NCG-ENGAGE HR - technology for Neuro-Cardiac guided rTMS

Many studies suggest a role of the connectivity of the dorsolateral prefrontal cortex (DLPFC) and the subgenual anterior cingulate cortex (sgACC) in depression. Prior research has demonstrated that neuromodulation of either of these nodes modulates parasympathetic activity and results in a heart rate deceleration.

A new method called "Neuro-Cardiac Guided rTMS (NCG-rTMS)" helps to adequately target the frontal-vagal network.  Iseger et al.^1,2 show that the NCG-rTMS reliably locates the point of greatest heart rate deceleration at the DLPFC. Data from other research groups could also replicate this. Due to functional differences, this point is located at different positions in the individual patients. In many people it is located in the FC3/FC4 range. In this case rTMS treatment according to the 5 cm rule is recommended. In some people, however, it is localized around F3 or F4. Then the rTMS according to the BeamF3 method will probably be more effective.

The NCG-rTMS thus offers a way to find the most effective individual access to the frontal-vagal network via feedback of the heart rate.

¹ Iseger TA et al., 2017:
Neuro-Cardiac-Guided TMS (NCG-TMS): Probing DLPFC-sgACC-vagus nerve connectivity using heart rate - First results.
(https://www.brainstimjrnl.com/article/S1935-861X(17)30793-3/abstract)

² Iseger TA et al., 2018:
Optimizing TMS Treatment for Depression Using Cardiac Response With Neuro-Cardiac-Guided-TMS (NCG TMS) (https://www.biologicalpsychiatryjournal.com/article/S0006-3223(18)30254-3/fulltext)

Iseger TA et al., 2020:
A fronto-vagal network theory for Major Depressive Disorder: Implications for optimizing neuromodulation techniques
(https://www.sciencedirect.com/science/article/pii/S1935861X19304139)

Kaur M et al., 2020
Investigating high- and low-frequency neuro-cardiac-guided TMS for probing the frontal vagal pathway
(https://www.sciencedirect.com/science/article/pii/S1935861X20300553)

- NCG-ENGAGE HR for better therapeutic outcome -

NCG-ENGAGE HR: Current Application

NCG-ENGAGE HR is a biofeedback system for the NCG-rTMS. Scientists and physicians use NCG-ENGAGE HR to locate the individual point of maximum heart rate deceleration at the DLPFC.

This is what we are working on:
In the future, NCG-ENGAGE HR will enable physicians to individualize rTMS therapy for depression and other diseases for patients. The method is intended to help determine the optimal dose of rTMS and provide information on the efficiency of the therapy proposed under NCG-rTMS. Further clinical data are currently being collected.

Features

• touch display for presenting data and user interaction
• easy-to-use ECG cable for safe recording during TMS
• connecting cables for receiving the trigger from different TMS devices
• TMS trigger and ECG stored on SD card (EDF+ format)

Technical data

• R wave detection sensitivity 99.9 %
• R wave specificity 99.1 % (own data bases without TMS artefacts)
• 24 bit resolution / SNR > 90 dB / noise RTI < 15 μV_pp
• ECG input for neuroConn‘s ECG cable
• input for medical DC power supply
• trigger input (BNC 5V TTL)
• SD card: speed class ≥ 10 / memory capacity ≥ 16 GB / reading speed ≥ 90 MB/s / writing speed ≥ 45 MB/s

NCG-ENGAGE HR - related systems