'RMT-Finder': an automated procedure to determine the Resting Motor Threshold for Transcranial Magnetic Stimulation

BackgroundTranscranial Magnetic Stimulation (TMS) studies identify the Resting Motor Threshold (RMT) to calibrate stimulation intensity. However, this procedure is time-consuming and subject to variability. We developed an automated procedure to improve the efficiency and standardization of RMT determination. New methodWe developed an algorithm that measures MEP amplitudes and automatically adjusts stimulation intensity to determine the RMT. Experiment 1 compared this automated method with the manual procedure in terms of reliability and equivalence. Experiment 2 developed a "Fast" automated process, assessing it against both the manual and initial automated procedures. ResultsAcross both experiments the automated approach demonstrated excellent test-retest reliability and strong agreement with the manual method (Intraclass Correlation Coefficients [&ge;]0.95), giving estimates of RMT statistically equivalent to those of manual measurements within {+/-}3% MSO, with the majority of comparisons within {+/-}2% MSO. Experiment 2 optimized the procedure, allowing empirical determination of the RMT in an average of <3 minutes with only 33-34 pulses. Comparison with existing methods RMT-Finder provides a reliable and time-efficient alternative to manual approaches. To the best of our knowledge RMT-Finder presents the first closed-loop feedback approach to identify the RMT without manual intervention. This procedure can improve standardization and reproducibility in TMS studies. ConclusionsAutomating RMT assessment allows rapid and highly reproducible assessment of this standard TMS measurement, making it viable for inclusion in routine clinical applications that require standardized procedures.