions outside those specified in this
operating manual.
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Magstim 2002
The Magstim Company Limited 3001-23-04 5 18th March 2005
SECTION 3: FRONT PANEL DESCRIPTION
NOTE
1. All operating functions described in this section assume that the
mains power switch, located on the rear panel, is in the ON position.
2. For the Magstim 2002- 3006-00, which is supplied without the
control unit shown in the above diagram, functions 4 to 17 are
implemented on the remote control coils. For details of the remote
control coils see Magstim Remote Control Coils Operating Manual –
3179-23.
ON/OFF (Standby) Button (1)
This switch toggles the operational state of the Magstim 2002. On initial
application of mains power, the Magstim 2002enters its Standby state.
This is indicated by the Power State indicator (3) flashing. Pushing the
ON/OFF switch when the unit is in its Standby state will set the
Magstim 2002into its operational state. This is indicated by the Power
State indicator (3) being continuously illuminated. All LEDs and symbols
will illuminate within a period of 5 seconds. At the end of 5 seconds the
OUTPUT % DISPLAY will default to 30%, and the inactive default
condition indicator (10) will illuminate. At the end of the session the
Magstim 2002can be returned to its Standby condition by pushing the
ON/OFF switch.
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Magstim 2002
The Magstim Company Limited 3001-23-04 6 18th March 2005
ARMED Indicator (2)
This LED is illuminated when the unit is in an armed condition. This
indicates that there is high voltage present inside the unit. On power-up
the armed indicator on the main unit flashes three times as part of a self-
test programme.
Unit Power Status Indicator (3)
Condition 1. –While the Magstim 2002is in the Standby state, as
controlled by the Mains Power switch (1), this LED flashes at
approximately 0.5Hz, indicating that the unit is in a standby condition.
Condition 2. – While the Magstim 2002is in the Operational state, as
controlled by ON/ OFF (Standby) button (2), this LED is continuously lit,
indicating that the unit is in the Operational state.
OUTPUT % DISPLAY Indicator (4)
This display is used to show the following:
1. The set power output as a percentage of maximum. After turning the
unit on using the ON/OFF button (1) the OUTPUT % DISPLAY will
display 30%. The OUTPUT CONTROL knob (16) can then be used to
change the output level in 1% steps. Note: The OUTPUT % DISPLAY
only shows the level the Magstim 2002is actually charged to if the
READY symbol (12) is illuminated.
2. The system status codes. These are detailed in Section 6 – System
Status Codes.
COIL IN Indicator (5)
This green LED will illuminate if there is a coil detected as being
connected correctly to the Magstim 2002.
COIL TEMPERATURE Indicators (6, 7 & 8)
These LED’s represent the surface temperature of the coil. The LED’s
illuminate sequentially as the coil temperature rises, beginning with the
bottom green LED and ending with the amber LED. When the amber
LED is lit, it means that the coil is getting close to its maximum operating
temperature. As soon as it reaches its maximum operating temperature,
the replace coil indicator will illuminate and the M2002will put itself into
a safe default mode and discharge internally.
NB If the temperature of the coil is below 5oC, the system will not
operate. The Magstim 2002will remain in its inactive default condition
until it detects that the coil temperature has risen above 5oC.
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Magstim 2002
The Magstim Company Limited 3001-23-04 7 18th March 2005
REPLACE COIL Indicator (9)
This red LED will illuminate if any of the following conditions are
present:
1. The Coil connected is not compatible with the Magstim 2002.
2. The surface temperature of the connected Coil has risen above its set
limit.
3. The connected Coil is faulty.
4. There is no Coil connected.
If this LED is illuminated the Magstim 2002will be put into its safe
inactive default condition.
DEFAULT CONDITION Indicator (10)
This LED is illuminated when the Magstim 2002has been put into its
safe inactive default condition.
ARMED Indicator (11)
This LED is illuminated when the unit is in an armed condition. This
indicates that there is high voltage present inside the unit.
READY Indicator (12)
This LED is illuminated when the Magstim 2002is charged and ready to
be triggered. A magnetic pulse can be produced by depressing one of the
Trigger Enable switches at the base of the stimulating coil and
depressing the TRIGGER button (15), or by depressing the footswitch,
or by applying a Trigger Input to the TRIGGER INPUT connector on
the rear panel.
Note: If the instrument has not been triggered for over 1 minute after the
READY symbol is illuminated the unit will automatically select the
default mode and discharge internally.
The function represented by this symbol is not implemented on the
Magstim 2002.
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Magstim 2002
The Magstim Company Limited 3001-23-04 8 18th March 2005
RUN Button (14)
The Magstim 2002can be put into the ARMED mode by momentarily
pushing the RUN button. This can only be achieved if the stimulating coil
is connected to the COIL OUTPUT socket (18) and the REPLACE
COIL symbol (9) is not illuminated. In the ARMED mode the ARMED
symbol (11) will illuminate and the instrument will charge to the level
displayed on the OUTPUT % DISPLAY (4).
TRIGGER Button (15)
The Magstim 2002can be triggered, and a magnetic pulse produced, by
pushing the TRIGGER button when the READY symbol (12) is
illuminated and one of the safety buttons at the base of the stimulating
coil is activated. The instrument will continuously charge and discharge if
the TRIGGER button is pressed and held.
OUTPUT CONTROL (16)
The output level setting as shown on the OUTPUT % DISPLAY (4) can
be increased, or decreased, by rotating the control clockwise or anti-
clockwise respectively. Each complete 360º rotation changes the output
level by approximately 20%.
SYSTEM STOP Button (17)
The Magstim 2002can be put into the safe inactive default mode by
momentarily pushing the STOP button. In this mode the DEFAULT
CONDITION indicator (10) will illuminate and the instrument will
discharge internally.
Note: The default mode is automatically selected if the coil is
disconnected, becomes faulty, the surface temperature of the connected
Coil has risen above its set limit, the SYSTEM STOP button is activated,
the instrument detects an internal fault, or if the READY symbol has
been illuminated for over 1 minute without the instrument having been
triggered.
COIL OUTPUT SOCKET (18)
This socket is used to connect the stimulating coil to the Magstim 2002.
Note that the unit cannot be armed and triggered unless the stimulating
coil is connected to this output. Ensure that the locating spot on the coil
plug is correctly lined up with the coil output socket before inserting the
plug. When the coil plug is fully engaged in the socket, lock the plug in
place by turning the black locking ring clockwise.
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Magstim 2002
The Magstim Company Limited 3001-23-04 9 18th March 2005
HIGH VOLTAGE Symbol
This sign warns that voltages in excess of 1500V are present within the
instrument (see also Section 2).
ATTENTION Symbol
See warnings in Section 2 regarding the use of the Magstim 2002.
APPLIED PART Symbol
BF Type Applied Part.
The applied part of this device, namely the stimulating coil, is electrically
isolated from the other parts of the equipment as required by safety
standards of BSEN60601-1.
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Magstim 2002
The Magstim Company Limited 3001-23-04 10 18th March 2005
SECTION 4: REAR PANEL DESCRIPTION
MAINS POWER Switch (1)
To connect the mains supply to the Magstim 2002set the mains power
switch the ON (I) position. To disconnect the mains supply, the mains
switch on the rear panel of the unit must be set to the OFF (0) position.
ISOLATED INTERFACE (RS232/ trigger) Port (2)
WARNING
(Only equipment complying with EN 60601-1, and configured in compliance
with EN 60601-1-1, should be connected to this interface port)
(Unless otherwise indicated, signal levels are 5V CMOS Logic)
Pin Connections (26D)
1. Aux GND 10. Aux. +5V 19. Aux GND
2. * 11. Aux. GND 20. *
3. Tout – O/C 12. Rx (RS232 Level) 21. *
4.* 13. Tx (RS232 Level) 22. *
5. +ve Trigger In 14. * 23. *
6. -ve Trigger In 15. * 24. †Trigger Edge/ Level
7. +ve Trigger Out 16. * 25. *
8. -ve Trigger Out 17. * 26. *
9. * 18. *
* Factory Use Only – DO NOT CONNECT
† No Connection – Edge Trigger
Connect Pin 24 to Pin 19 – LEVEL Trigger
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Magstim 2002
The Magstim Company Limited 3001-23-04 11 18th March 2005
TRIGGER INPUT/ OUTPUT
The trigger input is used to synchronise the Magstim 2002to an external
trigger input. Application of a 5V CMOS Logic Level to this input will
result in the instrument being triggered, provided the READY symbol
(12) is illuminated and one of the safety buttons at the base of the
stimulating coil is activated. This signal must be active for at least 10µs.
In most instances the Magstim 2002will be used in conjunction with a
recording instrument supplied by various manufacturers. In these cases
the Magstim and the recording instrument will have to be synchronised so
that the magnetic pulse produced by the Magstim occurs exactly at the
start of the recording sweep of the recording instrument. Almost all
recording instruments have some means of accepting an external trigger
signal via either a dedicated input port or via the foot switch trigger input.
The trigger output supplies a synchronisation signal to the external
recording instrument. A 100µs 5V CMOS Logic Level pulse of either
polarity is provided at this output whenever the Magstim is discharged.
Attention: Consult accompanying documentation before using the
Magstim 2002.
FOOT SWITCH Pneumatic Socket (3)
This socket is used to connect the supplied pneumatic FOOT SWITCH
to the Magstim 2002. The FOOT SWITCH can be used to trigger the
instrument when one of the safety switches at the base of the stimulating
coil is activated and the READY symbol on the front panel is
illuminated.
COOLING FAN OUTLET (4)
With the Magstim 2002turned on, air is drawn through slots at the bottom
of the instrument and expelled through the FAN OUTLET. Since it is
important to allow unrestricted air flow, the instrument must be placed on
a hard surface. In addition, there should be no obstructions placed closer
than 50mm to the FAN OUTLET.
POWER ENTRY MODULE (5)
FUSE ACCESS & VOLTAGE SELECTOR (6)
See Section 9 of this operating manual for instructions on how to replace
the fuses. NB The fuses should only be replaced with those specified in
this operating manual.
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Magstim 2002
The Magstim Company Limited 3001-23-04 12 18th March 2005
SECTION 5: PREPARATIONS FOR USE
IMPORTANT
To avoid interference problems the Magstim 2002, and its accessories,
should not be used in the vicinity of any equipment that does not comply
with EMC Standard EN 60601-1-2.
Before using the instrument, ensure that the correct fuses are fitted and that
the voltage selector is set to suit the supply voltage (see Section 9). Check
the Magstim 2002and its accessories for any signs of damage. If the
Magstim 2002, or any of its accessories, are damaged in any way they must
not be used.
If a number of Magstim 2002units are being used, or the Magstim 2002is
part of a BiStim system, it may be desirable for the units to be stacked on
top of each other. The Magstim 2002enclosure has been designed such that
the units may be safely stacked on top of each other. The maximum
number of units that can be safely stacked on top of the base Magstim
2002is 3. Attempts to exceed this limit could result in crush damage to the
base Magstim 2002. In addition, the stacked units could become unstable
and overbalance, causing injury to the patient, or user, and damage to the
Magstim units.
1. Insert the pneumatic connector of the foot switch to the rear panel
FOOTSWITCH socket on the Magstim 2002.
2. If a recording device is being used, synchronise the Magstim with the
recording instrument by following the instructions in Section 4 –
ISOLATED TRIGGER I/O Port.
3. Ensure that the locating spot on the coil plug is correctly lined up with
the COIL OUTPUT SOCKET, located on the front panel of the Magstim
2002. Insert the connector of the stimulating coil into the output socket.
When the coil plug is fully engaged in the socket, lock the plug in place by
turning the black locking ring clockwise until it clicks into place.
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Magstim 2002
The Magstim Company Limited 3001-23-04 13 18th March 2005
COIL
Please note: it is important that the coil is connected correctly. If the coil
appears to be misaligned, remove and re-connect the coil. Do not use if the
coil appears misaligned.
4. Set the MAINS POWER switch on the rear of the unit to the ON (I)
position. The Unit Power Status Indicator LED will flash at approximately
0.5Hz, indicating that the unit is in a standby condition.
5. Push the ON/OFF button on the front panel of the unit. The Unit Power
Status Indicator LED will be continuously lit, indicating that the unit is
operational and is in its safe inactive default condition.
6. All LEDs and symbols will illuminate within a period of 5 seconds. At
the end of the 5 second period, the OUTPUT % DISPLAY will indicate
an output power level of 30%, and the DEFAULT CONDITION indicator
will remain illuminated.
7. Ensure that all indicator LEDs are functioning properly before
proceeding; if not, contact The Magstim Company Service Department.
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Magstim 2002
The Magstim Company Limited 3001-23-04 14 18th March 2005
8. Press the RUN button. The ARMED indicator will illuminate and when
the instrument is charged to 30% the READY indicator will also illuminate.
This indicates that the instrument is ready for use.
Note: If the instrument has not been triggered for over 1 minute after the
READY symbol is illuminated the unit will automatically select the default
mode and discharge internally.
9. Hold the stimulating coil and press one of the Trigger Enable switches
located on either side of the coil handle. Press and hold the TRIGGER
key on the front panel, or depress and hold the footswitch. There should be
a clicking noise emanating from both the stimulating coil and the Magstim,
each time the Magstim is discharged, indicating that a magnetic pulse is
being produced.
Note: When using a standard 2nd Generation Coil, pressing one, or both, of
the safety switches at the base of the stimulating coil will enable the armed
M2002, allowing it to be triggered either via the trigger button on the unit –
item 15 in Section 3 (front panel description) of this operating manual, or
the footswitch – item 3 in Section 4 (rear panel description) of this
operating manual. If a Remote Control Coil is being used, depression of
one of the safety switches will cause the system to arm, depression of the
second switch will trigger the system.
On no account must the trigger enable buttons on the stimulating coil
be permanently activated, by taping down, or any other method of
fixing. They are designed as a safety interlock, to disable them could
result in a serious injury as a result of an inadvertent discharge of the
coil.
Ensure the instrument is functioning properly before proceeding.
Note: The Magstim 2002can also be triggered by applying a signal to the
TRIGGER INPUT Port, located on the rear panel of the unit.
Completion of Session:
During prolonged use, the temperature of some of the internal components
of the Magstim 2002will tend to rise. During operation this is regulated by
the operation of the cooling fan. However, when the unit is switched off,
the cooling operation is terminated. Therefore, it is recommended that, if
the Magstim 2002has been subject to prolonged use, the unit is left
switched on for approximately ten minutes after the last session has been
completed, to allow the fan to cool the unit.
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Magstim 2002
The Magstim Company Limited 3001-23-04 15 18th March 2005
SECTION 6: SYSTEM STATUS CODES
BASE Controller Error Codes produced by the User Interface.
Error Codes Description
U24 POWERDOWN
U25 Stack underflow
U26 Stack overflow
U27 RTS overrun
U28 Watchdog Timeout
U29 ROM Checksum Incorrect
U30 Unexpected RESET
U31 Unknown serial interrupt
U32 CSIO overrun
U33 Debug error
U34 No serial communications
U35 Loss of communication
U36 Bad NVRAM Checksum
Error codes produced by Coil.
Error Codes Description
C01 ROM Checksum Incorrect.
C02 EEPROM Checksum Incorrect.
C03 Invalid coil Category.
C04 Invalid Power Identification .
C05 Temperature sensor circuit failure.
C06 Bad Serial command or received data checksum.
C07 Internal Software Error.
C08 Invalid Coil Temperature ID.
C09 Invalid temperature algorithm coefficient.
C10 Coil controller malfunction.
C21 Coil Disconnected/ Coil Under Temperature.
C22 Brown Out Detected.
C23 No serial Communications.
C24 Bad Serial command of received data checksum (outside
TRIGGATE).
C25 EMC Detected (Coil adapter only).
C26 Invalid Coil Power Identification (Coil adapter only).
C27 Hardware Stop activated.
C28 Watchdog Timeout.
C29 Temperature Interlock 3 activation.
C30 Coil stop line fault.
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Magstim 2002
The Magstim Company Limited 3001-23-04 16 18th March 2005
Error codes produced by base system.
Error Codes Description
E61 Power fail
E62 Stack underflow
E63 Stack overflow
E64 RTS overrun
E65 WD Timeout
E66 Unexpected reset
E67 Bad checksum
E68 SYS debug error
E70 Coil under temperature
E71 Coil max difference
E72 Stack over temperature
E73 Stack under temperature
E74 Stack max difference
E75 HVCAP over temperature
E76 HV Transformer over temperature
E77 Charge threshold failure
E78 VREF check failure
E79 HVCAP voltage comparison failure
E80 Charging fault
E81 HV over voltage
E82 Invalid system configuration
E83 Stop line fault
E84 Base coil stop line fault
E85 UI stop line fault
E86 Dump system fault
WARNING – high voltage may be present up to 20
minutes after use on internal high voltage capacitor.
E87 Invalid coil category for current system configuration.
E88 Invalid NVRAM Checksum.
E89 Faulty charging relay detected
E90 Base arm LED drive failure
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Magstim 2002
The Magstim Company Limited 3001-23-04 17 18th March 2005
SECTION 7: USING THE MAGSTIM 2002
7.1 DESCRIPTION OF THE COIL – Standard 90mm Coil – 3193-00
Magnetic nerve stimulation can be achieved by discharging the Magstim
2002with the Stimulating Coil in the vicinity of neuromuscular tissue.
Current flows from the instrument through the coil in only one direction.
However, depending upon which side of the coil (labelled A or B) is
facing up, the direction of the current flow relative to the stimulated tissue
will change.
Standard 90mm Stimulating Coil - 3193-00
With Side A visible and Side B facing the area to be stimulated, coil
current flows in the anti-clockwise direction and the induced tissue
current flows in the clockwise direction during the stimulating phase.
With Side B visible and Side A facing the area to be stimulated, coil
current will flow in the clockwise direction and induced tissue current
flows in the anti-clockwise direction. The convention used above is that,
in the coil, current flows from positive to negative. In the tissue current
flow refers to ionic (+) movement.
7.2 COIL POSITIONING
Correct coil positioning is essential to allow accurate measurements of the
important parameters such as conduction latency, threshold of
stimulation, response size and waveform morphology.
The MAGSTIM 2002is supplied as standard with the Standard 90mm
Coil (P/N 3193-00), which is designed for the purposes of deep nerve
stimulation stimulation. Stimulating the motor cortex using the Standard
90mm Coil produces responses which can be recorded from the majority
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Magstim 2002
The Magstim Company Limited 3001-23-04 18 18th March 2005
of muscles in the body allowing for the functional assessment of motor
pathways. In the case of the MAGSTIM the discharge current in the
stimulating coil and the resulting magnetic pulse is mono-phasic allowing
for mono-hemispheric stimulation.
To record the best responses from muscles in the right side of the body
always place the coil such that Side A is visible to the operator and Side
Bis touching the subject. To record the best response from the left side of
the body always place the coil such that Side B is visible to the operator.
The above rules should be observed when stimulating the motor cortex or
the spinal nerve roots.
The induced stimulating current flows clockwise under the coil winding
when viewing Side A and counter-clockwise when viewing Side B. Since
the motor cortex is more sensitive to current flowing from posterior to
anterior, clockwise induced current primarily stimulates the left motor
cortex and counter-clockwise induced current stimulates the right motor
cortex.
When recording from muscles in the arms and hands position the
Standard 90mm Coil centrally on the vertex. In the case of circular coils
Stimulation takes place under the winding and not under the coil centre.
When recording from muscles in the lower limbs move the Standard
90mm Coil forward from the vertex and contra lateral to the target muscle
by approximately 5cms (2 inches) each way such that part of the coil
winding lies over the central fissure.
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