Background: Personalized MR neuro-navigation-based targeting approaches have been developed that have the potential to greatly increase TMS efficacy. Nevertheless, these have yet to be incorporated into routine clinical practice because of issues related to 1) the feasibility of neuro-navigation when applied to routine clinical practice, and 2) lack of biomarker-based validation of the critical target across individuals. Recent research at CU has begun to address both feasibility and targeting issues. In the MR-guided neuro-navigation approach, either structural or functional brain scans are used to identify a specific region of interest and the neuro-navigation system is then used to position the TMS coil to target that specific region across individuals. While this approach can be applied within specialized treatment settings, use of these devices requires expertise in 3D brain reconstruction that the majority of TMS providers do not possess. At CU, an initiative is underway to develop a virtual neuro-navigation system in which MRI images of the head and brain are uploaded into a server and neuro-navigation is performed in silico rather than in person. Scalp coordinates are then relayed to the clinician.~Study: Under this phase I study, Soterix Medical would develop an initial version of the software (TMSMap) and CU would perform feasibility testing on patients with treatment resistant depression
Phase I study of a virtual neuro-navigation package with built-in support for identifying specific surface-based targets to optimze TMS treatment.