MAGSTIM BiStim2 User manual

January 2014
Magstim BiStim²
Operating Manual
MOP02-EN
Revision 02

Magstim BiStim²
Operating Manual
© The Magstim Company Limited i MOP02-EN-02
TABLE OF CONTENTS
Table of Contents ................................................................................................................. i
Guarantee........................................................................................................................... ii
Section 1 Introduction....................................................................................................... 1
1.1 Indications for Use................................................................................................... 1
1.2 Contraindications..................................................................................................... 1
1.3 Devices Covered..................................................................................................... 2
1.4 Frequently Used Functions....................................................................................... 2
Section 2 Warnings and Precautions ................................................................................. 3
Section 3 Product Descriptions.......................................................................................... 5
3.1 Front Panel............................................................................................................. 5
3.2 Rear Panel.............................................................................................................. 9
3.3 Accessories .......................................................................................................... 10
Section 4 Operating Instructions...................................................................................... 11
4.1 Preparation ........................................................................................................... 11
4.2 Set-up................................................................................................................... 11
4.3 Connection............................................................................................................ 13
4.4 Operation.............................................................................................................. 14
4.5 Independent BiStim² Triggering (IBT)...................................................................... 15
Section 5 Maintenance ................................................................................................... 16
5.1 User Maintenance and Calibration.......................................................................... 16
5.2 Technical Maintenance.......................................................................................... 16
5.3 Voltage Selection and Fuse Rating......................................................................... 17
5.4 Cleaning and Disinfecting....................................................................................... 17
5.5 Servicing............................................................................................................... 17
5.6 Device Lifetime...................................................................................................... 17
5.7 Disposal................................................................................................................ 18
Section 6 Specifications.................................................................................................. 19
6.1 Safety Specifications.............................................................................................. 19
6.2 Technical Specifications......................................................................................... 20
6.3 Environmental Conditions ...................................................................................... 21
6.4 Handling ............................................................................................................... 21
6.5 Packing Instructions............................................................................................... 21
Section 7 Contact Details................................................................................................ 22
7.1 Product Enquiries.................................................................................................. 22
7.2 Servicing Enquiries................................................................................................ 22
7.3 Sales Enquiries ..................................................................................................... 22
Appendix A –SYSTEM ERROR CODES ............................................................................ 23
Appendix B –Trigger Input / Output .................................................................................... 25
Appendix C –MANUFACTURER’S EMC DECLARATIONS.................................................. 26

Magstim BiStim²
Operating Manual
© The Magstim Company Limited ii MOP02-EN-02
GUARANTEE
Equipment manufactured by The Magstim Company Limited is fully guaranteed, covering both
materials and workmanship, for a period of one year from the date of shipment. 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.
Any obligations which The Magstim Company Limited has under this guarantee are limited to repairs
or, should the company so choose, replacement of any defective parts of the equipment, except
batteries, without charge provided that the 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 the model name and/or number as well as
the serial number exactly as they appear on the invoice for the 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 Limited from any
further guarantee obligations.
The Magstim Company Limited will only accept responsibility for effects on safety, reliability and
performance of the equipment if:
modifications or repairs are carried out by persons authorised by The Magstim Company
Limited;
the electrical installation of the relevant room complies with local regulations; and
the equipment is used in accordance with the instructions for use.

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 1 MOP02-EN-02
SECTION 1 INTRODUCTION
1.1 Indications for Use
The Magstim Bistim² is a magnetic nerve stimulator intended for the stimulation of cortical and
peripheral nerves for diagnostic, research and therapeutic purposes.
The Magstim Bistim² consists of two Magstim 200² units and a Magstim Bistim² Connecting Module.
This enables the outputs of the two Magstim 200² units to output into a single stimulating coil either as
a single high energy pulse or as a pair of individual spaced pulses.
The Magstim Bistim² is capable of stimulating by inducing small currents in the nerve 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.
The Magstim Bistim² is intended for use by, or under the supervision of, a medical practitioner or
investigator and is to be used in a laboratory or a medical consulting room environment. The medical
practitioner or investigator should have knowledge about the principles of TMS, physiology and
potential side effects of TMS.
The Magstim Bistim² is a non-sterile reusable medical device intended for multi-patient use. The
Magstim Bistim² is not intended to come into contact with the patient as this achieved through use of
a stimulating coil.
The Magstim Bistim² is intended to be stationary during use however, can be moved if necessary
when not in use.
The Magstim Bistim² should only be used on a conscious patient.
USA Only: The Magstim BiStim² has not been cleared by the FDA for cortical stimulation.
Investigational uses require an IDE.
1.2 Contraindications
The Magstim Bistim² should not be;
used on or in the vicinity of patients or users with cardiac demand pacemakers, implanted
medication pumps, cochlear devices, implanted defibrillators and/or implanted
neurostimulators
used on or in the vicinity of patients with implanted metal objects of a ferrous nature
used on patients where the skin in the area to be contacted is broken
used on patients who suffer from multiple sclerosis
used on those with large ischaemic scars
used on pregnant women
used on infants under the age of 2 years
Magstim recommends that a standard questionnaire is completed to screen a patient’s suitability prior
to using any Magstim product on that patient and concurs with the recommendations given in the
paper titled “Safety, ethical considerations, and application guidelines for the use of transcranial
magnetic stimulation in clinical practice and research” by Rossi et al (2009).

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 2 MOP02-EN-02
1.3 Devices Covered
This document is applicable to the following device:
Magstim Bistim² System
This consists of:
2 x Magstim 200² Unit (P/N: 3010-00)
Magstim Bistim² Connecting Module (P/N: 3330-00)
Footswitch (P/N: 9525-01)
Magstim Bistim² UI Controller (P/N: 3021-00)
Magstim 200² UI Controller (P/N: 3020-00)
All parts of the Magstim BiStim² system, referenced above are suitable for use within the patient
environment.
Note: When the Bistim² Connecting Module is not connected, the Magstim 200² Units will operate as
if they were a standalone device. Please consult the Magstim 200² Operating Manual before using the
Magstim 200² Units as standalone devices.
Magstim 200² stimulator - MOP01
Note: Please also consult any labelling and information accompanying stimulating coils and other
accessories for safety and use information regarding these devices.
1.4 Frequently Used Functions
Frequently used functions as defined during Magstim’s usability process are identified with
(*). Frequently used functions are functions of the BiStim² that frequently involve user
interaction.

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 3 MOP02-EN-02
SECTION 2 WARNINGS AND PRECAUTIONS
Attention Consult Operating Manual: Consult the operating manual before using this device.
Operating Manual: Further information can be located in the operating manual.
Type BF Applied Part: Refer to Section 6.1 for further information.
High Voltages: High voltages are present in the Magstim Bistim² System and its accessories
during operation and for up to 20 minutes following operation. Therefore:
do not remove covers. Refer servicing to qualified personnel.
if there is any sign of external damage or if any parts are damp or wet, they
must not be used.
ensure that the system is disarmed prior to disconnecting the stimulating coil
and BiStim² connecting module.
Replace coil indicator*:The system monitors the coil temperature and if this reaches 40°C, the
stimulator will be disabled. The coil surface temperature may continue to rise after this point;
therefore, the coil must be removed from the subject as soon as the replace coil indicator is
illuminated.
Rear Panel Outputs*: Only equipment that meets the relevant IEC standard should be connected
to the Magstim Bistim².
This connection must be configured in compliance with IEC 60601-1-1:2000 or Clause 16 of IEC
60601-1:2005 (Second edition: IEC 60601-1-1) with the following interface voltage limitation: Max
signalling voltage +5.3V; Max voltage with respect to protective earth potential 30V peak
Magnetic Pulses: the system generates high intensity magnetic pulses through its coils, which
induce eddy currents in any conductive medium, such as the human body, nearby metallic objects
or electronic devices. Therefore, the system:
must not be used on, or in the vicinity of subjects with cardiac demand
pacemakers, implanted defibrillators, or other electronic or metallic implants;
must not be used in a position where the current can be induced in cables or
wires that are directly connected to the subject;
must not be used in the vicinity of objects that are sensitive to magnetic fields,
such as watches, credit cards and electronic equipment; and
must not be used when in contact with metallic objects, as these objects may be
propelled or damaged by the magnetic field of the coil.
Damage: If there are any signs of damage to the Magstim BiStim² System, or if any parts are
damp or wet, the system must not be used. If damaged, the Magstim BiStim² should be returned
to the Magstim Company Limited for servicing and repair (see Section 7.2 for contact details).

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 4 MOP02-EN-02
Explosive and Flammable Atmospheres: The Magstim Bistim² and accessories must not be
used in an explosive atmosphere, around explosive gases or in the presence of flammable
anaesthetics.
Protective Earth: To avoid the risk of electric shock, the Magstim Bistim² must only be connected
to a supply mains with protective earth.
Modification: No modification of this equipment is allowed.
Discharge noise: when the magnetic pulse is delivered, a discharge click is produced that may
startle. The use of ear protection is recommended.
Seizures: cortical magnetic stimulation runs the risk of inducing seizures. Magstim concurs with
the advice given in the paper titled “Safety, ethical considerations and application guidelines for
the use of TMS in clinical practice and research” by Rossi et al (2009) in respect to screening
candidates prior to administering TMS.
Environmental Conditions*: The system must not be used or stored under environmental
conditions that fall outside those specified in section 6.3 of this operating manual.
Stacking Limit: Magstim 200² units may be stacked on top of each other, but must not exceed
the stacking limit specified in Section 6 of this operating manual. If this limit is exceeded, the stack
may become unstable and overbalance risking injury to patients or users and risking damage to
the unit’s themselves.
If the stacking limit is reached it can have a weight of up to 80kg. Ensure that the surface upon
which to system is to be placed is capable of supporting this weight. Failure to do so may result in
injury or damage. The weight for each individual 200² unit is in excess of 20kg
Carrying*: On no account should the Bistim² connecting module be used as a carrying/gripping
point when transporting its host Magstim 200² unit. The Bistim² connecting module and its fixings
are not designed to be subjected to this level of force and the Bistim² connecting module will
become detached from its host unit. This could result in damage to Magstim 200² unit, Bistim²
connecting module, or those transporting the equipment
Connecting Equipment: Only equipment listed in Section 1.3 may be connected to the Magstim
BiStim². Equipment that meets the relevant IEC standard may be connected to the rear interface
ports at the rear of the Magstim Bistim². See Appendix B for further details.

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 5 MOP02-EN-02
SECTION 3 PRODUCT DESCRIPTIONS
3.1 Front Panel
The front panel, shown below, allows control of the Magstim Bistim² and provides the connection for
the stimulating coil.
Note: UI functions described in this section are to be performed on the master unit UI (Bistim² UI).
Control functions/buttons are not activated on the slave unit UI (200² UI) therefore cannot be used to
control system. The only function/button that may be used is the system stop button.
Figure 3.1: Detailed front panel
The upper unit is considered the master unit. The lower unit is considered the slave unit.
All operating functions described in this section assume that the mains power switches, located on
the rear panel of the master and slave units, are switched on.
3.1.1 On/Off Button* (1)
The on/off button toggles the master and slave units of the Magstim Bistim² between on and standby.
3.1.2 Armed Indicator* (2) & (9)
The armed indicator illuminates when the unit is armed allowing it to be triggered.
1
2
3
4
5
6
7
8
9
10
11
15
13
12
14
Master
Slave

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 6 MOP02-EN-02
3.1.3 Power Indicator* (3)
The power indicator flashes when the Magstim Bistim² is in standby, and illuminates when the
Magstim Bistim² is on. When power is initially applied to the Magstim Bistim², the power indicator
should flash indicating the unit is in standby state.
3.1.4 Output Display* (4)
The output display consists of 3 lines. The first and second lines display the power output as a
percentage of maximum of the master and slave units respectively. The third line displays the inter-
pulse spacing. The default value displayed after initially switching on the master and slave units are
30% for both power outputs and 10ms for the inter-pulse spacing.
If an error code needs to be displayed, the power output is replaced by error code(s). These are
detailed in Appendix A –System Error Codes.
3.1.5 Coil Indicator* (5)
This green LED will illuminate if there is a coil detected as being connected correctly to the Magstim
Bistim².
3.1.6 Coil Temperature Indicators* (6)
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 Magstim Bistim² will disarm itself.
Note: If the temperature of the coil is below 5oC, the system will not operate. The Magstim Bistim²
will remain in its inactive default condition until it detects that the coil temperature has risen above
5oC.
3.1.7 Replace Coil Indicator* (7)
This red LED will illuminate if any of the following conditions are present:
1. The coil connected is not compatible with the Magstim Bistim².
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 Bistim² will not arm until the reason for the indicator being lit is
resolved.

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 7 MOP02-EN-02
3.1.8 Disarmed Indicator* (8)
This LED is illuminated when the Magstim Bistim² has been put into its safe disarmed state.
3.1.9 Ready Indicator* (10)
When the Magstim Bistim² is armed, this LED will illuminated when the Magstim Bistim² is charged
and ready to be triggered.
3.1.10 Run Button* (11)
The Magstim Bistim² can be armed pushing the green run button. The Magstim Bistim² will charge to
the power level indicated on the output display. The Magstim Bistim² will not arm if the replace coil
indicator is illuminated.
3.1.11 Output Control* (12)
The output control allows the master power level, slave power level and inter-pulse spacing displayed
on the master unit UI to be adjusted. The master output power, slave output power and inter-pulse
spacing can be adjusted by rotating the output control clockwise to increases the level and rotating
anti-clockwise to decreases the level. To toggle between the master power, slave power and inter-
pulse spacing press the output control.
Each complete 360º rotation changes the master/slave power output level by approximately 20%.
3.1.12 Trigger Button* (13)
The Magstim Bistim² can be triggered to deliver the stimulus by pressing the yellow trigger button
along with one of the trigger buttons located on the coil. The instrument will continuously charge and
discharge if the trigger buttons are pressed and held.
3.1.13 System Stop Button* (14)
The Magstim Bistim² can be disarmed by pushing the red stop button. In this mode the disarmed
indicator will illuminate and the instrument will discharge internally.
Note: The Magstim Bistim² will disarm 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.
3.1.14 Coil Output Socket* (15)
This socket is used to connect the stimulating coil to the Magstim Bistim² system.

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 8 MOP02-EN-02
Note: It is normal for the pin indicated on the label to protrude from the coil socket on the master and
slave stimulator units. This is an intentional design feature.
Figure 3.2: Coil output socket front view Figure 3.3: Coil output socket angled view

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 9 MOP02-EN-02
3.2 Rear Panel
Figure 3.4: Blank Rear Panel.
3.2.1 Power * (1)
The Power switch allows the power supplying the unit to be switched on (labelled I) or off (labelled
O).
3.2.2 Isolated Interface* (2)
The trigger input is used to synchronise the Magstim Bistim² system to an external trigger input. This
is only functional on the master unit. Please see Appendix B for more information.
3.2.3 Foot Switch Socket* (3)
This socket is used to connect the pneumatic foot switch to the Magstim Bistim² system. The foot
switch can be used to trigger the instrument when one of the trigger buttons located on the coil is
also pressed. The instrument will continuously charge and discharge if the trigger buttons are
pressed and held. The foot switch socket is only functional on the master unit when.
1
2
3
4
5
6
Master
Slave

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 10 MOP02-EN-02
3.2.4 Cooling Fan Outlet (4)
With the Magstim Bistim² turned on, air is drawn through slots at the bottom of the instrument and
expelled through the fan outlet. There should be no obstructions placed closer than 50mm to the fan
outlet.
3.2.5 Functional Earth (5)
Functional earth connections of the master and slave units should be connected using the supplied
functional earth strap.
3.2.6 Power Entry Module & Fuse Access (6)
The standard IEC mains lead supplied by the Magstim Company Ltd should be connected to the unit
prior to the unit being switched on.
3.3 Accessories
A range of stimulating coils are available for use with the Magstim range of products. For more
details, please contact the Sales department. Contact details are shown in Section 7.3.
Please note, only “category A” high power stimulating coils will work with the Magstim Bistim².
Note: The use of the correct accessories is essential to the functioning of the Magstim Bistim². The
Magstim Company Limited cannot guarantee the instrument’s performance unless accessories used
are obtained from The Magstim Company Limited. Only Magstim accessories purchased from the
The Magstim Company Limited should be used with the Magstim Bistim².
Note: The Magstim BiStim² should only be powered using the power lead supplied by The Magstim
Company Ltd.

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 11 MOP02-EN-02
SECTION 4 OPERATING INSTRUCTIONS
Note: to avoid problems with interference, the Magstim Bistim² system should not be used in the
vicinity of any equipment not in compliance with the EMC Standard EN 60601-1-2, including mobile
phones.
Note: Please ensure you are familiar with all sections of this operating manual prior to following these
operating instructions.
Note: Please consult any labelling and information accompanying stimulating coils and other
accessories for safety and use information regarding these devices.
Note: UI functions described in this section are to be performed on the master unit UI (Bistim² UI).
Control functions/buttons are not activated on the slave unit UI (200² UI) therefore cannot be used to
control system. The only function/button that may be used is the system stop button.
4.1 Preparation
1. At the start of each session the operator must check the Magstim Bistim² system and any
accessories used for any signs of external damage and to identify any cleaning required*. If any
cracks are visible in the housing, or there is damage to any of the cables, the items must not be
used and should be returned to The Magstim Company Limited for servicing and repair. If
cleaning is required, please follow the instructions in Section 5 of this Operating Manual.
Note: The contacts in the coil connector, Bistim² connecting module and the stimulator coil output
socket should be checked regularly for any signs of tarnishing or burning*. See Section 5.2 for an
example of contact burning.
4.2 Set-up
Note: The Magstim BiStim² should be assembled following the instructions provided within this
section to ensure continued compliance of IEC 60601-1:2005.
Note: ensure not to position the Magstim BiStim², so it is difficult to disconnect the power lead.
1. Ensure that the master and slave units of the Magstim Bistim² are switched off on the rear*.
2. Place the master unit on top of the slave unit ensuring the feet of the master unit fit into the
recesses on the slave unit*.
3. Remove the two blanking plugs from the threaded inserts on the left-hand side of the master unit.
4. Insert the two M6x60 hexagon bolt into the mounting holes on the Bistim² Connecting Module.
Place the Bistim² Connecting Module against the side of the master unit so that the bolts locate in
the threaded inserts. Ensure that the coil output socket is facing the front*. (See Figure 4.1)
5. Using the supplied hexagon key tighten the bolts so as to secure the Bistim² Connecting Module
to the side of the master unit*. Do not over tighten the bolts as this may damage the cases of the
units.
6. Fit the two supplied blanking inserts to the mounting holes in the Bistim² Connecting Module.
These blanking plugs are a push fit but care is needed with the positioning of the inserts to ensure
that the tops are flush with the case surface.

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 12 MOP02-EN-02
Figure 4.1: Attaching the Bistim² connecting module
7. Remove the two blanking plugs from the threaded inserts on the right-hand side of the master
unit.
8. Insert the two M6x12 hexagon bolt into the mounting holes on the coil holder. Place the coil
holder against the right-hand side of the master unit so that the bolts locate in the threaded
inserts. (See Figure 4.2) *
9. Using the supplied hexagon key tighten the bolts so as to secure the coil holder to the right-hand
side of the master unit. Do not over tighten the bolts as this may damage the cases of the units.
Figure 4.2: Attaching the coil holder
10. Connect the supplied earth strap between a functional earth connection on the master and slave
unit*
To do this, unscrew the screw adjacent to the functional earth symbol on the rear of the master
unit using a Phillips screw driver. Place one end of the earth strap over the screw as shown in
figure 4.3 and re-attach to the unit back panel.
11. Figure 4.3: Attaching the earth strap
Repeat the above, to attach the opposite end of the earth strap to the slave unit.

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 13 MOP02-EN-02
4.3 Connection
1. If a foot switch is to be used, insert the pneumatic connector of the foot switch to the rear panel
Foot Switch Socket on the master unit of the Magstim Bistim² system*.
2. If an external triggering or recording device is to be used, connect it to the Isolated Interface on
the rear of the master unit of the Magstim Bistim² system*. Refer to Appendix B for more details
on the Isolated Interface.
3. Connect the lead marked “A” from the Bistim² Connecting Module to the coil output socket on the
master unit, connect the lead marked “B” from the Bistim² Connecting Module to the coil output
socket on the slave unit*.
4. Place the stimulating coil to be used into the coil holder on the right hand side of the stimulator*
as instructed in Figure 4.3.
Figure 4.4: Attaching the coil to the coil holder
5. Connect the stimulating coil to be used to the coil output socket on the Bistim² Connecting
Module*.
Note: There is locating key on the coil connector (Stimulating coil and Bistim² connecting module
leads A+B), which needs to be aligned with the corresponding receptor on the coil output socket.
It is then possible to rotate the outer collar of the coil connector clockwise, in order to lock the coil
to the stimulator/ Bistim² connecting module. (see Figure 4.4)
Figure 4.5: Locating key on the coil connector (left) and the receptor on the coil output socket (right)
Care must be taken to attach the coil connector to coil output socket correctly (see Figure 4.5).
Failure to do so can cause damage to the connector pins and in severe cases, internal damage to
the coil and the stimulator.
Coil locating key
Coil output
socket receptor

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 14 MOP02-EN-02
Figure 4.6: Diagram showing correct and incorrect ways to connect the coil to the stimulator
6. Connect the power leads to the rear of the master and slave units*.
4.4 Operation
1. Set the power switch on the rear of the master and slave units to the on (I) position. The power
indicators will flash indicating that the units are in standby*.
2. Push the on/off button on the front of the master and slave units*. The power indicators will
become continuously lit. The Magstim Bistim² system will start an initialisation sequence during
which the armed indicator will flash three times and LED’s in the user interface will light
sequentially.
Once the initialisation sequence is complete, the coil indicator and disarmed indicator LED’s will
be lit and the output display will read 30% on the first line, 30% on the second line and 10ms on
the third line.
Note: During the initialisation sequence, the operator must check that all LED’s are lit. If they do
not, the items must not be used and should be returned to The Magstim Company Limited for
servicing and repair.
3. Use the output control on the master unit UI to adjust the power level or the inter-pulse spacing to
the desired setting*. Rotating the control clockwise increases the power level, rotating anti-
clockwise decreases the power level.
4. Depress the output control to toggle the value being adjusted between the master power output,
the slave power output and the inter-pulse spacing*.
The inter-pulse spacing range can be change between 0-999ms and 0-99.9ms, when adjusting
the inter-pulse spacing, rotating the control knob on the clockwise several times until the display
shows the maximum inter-pulse spacing (999ms or 99.9ms). Press and hold the stop button on
the user interface and rotate the control knob clockwise at the same time. The display should
revert to either 1.0ms or 10ms. Turn off the Bistim² system and then turn on again and the default
inter-pulse time displayed should be in the new range (1.0ms or 10ms).
5. Press the run(green) button on the master unit UI to arm the Magstim Bistim²*. The armed
indicators of both the master and the slave system should light, and once the system is charged,
the ready indicators will also illuminate*.
Note: If the system is not triggered within a minute of being armed, it will revert back to the
disarmed state and will need to be re-armed before continuing.
6. Remove the stimulating coil from the coil holder* and position the coil over the desired target.

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 15 MOP02-EN-02
7. When ready to trigger the system, engage and hold one of the trigger/interlock switches located
on the stimulating coil, then press either the trigger(yellow) button on the on the master unit UI or
the foot switch*.
A clicking noise should be heard from both the stimulating coil and the Magstim Bistim² system. If
the inter-pulse spacing is large enough, two clicks should be audible.
8. When necessary, reposition the coil and/or modify the output power or inter-pulse spacing to suit
requirements for the next stimulus. Meanwhile, the stimulator will recharge and the ready
indicator will be illuminated when charging is complete.
9. At the end of the session, place the stimulating coil back into the coil holder and engage the
stop(red) button of the master unit UI to discharge the stimulator internally and put it into stopped
mode*.
10. Set the power switch on the rear of the master and slave units to the (O) position to switch the
unit off*
11. Sections 4.3 and 4.2 should be repeated in reverse to disconnect the Magstim Bistim²*.
Note: Ensure that the system is disarmed prior to disconnecting the stimulating coil and BiStim²
connecting module.
4.5 Independent BiStim² Triggering (IBT)
When the system is set in IBT Mode, triggering of the master unit does not automatically trigger
the slave unit, allowing an alternate, external trigger to be used via the isolated interface.
The output from the master unit is used to initiate a triggering window in the slave unit. This
allows the slave to be triggered externally any time between 1ms and 2s after the master has
been triggered. This external triggering can be achieved only via the isolated interface. When in
IBT Mode, the slave cannot be triggered by the footswitch or the UI controller.
To set the Magstim Bistim² System in IBT Mode, with an inter-pulse spacing of zero, hold down
the UI stop button and rotate the power level knob anticlockwise. The bottom display should
show an “E”.
Note:When you are in this mode you cannot adjust the inter-pulse timing.
The Magstim Bistim² System will remain set in IBT Mode following power-down. It will only revert
to standard operation when its mode is actively reset. To reset to standard operation, select the
inter-pulse time window, hold down the stop button and rotate the control knob clockwise.

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 16 MOP02-EN-02
SECTION 5 MAINTENANCE
5.1 User Maintenance and Calibration
There are no user maintenance or calibration requirements for the Magstim Bistim² system and
accessories. However, it is important that they are checked for any sign of damage at the start of
each session*. If any cracks are visible in the plastics, or if there is damage to any of the cables, the
items must not be used and should be returned to The Magstim Company Limited for servicing and
repair (see Section 7.2 for contact details).
5.2 Technical Maintenance
The contacts in the coil connector, Bistim² connecting module and the stimulator coil socket should be
checked regularly for any signs of tarnishing or burning*. Under conditions of exceptionally intense
use, it is possible for localised heating to manifest itself in the connector, which causes damage to the
contacts. Continued use in this condition will eventually cause the contacts to deteriorate and loose
electrical connection, which will cause damage to the system.
Repair is a specialised procedure and can only be undertaken by The Magstim Company Limited or
an authorised service centre. If any pins show damage, however slight, contact The Magstim
Company Limited service department for further advice or to arrange a return (see Section 7.2 for
contact details).
Warning: contact burning is communicable, so any coil with damaged contacts will infect a stimulator
with healthy contacts and vice-versa. Therefore, if damage is noticed on any coil connector or
stimulator coil socket the entire system must not be used until all contacts are carefully examined and
repaired where appropriate. If this is not done thoroughly there is a risk that the cycle of pin damage
will continue.
Figure 5.1: Example of contact burning

Magstim BiStim²
Operating Manual
© The Magstim Company Limited 17 MOP02-EN-02
5.3 Voltage Selection and Fuse Rating
The Magstim Bistim² system is preset at the factory to operate at 110V-120V or 220V-240V A.C., as
appropriate. The following are the fuse ratings for both the master and slave units:
Supply Voltage
Qty
Fuse Size
Rating
Voltage Selector
Setting
110V-120V~
2
20 x 5mm
T10AH, 250V
115
220V-240V~
2
20 x 5mm
T5AH, 250V
230
T denotes timed or antisurge fuses. Fast acting fuses are not recommended.
H denotes high breaking capacity (ceramic fuse).
Fuse Replacement: The Magstim Bistim² must be disconnected from the mains by disconnecting the
power cord from both of the 200² units. Insert the tip of a small blade screwdriver or similar tool into
the slot below the arrow to lever the retaining lip enabling the fuse tray to be pulled out. Replace the
blown fuse(s) with one of the correct rating (See above to ensure the correct fuse is replaced) and
locate and push home the tray ensuring the retaining lip clicks into place.
Changing The Voltage Selector Setting: The Magstim Bistim² must be disconnected from the mains
by disconnecting the power cord from both of the 200² units. Remove the fuse tray as instructed
above, rotate the voltage selector to the desired setting and replace the cover. A legend will indicate
the voltage selected when the fuse cover is replaced.
Note: Only replace fuses with those of the correct rating, and only operate the instrument with
the voltage selector set at the appropriate voltage. Failure to do so may cause serious damage
to the device(s).
5.4 Cleaning and Disinfecting*
The Magstim Bistim² system and accessories cannot be sterilised; therefore, do not allow them to
become contaminated with bodily fluids. They may be cleaned using a cloth moistened with isopropyl
alcohol, however ensure that the Magstim Bistim² and accessories have dried thoroughly before use.
It is the responsibility of the user to ensure the Magstim BiStim² is cleaned when necessary.
Note: The Magstim Company Ltd recommends that a solution of 70% isopropyl alcohol should be
used.
5.5 Servicing
The Magstim Bistim² contains no user serviceable parts. Servicing of Magstim Bistim² system and
accessories must only be carried out by The Magstim Company Limited or one of its authorised
service centres. To arrange a return or for further information, contact the service department at The
Magstim Company Limited (see Section 7.2 for contact details).
5.6 Device Lifetime
The lifetime of the Magstim Bistim² system is defined as being five years from the date of shipment.
The Magstim Company Limited will support the products for the duration of their lifetime.