Automated robotic control system for EEG-BCI-guided closed-loop TMS

Brain-state-guided and closed-loop transcranial magnetic stimulation (TMS) protocols have emerged as methods for decreasing the variability and increasing the therapeutic effectiveness of stimulation protocols. However, most existing brain-state-dependent TMS systems only control the timing of stimulation, while the location is fixed and manually adjusted between blocks or sessions. This limits flexible targeting of distributed networks. We developed a system that jointly manages TMS pulse timing and location automatically controlled by an electroencephalography (EEG)-based brain- computer interface (BCI). A machine-learning algorithm infers the brain state in real time to guide the robotic coil placement and target. We present a proof-of-concept study in which a BCI controlled both the target site and the timing of TMS. A pre-trained convolutional neural network discriminated between resting state and movements performed with the right or left hand; the classifier output determined the hemisphere in which primary-motor-cortex hand area was stimulated and when. Preprocessing and decoding of 2-s EEG segments required 150 ms, and the robot took 7.5 s to move from the vertex home position to the predefined motor targets. The EEG-BCI-guided robotic TMS system expands the toolkit for brain-state-dependent and closed-loop neurostimulation by enabling control of stimulus location based on volitional brain activity. Thus, the system can benefit both neuroscience research and clinical neuromodulation applications. A prominent application of the system is automatically controlling spinal cord injury or motor disorder TMS rehabilitation with motor imagery, optimizing stimulation timing to the brain state producing optimal rehabilitation results.