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Neuro-MS.NET (ver.2)_003_UM

1. Using this window you can setup the toolbar appearance text icon ratio icon size text width hotkeys if they are required The Commands tab of Toolbar setup window Fig 70 allows customizing the in formation panels In this window you can see all menu commands available in this context i e when Toolbar setup window is opened Any of these commands can be added to any toolbar as a button Toolbar setup Toolbars Commands ENS mee Pen a Command groups Commands Device 4 Exit Abs Help Report Import Report templates Setup R New Ctrl N Treatment S E i View s Open treatment manager Ctri O Hotkey D Patient from folder file D Properties B Save Ctrl S fc Save all Separator To create the toolbar use the mouse Select the desired item in the list of commands and drag it to the toolbar To remove an item pull it out of the corresponding toolbar Command uses a special hotkey for this context Reset settings Reset hotkeys Cancel Fig 70 Toolbar setup window Commands page To add the button to the toolbar select the required element from the list of com mands and drag it with the mouse to any place of any toolbar Besides in this mode you can drag the available buttons between the toolbars remove them from the toolbars by pulling them out of the toolbars boundaries 59 Neuro
2. Footswitch setup Repetitive session mode Footswitch setup lt Back Next gt a OK Cancel Fig 62 Hardware setting page 53 Neuro MS NET version 2 User Manual 54 Power supply Power supply frequency Hz Electric mains frequency in your region in Hz for the notch filter settings In Russia and Europe this value equals to 50 Hz in USA 60 HZ Wireless keyboard Button for Bluetooth keyboard connection via wireless bluetooth interface Press the button once when you connect the wireless keyboard to your computer for the first time If the Bluetooth keyboard is connected through USB port it will function without pressing this button Footswitch unit Press Footswitch setup button to establish relations between footswitch pedals and menu commands Footswitch unit customization is executed separately for single pulse mode and repetitive stimulation mode Report page Fig 63 Setup General Report Software Show New report dialog Hardware Report Show glossary with report Treatment manager __ Copy reports to folder Administration Upgrade GDT Report name template NAME_ ID_ SHORTDATE_ TIME Font Segoe UL 9 75 Report templates lt Back G Next gt r OK r Cancel Fig 63 Report setting page Show New report dialog If the checkbox is checked the dia
3. ccccccecseeeceeeeeeeeseeeeseeeeneeesaeeens 28 2 14 How to Exit the Prograim ccccccccseccseeseeeceeeseeeseeeceeeseeeceeeseeeseeesseeneeenes 31 215 VV OURING WII KACO sarei suid soieneedstar E E 31 2 16 Treatment In COOMS een E 35 2 17 Treatment Report Templates ccccccccccceeeceeeseeeceeeceeeceeeseeeceeeseeeseeenes 38 21A Patient PNO Oiane Datahac Mawwnie data whae Leune denise 43 2 17 2 Treatment Algorithm iasnidontaeniantccasddanrvemenereenddaistensenaiaiddeisteuerarebadene 45 2 17 23 treatment HIStory cererii a a 46 2 17 4 If then Conditional Element cccccsccccseceseeeeeeseeeseeeeeneeeensaees 47 2A Dix Tape Container isai a a Ran les cana tre 49 2 18 Hardware and Sorftware Configuration Settings cccceceseeceeeeeeeeeeeeees 51 2 19 TOODA eree a sxteaa sews cence setenmeeee 58 2 20 AMINES S CUUINGS nea aa a emmanuel 60 Sx Treatment Templates inuina a ai 62 Oi FACCONGING SINGS eia E EE E A 62 32MIN SE Saa E nwa ces tates 63 3 9 Program Templates zostactsanasncusanarectsenasenusensractsenatenunendtactsenatenuuendrecndensteenatnns 64 34 GOUISE Templale S oeit E E E 68 A gt APPENAIX siera aaa aa 70 4 1 Work with Neuro EMG MS Digital System ccececseeeeseeeeeeeeeeeeeeeseeeeess 70 4 2 Stimulation Parameters Ranges ccccccccceececeeeeeceeeeseeeeeseeeeseeeeeseeeesseeeas 72 4 3 FOOLSWILC UNI oieri isinin ee a E 72 4 4 Performing of Double bli
4. 22 Work with Program Monophasic stimulation can be performed only if you use Neuro MS D magnetic stimulator with the expansion unit If referece data for stimulation site and recording site is available you can review it using View Help window F1 or toolbar button You can find the detailed in formation about adding and editing the reference data in 3 1 Recording Sites and 3 2 Stimulation Sites 2 10 Repetitive session Mode Repetitive Session mode page Fig 16 helps to perform repetitive magnetic stimu lation according to predetermined programs see Treatment Algorithm chapter When you first open Repetitive session mode page the first unexecuted stimulation program will be selected automatically english_Test 28 03 2012 Programs Neuro MS NET x T pL iT a Fa i E E Fe Ei Ana er S Stimulation algorithms _ Single pulse mode MT MU Repetitive session mode History x 1oypedsuy Z Pe I Programs Program Stimulation site Pulses pcs Dur MT Executed Depression 1Hz Dorsolateral prefrontal co right y 45 Depression 5Hz Dorsolateral prefrontal cort left 2000 00 19 32 Ap Depression 10Hz 100 Dorsolateral prefrontal cort left 2000 00 19 31 Depression 10Hz 120 Dorsolateral prefrontal cort left 3000 00 36 56 Depression 20Hz Dorsolateral prefrontal cort left 4000 00 21 30 Ampl 4 50 gt
5. E gt of o S Ready ME E s di dt 67 8 A ps Ampl 50 Fig 16 The Repetitive session mode window Programs mode The table of stimulation programs contains program name and stimulation parame ters e Stimulation site the area of body affected by the repetitive magnetic stimulation e Pulses pcs the number of pulses in the program e Dur s the program duration in seconds 23 Neuro MS NET version 2 User Manual 24 e MT MT value used to calculate relative stimulation amplitude for each pro gram To emphathise the currency of running MT value color background highlight ing is used analogous to highlighting described in the Single Pulse Mode MT chapter e Executed flag of stimulation program execution the program set the flag auto matically when the stimulation program finishes but you could set it manually see below In the Course mode Repetitive Session mode page displays all stimulation pro grams available in current session Fig 17 In this mode the stimulation program table contains the information concerning the program belonging to certain session type The term Session type is described in Course Templates chapter The table header provides the opportunity to move to the next or to the previous session english_Test 28 03 2012 Course Test course Session 1 Neuro MS NET x Th e O gil z AE EL yh SOS r M
6. Data transfer Folder for temporary storage The folder for temporary storage of da ta transferred from database to CD The data are stored in the folder till the folder size achieves the maximum possible size to burn it on CD Maximum disk size The size of compact disk used for the treatment storage The size can be selected from the combo box and set arbitrary View Show only compatible treatments If the checkbox is checked the Treatment Manager will display only those treatments that can be reviewed opened with this program 95 Neuro MS NET version 2 User Manual 56 Administration page Fig 65 Setup General Administration Soft enan User database Hardware No Change Report Treatment manager Users Administration Guest Add Upgrade GDT Workstation name Patient and treatment data J Photo First name __ Middle name V Doctor V Assistant V Nurse Additional parameters Default patient sex Do not show v Validate input data lt Back Next gt OK Cancel Fig 65 Administration setting page Users The list of users Add Delete and L amp a buttons are intended to edit the list of users Workstation name The name of network station computer in case of operation with network database Patient and treatment data Customization of patient s card appearan
7. In Patients mode the right part of the dialog shows the list of performed treatments To open the treatment double click the treat ment name To open the patient card double click the patients surname Fig 24 To t return to the list of patients press button Treatment manager Database Data View l v Patients F6 ES k fF TCMS Ed E _ Se Treatments F7 oo gt Name Show Info Panel i Patient folder K TCMS Panels gt lal Kypc Depression 5Hz base course 10 28 2011 8 48 AM lpacun EB Treatment filter Course Depression 5Hz base course 11 27 2012 emulation B T Toolbar customization english_Test r Var a Fan xg Columns Ts Inspector Report Conclusion X etpos A H E 4 i John Smith 34 years 27 11 2012 E3 John Smith Update pit Clinical Info Single pulse mode MT M Stimulation algorithms Repetitive session mode History Conclusion 4 iy Reports Comprehensive v Find Search templates Open New Cancel Extended search c cardbasemdb Fig 23 Switching between view modes 29 Neuro MS NET version 2 User Manual 30 Treatment manager Database Data View John Smith x S amp EA Q E E by amp Name Type Creation d Treatment S Kypc Depression 5Hz base cour Treatment 28 10 2011 Ts Inspector Report Conclusion 7 x Course Depression 5Hz base co Treatmen
8. Stimulation algorithms l Single pulse mode MT MM l Rapatitiva session mode History x 3 pulses 50 Hz vi iop dsu 10 bursts 5 0 5 0 Hz 00 19 32 600 pulses 20 00 03 47 2600 pulses 4 Sessionlof20 gt 00 23 19 Type Program Stimulation site Pulses pcs MT Executed Type 1 Depression 10Hz 100 Dorsolateral prefrontal left 2600 00 23 19 ai 43 ha gt Q Ready amp E a di dt 67 8 A ps Ampl 45 Ampl Fig 17 The Repetitive session mode window Course mode The stimulation program can include several subprograms At the top part of Repeti tive Session mode page you can see the schematic plan of stimulation subpro grams The scheme interpretation can be found in the Basic Notions chapter In case a complex stimulation program is applied you can select the subprogram to start the stimulation first To select the other stimulation subprogram click the correspond ing area on the stimulation program graph with the left mouse button After that the selected subprogram will be framed with blue Work with Program To control repetitive stimulation use three buttons located at the bottom part of Re petitive Session mode page e start stimulation o ij suspend resume stimulation e E stop stimulation Also you can use Pulse button on the coil to control the stimulation You can use Pulse button
9. Hardware Report etc menu items Below the menu you can find toolbar with tool buttons You can press any button using mouse If Neuro MS NET use Touch style see Scale and Touch style chapter then after program running the main menu would be hidden To show or to hide menu click on main application window icon Fig 7 Main application Main menu Toolbar window icon g Neuro MS NET x Treatment Hardware Report View Setup tig RS Ls D a iop edsu Magnetic stimulator is not connected Fig 7 Neuro MS NET main window The program control is operated with the help of a menu Most frequently used menu items are also represented by buttons on the toolbar Toolbars can be placed in the top bottom or on the side of the window Fig 8 To place a toolbar move the panel with the mouse cursor by the drag marker and drag it to a new place To show or hide the panels or set their view button size signature visibility and sequence hotkeys and etc click the right mouse button on the panels and select the menu item Setup from the context menu You can find more infor mation in Toolbar chapter Neuro MS NET version 2 User Manual g Neuro MS NET x f ji o iop dsuj amp Inspector ourse P p New amp Open treat Magnetic stimulator is not connected Fig 8 Toolbar arrangement All the data are saved in the database card f
10. Placebo controlled trial group box The window of placebo trial setup is represented in Fig 81 Use buttons located at the top part of the window to perform the following actions add treatment course template the effectiveness of which is to be studied see chapter 3 4 Course Templates The course template added becomes unchangeable delete treatment course template If you delete the course template you lose data for this placebo trial 2 setup placebo trial report template the same as treatment report template setup see chapter 2 17 Treatment Report Templates 73 Neuro MS NET version 2 User Manual To add placebo trial data to report template use the Placebo element H Course template name Min number of patients korto a Recent ampia e Report repetitive stimulation 9 12 2013 12 08 24 PM Depression 1Hz base course 100 9 12 2613 12 08 56 PM Schizophrenia negative symptoms 9 12 2013 12 09 15 PM Panic disorder Fig 81 Placebo trial setup window Table list of placebo controlled courses contains the following data e Course template name the name of course template the effectifeness of which is studied Time and date of placebo trial beginning are displayed in the top right corner of the window e Min number of patients the minimal number of patients for trial 10 65535 This parameter is used for the random distribution of
11. Those methods vary according to professional opinion and experience of the doctors Medical protocol for magnetic stimulation contains necessary and sufficient information for treatment course admin istration Motor evoked potential MEP the compound muscle action potential recorded from the muscle while stimulating the certain part of central nervous system by single pulse Normally it represents the double humped trace the first phase is negative upward the second one is positive downward MT motor threshold the minimal stimulus value required to evoke the motor evoked potential Stimulation site the definite body area affected by the magnetic field Recording site a part of body for motor threshold acquisition Magnetic stimulator can generate following types of stimuli e Monophasic stimulus stimulus where current in the coil flows in one direction increasing sinusoidally and decreasing exponentially Fig 1 This type of stimula tion is available only on Neuro MS D magnetic stimulator with the expansion unit Coil current Time Fig 1 The monophasic waveform Basic Notions e Biphasic stimulus stimulus where current waveform in the coil is characterized by one period of damping sinusoid Fig 2 This is the standard stimulation type provided on any magnetic stimulator manufactured by Neurosoft Ltd Coil current Time Fig 2 The biphasic waveform e Biphasic burst stimulus only whe
12. it is more convenient to use dropdown lists for scales located in the title of registration window Fig 28 33 Neuro MS NET version 2 User Manual 34 g John Smith 34 years 27 11 2012 Course Depression 5Hz base course Session 1 Neuro MS NET x Ti L pe ea a E M4 Stimulation algorithms a I Single pulse mode MT im Repetitive session mode History 7oms MEP 45 mV Absolute amplitude a 45 hr P Stimulation type Ar Biphasic y 100 pV 150 pV Stimulation site Recording site 200 pV 250 uV 400 pV en X ay 500 pV 1oyDadsuy Z p lt I Right hand motor cor m abductor pollicis b 750 pV AN 41 mV Ve 115 mV_ mV R ES n e a 2 mV ae 2 5 mV 4 mV r a i 5 mV a ne Co TSA Bo o as mv 20 mV ER Dai di r 125 mV A 40 mV 50 mV m Ampl mV 0 957 Lat ms 20 5 Dur ms 17 0 100 5 5 iS ht GR Be GE Ac Lee Les SS ee ee ee a i a V LL lis alk O Ready a 4 EA di dt 67 0 A ps Ampl 45 Fig 28 Scale setting Automatical arrangement of M wave markers occurs after the trace acquisition If M wave is not found on the trace automatically very low amplitude you can start the manual search by means of the mouse cursor press Alt and holding it click the left mouse button on the supposed wave location On the M wave there can be 5 markers of the feature points 1
13. Enter comment If Diagnosis then Diagnosis Diagnosis else Fig 56 Parameters of If then element If the information about diagnosis is entered Diagnosis tag the Diagnosis infor mation about diagnosis text will be added to the report else the report will not con tain this information Let us consider the If Diagnosis then string in more de tail It should be read as if diagnosis Diagnosis is not equal to an empty string i e not empty then To read a tip on generation of such logical expressions press the eS button Fig 56 The elemen can contain not only text but any other elements 2 17 5 Table container The table container allows formatting the information in the report by strings and col umns Using it you can display any information side by side To add the table container to the report template click on the o icon located on the toolbar with the left mouse button or select Insert table container menu command in the local menu Fig 57 After that the table container will appear on the template editor at the text cursor position Fig 58 The element settings will appear at the right part of the window Fig 59 49 Neuro MS NET version 2 User Manual OT Y CFri i L Paste Ctrl V Faal Image from file Hyperlink Insert page break Ctrl Return Insert table container NS Se Edit user tags Fig 57 Se
14. MS NET version 2 User Manual To assign the new hotkeys for the commands use Hotkey button 2 20 Amplifier Settings To customize amplifier settings number of channels filter parameters etc for all al lowed amplifiers use Setup Amplifiers menu command The program will display Amplifier settings by default window Fig 71 Amplifier setup by default Amplifier Neuro MEP Micro Neuro EMG Micro 2M Channels 1 2 Setup All channels Channel 1 Input signal range 50 mv x Low frequency HPF 5 Hz x High frequency LPF 10000 Hz x Notch fites On Notch filter type Adaptive l High harmonic filter Jot o Sampling rate 20000 Hz Impedance measurement Fig 71 Amplifier settings by default Amplifier the amplifier type Channels the amplifier channel which will be used for signal acquisition Input signal range Maximal signal range at the amplifier input which is received by the device without distortions The input range should be 2 3 times higher than the maximum possible expected signal obtained from the patient Too high values of input signal increase noise level and too low values lead to amplifer saturation and signal distortions Low frequency HPF Low cutoff frequency high pass filter High frequency LPF High cutoff frequency low pass filter Notch filter Notch
15. Y Treatment mf Treatment algorithm AML Treatment history Fig 44 Selection of Patient photo element Report template editor z pE g EN Current template Comprehensive Af B APE i m f ve ra x ee j i ES BS Ey E ME g AX B segoeul 10 Y General A Patient photo Y Treatment Patient Name Age M Treatment algorithm ML Treatment history fo y ic 1 ahonms es Date LongDate y If Diagnosis then Diagnosis Diagnc If Doctor then Doctor Doctor Treatment algorithm M Treatment algorithm d g Course Number of sessions MT update period Ga Sessions 1 N 4 my Fig 45 Insertion of Patient photo element Image General Patient photo Alingment Specified size Width mm ma 40 Height mmi a 40 oS From new line Fig 46 Setup of Patient photo element z Treatment r 2 If then v Setup g Image General Patient photo Alingment Width mm 40 gt Height mmda 40 m From new line Work with Program On report generation the patient photo symbol Fig 45 will be replaced by real pa tient photo 2 17 2 Treatment Algorithm To add the information about treatment algorithm to the report template click on Treatment algorithms element located at the left part of the page with the left mouse button Fig 47 and then click on the place of possible element loca
16. a PD rs GRAE ay A Fe s l oe 2 Mm Ee AD A Segoe UI 10 10 B IUl mm oo 4 JL Single pulse mode Tiu iM Repetitive session mode zen History g Comprehensive 7x a Keb tebe Debe Sede se he Se be Sr be Teh e sede Geb ewe beste betre d 43e dete bese betes bears betel gej f a Neurosoft company e Treatment report Patient John Smith 33 years Date Tuesday December 13 2011 Treatment algorithm d Y Course Depression 5Hz base course Number of sessions 20 MT update period 5 4 g Sessions 1 20 type 1 4 Program Depression 5Hz Stimulation site MT Right hand motor cortex C3 Stimulation site treatment Dorsolateral prefrontal cortex DLPFC left gt 1 mt 4 100 50 50 Hz 2095 x 40 Treatment history Session 1 ae T Fix MT 15 33 49 27 11 2012 MT 50 r e Cooled angulated figure of eight coil Right hand motor cortex C3 m abductor pollicis brevis gt ea Repetitive session mode 15 33 55 _27 11 2012 Program Depression 5Hz MT 7r 50 Cooled angulated figure of eight coil Dorsolateral prefrontal cortex DLPFC left Conclusion Doctor oe Fig 31 Build in report Ae 35C 7 di dt 67 8 A ps Ampl 50 Work with Program i John Smith 33 years 12 13 2011 Course Depression 5Hz base course Session 1 Neuro MS NET x a gt 9 AE FS 20 m i re ie Y _ Single pulse mode MT y ill Repetitive s
17. be chosen automatical ly 2 14 How to Exit the Program To exit close treatment use Treatment Close menu command or press toolbar button To exit the program choose one of the following ways e Treatment Exit Alt X menu command toolbar button e click on the _ _ close button in the upper right corner of the program window 2 15 Working with Traces Neuro MS NET provides ample opportunities for you to work with traces recorded from a patient Recorded traces are displayed in acquisition window To the left of each trace in the window there is a button with its number Fig 26 If the trace is selected then the button has the heading in bold type with a dark back ground Most of menu commands affect only the selected trace To select the trace click the left mouse button on the trace or on the adjacent button To select several traces click the left mouse button holding the Ctrl key on the keyboard All traces on the display panel can be selected by Trace Select all menu command To move to the next trace use Trace Next Ctri Down menu command to the previous one Trace Previous Ctrl Up 31 Neuro MS NET version 2 User Manual 32 i John Smith 34 years 27 11 2012 Course Depression 5Hz base course Session 1 Neuro MS NET x Tso BES Re Sik eae a M Stimulation algorithms a I Single pulse mode MT M Repetitive session mode History ia 75ms 7 MEP 15mV 7 Abso
18. command In the window that appears enter the patients data see The Very Beginning New Treatment chapter If you will use standard treatment template scenario choose the appropriate template in Template menu You can find the detailed description of templates in Treatment Templates chapter Press v button lf you didn t choose treatment template at the beginning of the treatment the program would display Stimulation algorithms tab and ask you to form the treatment structure manually You can find the detailed description of stimula tion algorithm creating in Treatment Algorithm chapter On Single pulse mode MTY tab obtain the motor threshold using stimulation button wks and fix amplitude value on the definite body areas button tts You can find more information in Single Pulse Mode MT chapter Switch to the Repetitive Session mode tab Perform the repetitive stimulation session according to the algorithm using Start P Pause J and Stop S buttons To replace the coil use Hardware Coil replacement menu command or corresponding toolbar button You can find more information in the Repetitive session Mode chapter To find more informanion about printing the treatment report read How to Print the Treatment Report chapter To complete close the treatment use Treatment Close menu command or toolbar button Neuro MS NET
19. control buttons located at the bottom of the page you can perform following ac tions F add new recording site e delete the selected recording site e amp move the selected recording site one position higher e LY move the selected recording site one position below Treatment Templates To save settings press v button and to cancel the operation press x but ton Recording sites m abductor pollicis brevis Name m abductor pollicis brevis m abductor digiti minimi Comment Help window content Available properties Y se es lowe lt x Fig 73 Recording sites page 3 2 Stimulation Sites To edit the list of stimulation sites use Stimulation sites command in the Set up Treatment templates menu Stimulation sites page Fig 74 has two parts At the left part of the page the list of stimulation sites is represented and at the right part of the page you can edit corre sponding settings You can name each stimulation site add a comment and set a content of help win dow If the stimulation site will be used to detect motor threshold you can set a list of corresponding recording sites Recording sites for this list will be set on the bases of preformed recording site list see Recording Sites chapter and will be ordered ac cording to usage priority To change the content of help window click on the A button Using control buttons
20. from the list can be linked with Report New ER report 1 and Report New report 2 menu commands For this purpose use Set up Change menu command Software page Default treatment report The number of reports is unlimited Treatment report is generated according to the special report template in which the certain information and its view in the report are indicated The number of generated report templates is unlimited By default reports are saved together with the treatments in the database To copy reports simultaneously to any catalogue folder on the computer disc check the Copy reports to folder checkbox see Hardware and Sorftware Configuration Set tings chapter Report tab and select folder name Therefore when the report is be ing saved to the database it will be copied to the indicated catalogue at the same time 37 Neuro MS NET version 2 User Manual 38 To print the report use Report Print menu command Also the report can be exported to the external file Report Export menu command or sent by e mail Report Send menu command Working with a new treatment it is convenient to enter some information to Clinical in fo and Conclusion windows Further their contents can be copied to the exam report manually Report Insert conclusion or using the report template 2 17 Treatment Report Templates The treatment report templates are powerful mechanism to speed up t
21. instead of Enter working with dialog boxes After stimulation start the program launches autotesting to define the ability to perform the stimulation pro gram After that the program will display messages concerning the restrictions inhibit ing the stimulation performance if it is nesessary For example if the expansion unit is missing and the stimulation program contains monophasic stimiulation the message concerning the inability to perform the program will appear Or in case you face the situation when the program parameters do not correspond to the device hardware you will be offered to change the stimulation parameters according to the device capabili ties Fig 18 Warning x Stimulation program can t be executed There are some limitations in stimulator A Recommended parameters Subprogram 1 Pause between trains s 5 gt 10 OK Fig 18 The restriction message example The stimulation parameters are not changes automatically because of high safety requirements to rTMS In case the stimulation program autotesting was successful the message box remind ing of new coil position would appear The stimulation starts after the requirement confirmation You can monitor the stimulation process in the popup element The element is active during the stimulation and contains the information about the stimulation pro gram Fig 19 25 Neuro MS NET version 2 User Manual 26 Stimulation process stat
22. located at the bottom of the page you can perform following ac tions E add new stimulation site 63 Neuro MS NET version 2 User Manual e delete the selected stimulation site e move the selected stimulation site one position higher x move the selected stimulation site one position below Stimulation sites Dorsolateral prefrontal cortex DLPFC Haie dete Hated Wickit Cone CA Left temporal parietal cortex TP3 Comment Supplementary motor area SMA Left hand motor cortex C4 ReCeaNIG Sis NETS Right hand motor cortex C2 m abductor pollicis brevis m abductor digiti minimi Available properties Y tls Uw Help window content Le ha bow aata malian Fig 74 The list of stimulation sites The analogous buttons located in the setup area are used for recording site list form ing The iin button allows setting the range of M wave search for the current stimula tion site and selected recording site Keep in mind that by default the M wave search is performed by the whole trace To activate the possibility to set M wave search range mark the Possibility to set M wave search range checkbox see chapter 2 18 Hardware and Sorftware Configuration Settings Software tab Single pulse mode group box To save settings press v button and to cancel the operation press a but ton 3 3 Program Templa
23. this window single pulse mode parameters and table with possible ways to record motor threshold MT are displayed Also in the table you can find the information about current MT value and stimulation type for its detection To emphasise the currency of running MT color background highlighting is used e Red MT is not detected and it is required to detect it or there are critical differ ences between used equipment configurations for example last time motor threshold was detected using other type of coil e Yellow only for Course mode MT is not detected and it is not required to de tect it during the session e Green MT is detected To find the cause of MT value invalidity click on the MT field with left mouse but ton 19 Neuro MS NET version 2 User Manual 20 In the Course mode MT value currency is specified by the MT update period pa rameter This parameter is set in course properties see Treatment Algorithm chap ter For example if this parameter is 5 and MT was detected during the first proce dure then the program would remind you to update MT value only during the sixth procedure background highlighting would change colour from green to red MT detection can be performed objectively using digital EMG and EP system or sub jectively on the basis of contraction of muscles during the stimulation If digital EMG and EP system is used for MT detection then run the el
24. version 2 User Manual 2 12 To close the program use menu command Treatment Exit Alt X or toolbar button You can find more information about functions and capabilities of Neuro MS NET in following chapters of the manual Work with Program 2 1 General Requirements Neuro MS NET software is intended to control magnetic stimulator of Neuro MS D series manufactured by Neurosoft Ltd using the computer Neuro MS NET can control both magnetic stimulator of Neuro MS D series and digi tal EMG and EP systems manufactured by Neurosoft Ltd You can find information on how to work with digital EMG and EP systems manufac tured by Neurosoft Ltd in corresponding technical manuals In this chapter you can find detailed instructions which will help you to work with pro gram Most of high frequency actions in the program can be carried out in several ways For instance to start single pulse stimulation in the Single pulse mode MT page you can use e Stimulation Stimulus menu command you can choose the command using mouse clicking the left button or keyboard Alt to open the menu arrow keys to navigate through the menu and Enter to select the item e Stimulus button at the bottom of the screen place the mouse cursor on the button and click the mouse left button If you use touchscreen use your finger instead of mouse e Stimulus button on the coil e left pedal of the footswitch unit if yo
25. wave onset marker 2 negative peak marker 3 negative peak end marker 4 positive peak marker 5 M wave ending marker Conduction block state on the trace can be changed either by Trace M wave re sponse on off toggle menu command or ES button located at the bottom of the screen This command is applied to the selected traces and can be applied to several traces simultaneously To correct marker position on the trace move the mouse cursor to the marker the cursor changes its view to and then press the left mouse button drag Work with Program the marker to a new place and release the mouse button After shifting the markers automatic renewal of analysis windows takes place see below To setup the appearance of acquisition window trace management at signal acquisi tion marker names and visibility use Setup Edit menu item Software tab Trace review group box The trace review panel is represented in Fig 29 Sample 75ms 7 MEP ys f i FE 100 3 3 Name wm e WN e v Marker names Reset all Visibility iy v FA iv J Fig 29 Trace review panel setup Trace review panel setup Properties AER r Search Remove stimulus artefact tre M wave automatic search 4 Markers Without button IE Ja Rounded button F Line color E Red Button color E Aqua 4 Trace review panel Inactive background AliceBlue Grid E Stee
26. way Fig 41 Report template editor cS EE g g at Current template Comprehensive z Ar nat lt lt a lt lt gt BBR sepeu 710 B Z UIA 4 EE EEg eal Hospital _ Treatment report Patient Name Age Temperament Temperament Fig 41 User tag usage While generating the treatment report the dialog box shown in Fig 42 will appear on the screen Here you should select the patient temperament User tag values input x Temperament String Temperament Choleric Phlegmatic Melancholic Fig 42 Input of user tag values The report is shown in Fig 43 Mi bets Peep ede fete Ps Fr Ba ee le Be fe Ge Pcie Potts aZe tds dg P15 Petes are twee A Neurosoft company Treatment report Patient John Smith 33 years Temperament Choleric Fig 43 Built in report with data about patient temperament Let us rewiev several main elements blocks that can be used to create the report template 2 1 7 1 Patient Photo To add patient photo to report template select the Patient photo element at the left part of the screen using left mouse button Fig 44 Then position patient photo at the editor template with the left mouse button Fig 45 The settings of Patient photo el ement will appear at the right part of the window Fig 46 Using this window you can adjust the element appearance 43 44 Neuro MS NET version 2 User Manual 2 Patient photo If then
27. with tree structure describing treatment algorithm on the base of actual data 2 17 3 Treatment History To add the information about treatment history to report template select the Treat ment history element in the left part of the screen using left mouse button Fig 50 and then click on the place of possible element location at the editor template with the left mouse button Fig 51 The settings of Treatment algorithm element will appear at the right part of the window Fig 52 Using this window you can adjust the element appearance e General general settings e M wave analysis settings for M wave analysis traces and or tables presentation To add the information about treatment history to the report template click on Treat ment history element located at the left part of the page with the left mouse button Fig 50 and then click on the place of possible element location at the editor template with the left mouse button Fig 51 The Treatment history element settings will ap pear at the right part of the window Fig 52 Elements hx General Treatment M Treatment algorithm g Treatment history Ne ae Fig 50 Selection of Treatment history element Work with Program Report template editor al ER i g y Current template Comprehensive 4 p MEERE peman a o E E ME g AS e segoe ut z sr ERE Mea ia A iz Treatment history Show p
28. 005 x ag Stimulation type A Biphasic v 2 m 100 850 x 20140 1005 x a9 Absolute amplitude a 50 m JUL Depression 10Hz 100 Relative amplitude 4 100 gt IUL Depression 10Hz 120 Pulses frequency in train Hz 4 5 0 Uy dhk Depression 20m2 Pulses in train 4 50 a A Hallucinations Number of trains 4 40 gt NUL Schizophrenia auditory hallucinations T g Pause between trains s 4 20 0 gt a i Experimental EEF ne Waiting time s 4 0 5 Uy NUL Obsessive compulsive disorder NUL Schizophrenia negative symptoms NUL Panic disorder NUL Post traumatic stress disorder uks amma uci WE LA utd es hl Lv x Fig 76 Program templates Subprogram element The ranges of the admissible stimulation parameters you can find in the chapter 4 2 Stimulation Parameters However the variation ranges of some parameters depend on current values of related parameters For example the variation range of Pulses in burst parameter is from 2 up to 10 but its maximal value depends on Pulses fre quency in burst and Bursts frequency in train parameters For more convenience Neuro MS NET software displays messages with information about restrictions of pa rameter variation ranges Fig 77 It occurs when some parameters reach its bounda ry values when editing 66 Treatment Templates Pulses in burst Range 2 10 min 7 max
29. 1 0 Hz 100s 40 f N j Name Dorsolateral prefrontal cortex DLPFC v NUL Depression 10Hz 100 Side Left WUL Depression 10Hz 120 INL Depression 20Hz a M Hallucinations NUL Schizophrenia auditory hallucinations a M Experimental NUL Obsessive compulsive disorder NUL Schizophrenia negative symptoms NUL Panic disorder NUL Posttraumatic stress disorder i k k hE ha eed E basas kataa Fig 75 Program templates Program element Subprogram element M contains basic parameters for repetitive stimulation right part of the page on Fig 76 Editable properties e Stimulation type biphasic monophasic or burst e Absolute amplitude stimulation amplitude in case if motor threshold MT is not detected 65 Neuro MS NET version 2 User Manual e Relative amplitude stimulation amplitude depending on motor threshold MT value e Pulses bursts frequency in train Hz e Pulses frequency in burst Hz e Pulses bursts in train e Pulses in burst e Number of trains e Pause between trains s e Waiting time s time to the next subprogram Program template setup 4 iM Depressions 1 0 55 Lin gt b nM Depression 1Hz 100 dias SS T a Jill Depression 5Hz S 2 aT a 1 m Ap 100 50 04 7095 x 40 50 pulses 5 0 Hz 2 a 40 19 4 lL Complex program test 2000 pulses 00 19 32 E 1 fie 100 507742 2
30. User manual Neuro MS NET ver 2 Software UM058 02 003 000 02 09 2013 Neurosoft Ltd 2014 5 Voronin str Ivanovo 153032 Russia P O Box 10 Ivanovo 153000 Russia Phone 7 4932 24 04 34 Fax 7 4932 24 04 35 E mail com neurosoft ru Internet www neurosoft ru Contents PAULO III OR Masctecenecec eters aettiee t oe E A a 4 PTR OGIUICIIO MN wecanosciresetabesdiecansostancds wera vensnaussencweneuongessevans weuaenossauasenscuaveuguansuencnauauoueneieues 5 BASIC NOUONS cette ce terete teeta tare eat tare a a te ie dette teas 6 Tte QUICK Staca a E A A EA 9 25 Work with Programai ia aaa aa aaa aiaa 10 2 1 General ReguremMENIS emac 10 22 ocaeca TOUCM SIVE ic anssccncasiscachencencascmamscassbalsganskamnesdeneeanansintisweess Selsegenehacees 11 2 3 Software Setup Computer Requirements ccceeeeeseeeeseeeeeeeeeeseeeesseeeens 11 2A Neo MS NE TRUN pecias a E 12 2 5 General PrNCIDIES einna a 12 2 6 The Very Beginning New Treatment ccccseccseeseeeseeeseesseeeseeeseeesaeees 15 2e US Ba Ae eee een eee ne ae ete ee ee ee ee 16 2 0 Treatment AG ONIM ises a aR 17 2 9 Single Pulse Mode MT srekiitonir innra aside tadiedanodeee slate rietwcodeadsdedatie 18 2 10 Rep titive SESSION MOOG screena a E E E ES 23 ZT Weed ON a a a een dannnea 27 2 12 How to Print the Treatment ReEport ccccccceeeceeeceeeeeeeeeeeseeeseeseeeneeenes 27 2 13 How to Rewiew Previous Treatments
31. adsuy Z Fig 5 The show hide menu icon 2 3 Software Setup Computer Requirements lf you purchase the Neuro MS system together with the computer it is delivered with installed and configured software If you purchase the Neuro MS system separately please study carefully the following paragraphs Neuro MS NET software can run properly on any computer with the Intel Celeron 2 4 GHz processor Intel Pentium Core 2 Duo is recommended and higher with not less than 2 Gb memory and Windows XP SP3 and above Windows Vista SP1 and above Windows 7 operating systems For software setup there should be 1 Gb of free hard disk space and 1 Gb of free hard disk space for the patient database Neuro MS NET interfsace provide an opportunity to use touch input i e by touching the monitor screen with the finger To facilitate text entry using virtual keyboard it is recommended to work on computer with Windows 7 operating system All the data of treatments performed with the use of the program are saved on the hard disk in a database common for all Neurosoft Company systems Neuro MS NET version 2 User Manual The software is delivered on a compact disk CD The installation process is execut ed in the following order Log in the system as administrator Insert the compact disk to the disk drive and wait the installation program to start Fig 6 If the autorun hasn t started and the window hasn t appeared Fig 6 find AUTORUN EXE
32. ails were entered with a mistake you can correct them using the Treatment Properties menu item 2 Status Bar At the bottom part of the Neuro MS NET main window you can see status bar which shows the current state of the magnetic stimulator Fig 10 Work with Program r pr id ie s m T G AS Ready 2 23 C di dt 68 1 A ps Ampl 45 5 Device version 2 N r s Ring 150 Main unit firmware version 24 3 Serial number 51 Main unit serial number 89 Manufacturing date 4 25 2011 DLL version 3 1 0 0 Elapsed pulses 183138 Fig 10 The status bar of the magnetic stimulator lf magnetic stimulator is switched on status bar displays the following information 1 Information the dropdown element which contains detailed information about connected magnetic stimulator main unit firmware version main unit serial number etc To open the dropdown list click on the element 2 Ready the readiness indicator of magnetic stimulator The indicator highlights green if the stimulator is ready to produce the pulse of the specified amplitude 3 High voltage the high voltage indicator The indicator highlights yellow when the stimulator is switched on and high voltage is supplied inside the stimulator 4 Coil type the dropdown element which contains information about the type of used coil manufacturing date serial number elapsed pulses To open the dropdown list click on the element 5 Coil temperature the elem
33. ave settings press y j button and to cancel the operation press x but ton 69 Neuro MS NET version 2 User Manual 4 70 Appendix 4 1 Work with Neuro EMG MS Digital System Neuro EMG MS is a 2 channel digital system developed for the operation with the magnetic stimulators of Neuro MS D series and is intended for the acquisition of motor evoked potentials see Single Pulse Mode MT chapter Before run the program you should check whether the devices the magnetic stimula tors of Neuro MS D series and Neuro EMG MS digital system are connected to the same USB hub To provide the proper acquisition of motor evoked potential using Neuro EMG MS digital system check whether the electrodes are connected correctly the belly tendon scheme is most often used Electrodes should be connected to Neuro EMG MS digital system according to colors Electrode color and socket color should match Before the surface electrodes placement degrease the skin in places of electrodes setting with the alcohol The active electrode black is placed on muscle motor point the reference one red is set on the tendon of this muscle or the bony prominence lo cated distal the active electrode The ground green electrode is placed higher the active and the reference ones Example 1 Ulnar nerve The recording electrode is on abductor digiti minimi muscle Fig 79 he A Grd S it W R F
34. ce requested at the beginning of each new treatment It is necessary to check the checkboxes op posite those fields which should be included in the dialog box Additional parameters Customization of additional user parameters introduced in patient card Default patient sex This element allows to specify the patient sex by default at the beginning of each treatment Validate input data If the checkbox is checked the check of availability of entered patient name sex age and weight is carried out at the beginning of each new treat ment before the patient card closing Work with Program Upgrade page Fig 66 Setup General Upgrade Software Turn on autoupgrade Hardware Folder with distributive Report Treatment manager Administration Software upgrade settings Upgrade ee User s CnNoIce GDT Full upgrade settings Upgrade similar sections and adding new Leave similar sections and adding new Leave existir ting lt Back OK Cancel Fig 66 Upgrade setting page Turn on autoupgrade If the checkbox is checked the program is updated automati cally The program checks the presense of new program version in the specified fold er on each program start and if it is available updates automatically Software upgrade settings Choose the variant of software upgrade using radio but tons located in this group box 57 Neuro MS NET version 2 User Man
35. d simultaneously Software page Fig 61 Setup General Software Soft sean Single pulse mode Hardware FEER E Initial stimulus amplitude 9 ES gt nitial stimulus amplitude i 30 Treatment manager Next stimulus blocking duration s 4 0 r Administration Upgrade Saving traces at MT fixation GDT Traces with M wave 4 Automatically move to repetitive stimulation mode after fixation of all MT Possibility to set M wave search range Trace review Trace review panel setup Setup Placebo controlled trial Placebo controlled trial setup Setup Default treatment report First Comprehensive v l Second Autosave on new treatment v Open clinical info in new treatment lt Back Next gt OK Cancel Fig 61 Software setting page Single pulse mode group box Initial stimulus amplitude field allows to change the initial stimulation amplitude to be applied at the creation of new treatment Next stimulus delay s field allows to change the delay of the next stimulus delivery Saving of traces at MT fixation option allows choosing the criterion of trace saving to stimulation history at MT fixation 52 Work with Program lf the Automatically move to repetitive stimulation mode after fixation of all MT check box is marked the software after fixation of last MT will go to repetitive stimulation mode au
36. direct dependence on pulses frequency in burst and inverse dependence on bursts frequency in train Fig 77 The window with information about restrictions For the sake of simplicity all editable subprogram parameters are represented graph ically see Basic Notions chapter Subprogram name is formed on the basis of its parameters It helps to make record short and informative N 100 50 2 2095 x 40 Stimulation type A Biphasic Monophasic Relative amplitude 100 Pulses in train 50 Pulses frequency in train Hz 5 0 Pause between trains s 20 0 Number of trains 40 N 100 8 50 0 Hz me 20 1 0Hz 10 0s 40 Stimulation type N Burst designation T Relative amplitude 100 Pulses in burst 8 Pulses frequency in burst Hz 50 Bursts in train 20 Bursts frequency in train Hz 1 0 Pause between trains s 10 0 Number of trains 40 Using control buttons located at the bottom of the page you can perform following ac tions e add new group of programs new program or new subprogram delete the selected element ES copy the selected element LS insert copied element move the selected element one position higher y move the selected element one position below EA expand all elements E collapse all elements 67 Neuro MS NET version 2 User Manual To save settings press y button and to cancel the opera
37. ectrode imped ance measuring process before the stimulation To run this process use menu com mand Hardware Impedance measurement Ctrl Z or toolbar button Place the electrodes you should start with the ground electrode simultaneously observing the impedances on the screen Fig 13 Chan 1 Minus D 10 10 Plus S 10 00 Common 29 60 Close Fig 13 The impedance measurement Stimulated area and placement of electrodes should correspond with choosen way of MT recording stimulation site recording site If there is too high impedance in some recording site red or orange highlighting it is necessary to position the electrode more carefully Try to obtain the acceptable level of impedance To finish the electrode impedance measuring process press button or Esc If you are experienced enough you can perform treatment without impedance measuring of the placed electrodes lt is recommended to perform signal monitoring using Hardware Monitoring menu item and make sure that there are no noise and artefacts on the record In Absolute amplitude field set the minimum starting value which would be enough to evoke the motor evoked potential Move the coil to the stimulation site Perform the single pulse stimulation using Stimulus button at the bottom of the page or the same button on the coil If you use digital EMG and EP system the program obtains patient responses after each pulse in t
38. emplates The program offers two operation modes Course and Programs Course mode the main treatment mode formed on the basis of medical protocol This mode implies several procedures Programs mode is the special treatment mode It allows per forming stimulation on one or more programs and implies only one procedure To systematize the doctor s work to facilitate treatment template creation and treat ment performing Neuro MS NET contains course templates and program templates To unify recording site names and stimulation site names the program contains cor responding lists To edit mentioned lists and templates choose the corresponding command in Setup Treatment templates menu Formed lists of recording sites stimulation sites program and course templates can be exported selectively to external file using Setup Treatment templates Export menu command To import settings use Setup Treatment templates Import menu command 3 1 Recording Sites To edit the list of recording sites use Recording sites command in the menu Set up Treatment templates Recording sites page Fig 67 has two parts At the left part of the page the list of recording sites is represented and at the right part of the page you can edit corre sponding settings You can name each recording site add a comment and set the content of help win dow To change the content of help window click on the 4 button Using
39. ent which shows the coil temperature To the right of temperature value a 5 segment three colored temperature scale The segments of this scale highlight one by one after achieving the following temperature first green segment at less than 30 C temperature second green segment at coil tem perature from 30 up to 34 C first yellow segment at coil temperature from 34 up to 38 C second yellow segment at coil temperature from 38 up to 41 C red segment if the coil temperature exceeds 41 C 6 di dt the element which characterize the strength of magnetic field induced by the magnetic stimulator 7 Absolute amplitude the element which shows the stimulus amplitude in per cents from the maximal power of the magnetic stimulator 2 8 Treatment Algorithm Perform steps described in the The Very Beginning New Treatment chapter Use Stimulation algorithms tab Fig 11 to view and to edit the existing algorithm Neuro MS NET version 2 User Manual i John Smith 34 years 27 11 2012 Course Depression 5Hz base course Session 1 Neuro MS NET x on LP a mae lon Te gm p le g Fe E ex LY La M Stimulation algorithms L Single pulse mode MT Mil Repetitive session mode History 7x 4 g Depression 5Hz base course 7 a Sessions 1 20 type 1 100 20 0 s 4 lll Depression 5Hz iop dsu Available properties Y 1
40. eral prefrontal cortex DLPFC left 2 5 v Wl Depression 5Hz Session 1 type 1 3 57 57 PM Duration 2000 pulses 00 19 32 J on 2 Subprograms a ML D ion 5Hz Session 2 t 1 3 59 56 PM on He 20 E AE e Sinus 1 m A 100 50 242 2295 x 40 2000 pulses 00 19 32 2 JM Depression 5Hz Session 3 type 1 4 00 06 PM ill Depression 5Hz Session 4 type 1 4 00 15 PM SUM Depression 5Hz Session 5 type 1 4 00 24 PM ibn Fix MT Traces 3 4 00 48 PM WL Depression 5Hz Session 6 type 1 4 00 53 PM Magnetic stimulator is not connected Fig 21 The History page 2 12 How to Print the Treatment Report The main way to receive printed treatment results is to generate the report and to print it 2 Neuro MS NET version 2 User Manual i BI To create new report use Report New report 1 menu command Ctrl R or toolbar button To print the report use Report Print Ctrl P menu command You can view the report before printing and make corrections all the information can be corrected To create reports of different tyoes use Report Template editor menu command 2 13 How to Rewiew Previous Treatments To review analyse or continue the created treatment use Treatment Open treat ments manager menu command press Ctrl O or toolbar button The pro gram will open Treatments manager dialog Fig 22 In case you use Neurosoft database to store results the list of treatments in Treat ment
41. erties e Number of sessions set the maximum number of sessions in the course If this number is exceeded the course will be considered executed e MT update period is used to emphasise the currency of running MT value 68 Treatment Templates Session type element a describes treatment sessions which contain the same set of stimulation programs The most important editable properties are e Session repetition is used to set diapasons and or numbers of sessions which contain the same set of stimulation programs If the repeatability is not set this ses sion type will be used during the whole course e Ignore is used to exclude temporarily the selected session type from course You can see the example of complex treatment course Complex course on Fig 78 It im plies 20 procedures and contains two session types Program 1 of the first session type will be performed each time and Program 2 of the second session type only from 6 to 14 pro cedure So from 6 to 14 procedures the treatment will be performed on two programs Prodram and Subprogram element descriptions are analogous to given in Program Templates chapter aii button at the bottom of the screen is used to add new group of courses new course new session type new program or subprogram Functionality of other buttons is analogous to one described in Program Templates chapter To s
42. ession mode History we Comprehensive gt xX 2 id 9 ols 2 nasHaa Bcraska PazmeTka CTp aHn ybi CCHNKN PaccbhlAaku PelleHsMpoBaHne Bug a cm a y 7 a eir silos Ga Ha tn e Segoe UI 10 AA Aa as s azy 2 Al 7 PA AabOBerr AabOBerr AabGB hienat Pa 3 X KX UW abe x x A aby A v isr SD Te pEi T O6pr4Hei 1 bes wHte 3aronose ee D Samen 63au P a akmpoB H RL R A E R A RAA AAR ARS ir gt je Neurosoft company Treatment report Patient John Smith 33 years Date Tuesday December 13 2011 Treatment algorithm lt y Course Depression 5Hz base course Number of sessions 20 MT update period 5 4 we Sessions 1 20 type 1 pa o 4 Software Depression 5Hz Stimulation site MT Right hand motor cortex C3 Stimulation site treatment Dorsolateral prefrontal cortex DLPFC left Init N 1 50 500a 2005 x 49 wo C Treatment history 7 Magnetic stimulator is not connected Fig 32 Microsoft Word report Microsoft Word report allows obtaining access to all facilities of Word editor developed by Microsoft Company Fig 32 However to work with this editor Microsoft Word must be installed on your computer To create a new treatment report use Report Templates menu command In the menu select the template according which the report will be generated To speed up E3 the work any of two report templates
43. file on the CD and run it gn NeuroSoft company installation CD s l Medical Neuro MS NET equipment Magnetic stimulation ce amp Microsoft Directx and clinical hihaan A Acrobat Reader PDF file viewer __ Documentation Fig 6 The window of program installation run Point the mouse cursor at Neuro MS NET line and click the mouse left button Follow the installation instructions If you have no Internet connection ignore program at tempts to download updating files The program procedes installation after several failed attempts To set up the program and hardware run the program see the next chapter and choose Setup Change menu command You can find more information in the Hardware and Sorftware Configuration Settings chapter 2 4 Neuro MS NET Run To run Neuro MS NET program click Start button and choose All pro grams Neurosoft Neuro MS NET Neuro MS NET menu command or click twice on Neuros HE program icon On the desktop 2 5 General Principles Neuro MS NET works under Windows operating system and comply with Windows software requirements If you have worked with Windows programs for example Mi Work with Program crosoft Word you would grip with Neuro MS NET If you have not work with Windows operating system you should learn basic Windows concepts When you run the program the main window will be displayed Fig 7 At the top of the screen you can find Treatment
44. filter state 50 or 60 Hz 60 Work with Program Notch filter type Recursive notch filter has high suppression ratio but it can lead to the distortion of high amplitude responses so it is recommended to be used in the acquisition without stimulation Adaptive notch filter has low suppression ratio it does not lead to the responses distortion and can be used in the acquisition with stimula tion High harmonic filter Adaptive high harmonic filter is useful when the interference level is considerable at high frequencies Sampling rate A D converter sampling frequency Impedance measurement Green yellow red thresholds are set to control the quality of electrodes placement using impedance color imaging To customize amplifier settings during the treatment use Hardware Amplifier setup P ie Ten menu command or toolbar button Customize amplifier settings in the window that appears Fig 72 Amplifier setup Channels 1 2 D3 D4 Setup All channels Channel 1 Input signal range 60 my Y Low frequency HPF 5 Hz bd High frequency LPF 10000 Hz Y Notch filter On v Notch filter type Adaptive X High harmonic filter Off X l Sampling rate 20000 Hz v Impedance measurement Green yellow threshold kQ 4 245 gt Yellow red threshold kO 40 o Fig 72 Amplifier setup 61 Neuro MS NET version 2 User Manual 3 62 Treatment T
45. g of the corresponding trace takes place ie John Smith 34 years 27 11 2012 Course Depression 5Hz base course Session 1 Neuro MS NET x fa ee Ais Tsim ee Sree yeah eS a M Stimulation algorithms Single pulse mode MT Ml Repetitive session mode History 7x 73ms 7 MEP 1 5mV 7 Absolute amplitude 4 45 z Stimulation type Ar Biphasic v Stimulation site Right hand motor cortex C3 b j oe b a Recording site m abductor pollicis brevis v A N Lat ms Ampl mV Dur ms 1 20 5 1 66 17 0 D a F j g i j 2 20 5 1 31 17 0 so g s Kik s e y 4 20 5 1 23 17 0 4 20 5 1 56 17 0 5 20 5 0 957 17 0 Ampl mV 1 23 Lat ms 20 5 Dur ms 17 0 100 5 5 Ah ddal eb Res Es Ac teed ag A E3 Q Ready O 4 358 C di dt 67 8 A ps Ampl 45 Fig 15 The Single pulse mode MT page M wave analysis After receiving the qualitative M wave start MT acquisition diminishing the amplitude value Find the minimal stimulus intensity required to receive the qualitative M wave during several pulses It is the motor threshold MT Finish the stimulation To save the obtained result press Fix MT button to reset results press Jk Reset MT button Remember that if you fix MT all obtained traces are saved in the data base Obtain and fix MT for other sites analogously
46. ge tag To look though the list of all available tags press Ctrl Space key combination or button on the toolbar Fig 35 while editing the template Please pay attention to the fact that the text replacing the tag will be of the same style size typeface bold letters etc as the tag itself Report template editor s E Current template Comprehensive AF i ba aa An Segoe UI 10 v I U A pA b Hospital S a we lil HI 4E Treatment report Patient Name Age Fig 34 Tag usage 39 Neuro MS NET version 2 User Manual 40 ACL U ID String Patient ID Name String Patient name LastName String Name FirstName String Name MiddleName String Middle name Policy String Social security number BDate String Birth date Age String Patient age N Sex String Patient sex Weight Number Patient weight kg Height Number Patient height cm BMI String Body mass index Department String Department Hospital String Hospital Address String Home address Phone String Phones EMail String E mail Station String Workstation RegDate String Date of patient folder creation CardName String Folder file name CardComment String Patient card comment LongDate String Treatment date long format Time String Time of treatment beginning EditDate String Last changes date Comment String Treatmen
47. gnetic stimulator before you have read the us er manual Introduction Introduction Neurosoft Ltd modifies constantly the manufactured devices and software for them Thus the software can differ from this one described in this manual The last version of the user manual is provided on the compact disk supplied with the device The user manual is delivered together with Neuro MS NET software and the magnetic stimulator of Neuro MS D series manufactured by Neurosoft Ltd To obtain the motor threshold it is required to purchase the digital EMG and EP sys tem manufactured by Neurosoft Ltd We hope that our devices will increase the diagnostic opportunities and prestige of your clinics and you will enjoy while operating on them You can send your responses and recommendations to the following address Post Office Box 10 Ivanovo 153000 Russia or by e mail help neurosoft ru You can find additional information on Neurosoft products on our website www neurosoft ru or ask questions by phone 7 4932 24 04 37 Service Department 7 4932 24 04 34 Commercial Department Neuro MS NET version 2 User Manual Basic Notions Medical protocol the documented plan of desease detection diagnose and treat ment Protocols are created on the basis of medical practice collective experience and outcomes evaluation Medical protocols are used by medical personnel as guides in order to avoid inefficient methods of treatment
48. he form of traces left part of the page on Fig 12 The program anal yses traces and marks M waves if it is possible Work with Program By default the M wave search is performed for the whole trace If you want to change the range of M wave search use Setup Edit menu item Software tab Single pulse mode group box If the Possibility to set M wave search range checkbox is marked the Ea button appears in Single pulse mode window Use this button to set the M wave search range by time duration and amplitude Fig 14 M wave search range Stimulation site Right hand motor cortex C3 Recording site m abductor pollicis brevis M wave search interval ms Beginning lt 4 gt End 4 200 M wave duration ms Min q y p Max 4 e M wave amplitude peak to peak pV Min 4 90 j Max 4 50000 gt Reset yv x Fig 14 The window of M wave search range setting In case an error message appears during the acquisition check the device connection to the computer and then execute the Hardware Device reset menu command Perform several pulses moving the coil over the stimulated area to obtain the ac ceptable result If the required M wave was not obtained try to increase the absolute amplitude value All acquired traces refer to examination conditions and depend on the stimulation am plitude the stimulation type and the way to record MT stimulation site recording s
49. he middle of the fifth metacarpal bone A point on Fig 80 71 Neuro MS NET version 2 User Manual 4 2 Stimulation Parameters Ranges Repetitive stimulation in Neuro MS NET is based on execution of separate stimulation subprograms Each subprogram is represented as a set of perameters Those parameters define the stimulation process The ranges of the admissible parameters during the different waveforms are repre sented in Table 2 Table 2 The ranges of the admissible parameters at different waveforms er Burst stimulation Absolute amplitude 1 100 Frequency in train Hz 0 1 30 0 1 25 Frequency in burst Hz 1 100 Pulses in train 1 65535 1 500 Pulses in burst 2 10 Pause between trains s 0 300 Trains count 1 65535 Notes if you use the expansion unit 4 3 Footswitch Unit The delivery set does not include the footswitch unit The footswitch unit is connected to the computer by means of USB Interface Pressing on the switch corresponds to execution of the menu command In dialog mode pressing on the switch corresponds to pressing the keybord button Table 3 Table 3 Default footswitch commands Pedal Menu command Buttons in dialogs Single pulse mode page Left Stimulation Stimulus Enter Middle Stimulation Intensity Increase Tab Right Stimulation Intensity Decrease Esc Repetitive session mode page Left Stimulati
50. he report crea tion The sequence composition and type of information included in the report are de fined in the template Several templates are provided with the program by default but you can change these templates and create the new ones taking into account the concrete requirements This mechanism provides the flexible system of the report generation To edit the report templates use Report Template editor menu command The report template editor is shown in the Fig 33 Report template editor cS LEI wit Current template Comprehensive X Ar Elements a ge 4 B segoe ut lt w p Setup g V Caner y Template patent phot z Comprehensive atient photo KY Treatment re TSO p gt If then Create Y Treatment Patient Name Age ong 7 TE z ass MM Treatment algorithm Date LongDate V If Diagnosis then Diagnosis Diagno ru A TEAMENE MAOY v_ If Doctor then Doctor Doctor Treatment algorithm 1 M Treatment algorithm d g Course Number of sessions MT update period 4 ia Sessions 1 N d ni Program Stimulation site MT Stimulation site treatment 1 Ny A pCHz Ds y E Treatment history Treatment history me gt ok Cancel Fig 33 Report template editor The toolbar for the report template control is located at the top part of the window Us ing the buttons of this tooloar you can create the new report templates remove the existi
51. ictures in items Indent ha 40 o Y Treatment WW Treatment algorithm M Treatment algorithm ji g Course ML Treatment history Number of sessions Font MT update period Segoe UI Sessions 1 N a a Font size u Program Stimulation site MT Stimulation site treatment p 1 m Ay A BCHz Ds y E fo Treatment history Conclusion Conclusion Fig 51 Insertion of Treatment history element Treatment history General M wave analysis M wave analysis Show pictures in items Sort by amplitude Indent 40 _ Number of traces all oy 1 N Segoe UI yi Font size a0 e Fig 52 Treatment history settings During the report generation the treatment history icon Fig 51 will be replaced with list of events saved in the treatment history 2 17 4 If then Conditional Element Sometimes you have to include some information to the report depending on some conditions For example if the patient is diagnosed the corresponding information is 47 Neuro MS NET version 2 User Manual 48 entered then the diagnosis can be included to the report else it has no sense to in clude this information into the report In this case the special conditional elements If then can be used These elements allow to include some data in the report if one condition is fulfilled and include another information or do not inc
52. ig 79 MEP acquisition from abductor digiti minimi muscle To record the motor evoked potential from abductor digiti minimi muscle it is required to degrease the skin in medial area of the hand surface The reference red electrode should be placed on the point of abductor digiti minimi muscle fixation to abductor digiti minimi brevis muscle It is indicated as a R point on Fig 79 It is a little bit more distal the metacarpophalangeal articulation of a hand over the base of proximal phal anx of little finger The active electrode black should be placed on the middle of Appendix head of abductor digiti minimi muscle over the middle of the fifth metacarpal bone A point on Fig 79 Example 2 Peroneal nerve The recording electrode is on the extensor digitorum brevis muscle Fig 80 Fig 80 MEP acquisition from the extensor digitorum brevis muscle To acquire the motor evoked potential from the extensor digitorum brevis muscle it is required to degrease the skin from the lateral side of foot backside The reference red electrode should be placed in the point of extensor digitorum brevis muscle fixa tion to the proximal phalanx of little toe It is indicated as R point on Fig 80 It is a lit tle bit more distal the metatarsophalangeal articulation over the base of proximal phalanx of little toe The active electrode black should be placed on the middle of head of extensor digitorum brevis muscle over t
53. ile system During the first start the da tabase is created automatically in C cardbaseMdb directory on a computer hard disk In future you will be able to create new and connect any available databases created by NET programs produced by Neurosoft Company For database description such terms as card file patient card and treatment are used Treatment in Neuro MS NET program refers to a collection of data obtained during a medical treatment using magnetic stimulator produced by Neurosoft Ltd Treatments are saved in a patient card Patient card contains basic patient data surname name date of birth etc and may include any number of treatments and exams carried out at different times by any Neurosoft devices Patient cards are saved in card files Card file is a pool of any quantity of patient cards Each card file has a unique name and may contain besides patient cards nested card files Cards can be combined in to card file by any feature Well engineered card file system will help you to put into order all stored information and to speed up access to it Experienced user should know that card file system database represents several files saved in a directory folder on a computer hard drive If it is necessary you can create several data bases on a computer hard disk see more details below 2 6 The Very Beginning New Treatment Work with Program To start a new treatment use menu command Treatmen
54. ite If M wave is not found on the trace automatically very low amplitude you can start the manual search by means of the mouse cursor press Alt and holding it click the mouse left button on the supposed M wave location lf the markers are placed inaccurately you can correct their placement with the mouse You can find more information about working with traces in the Working with Traces chapter At the bottom of the screen the data for selected trace M wave amplitude in mV la tency and duration of acquired potential in ms and the number of traces which con tain M wave are displayed At the bottom part of the page you can find the information about M wave amplitude in millivolts latency and its duration in milliseconds These values are obtainable and in dividual only for selected trace with defined M wave 21 Neuro MS NET version 2 User Manual To analyse basic M wave parameters latency duration and amplitude for all traces make M wave analysis table visible using View M wave analysis menu command AH or toolbar button The Single pulse mode MT page will have the view shown on Fig 15 M wave analysis table contains the information about traces with defined M wave When selecting the trace the corresponding line in the quick analysis table is automat ically selected And vice versa when selecting a line in the quick analysis table by the mouse or arrow keys selectin
55. lBlue Unselected trace E Green Ampl mV 0 17 Lat ms 20 5 Dur ms 16 8 Active background Selected traces background color Description comment M wave onset marker Negative peak marker Marker of negative peak end Positive peak marker M wave ending marker nata anka 2 16 Treatment Reports Treatment reports are saved in the database together with the treatments data Be sides text the treatment report can include tables graphs and pictures There is a possibility of both automatic report generation and input of any information using the computer keyboard The program allows creating two types of reports built in and Microsoft Word format Microsoft Word 2007 or later version is necessary You can select the type of exam report using Report Use Microsoft Word menu command Fig 30 35 Neuro MS NET version 2 User Manual 36 _Report View Trace Setup ES New 3 Ba Open Delete Templates gt Templates editor Insert conclusion v Use Microsoft Word Properties New report 1 Comprehensive Ctri R gh wor Fig 30 Selection of report type The built in report is similar to the standard WordPad program in Windows The editor has such advantages as fast work no necessity to install additional software and good quality of the created report Fig 31 english_Test 28 03 2012 Course Depression 5Hz base course Session 1 Neuro MS NET T
56. lection of Insert table container element my gt E liM Segoe UI 10 S Hospital _ _ Treatment report Patient Name Age Date LongDate If Diagnosis then Diagnosis Diagnosis _ _ If Comment then Comment If Doctor then Doctor Doctor Treatment algorithm Ht M Treatment algorithm 4 y Course Number of sessions Fig 58 Insertion of table container 4 x setup Table container mne B Hide borders Width autofit Column width N Width mm 1 Column count 2 Row count 2 ma To access additional settings click right mouse button on the table in editor Fig 59 Table container settings 50 Work with Program 2 18 Hardware and Sorftware Configuration Settings The setting of program basic parameters is carried out by the Setup Change menu command General page Fig 60 Setup General General Software User Hardware Login Guest Report g 9 Treatment manager Password Administration _ Request login and password Upgrade GDT Protect settings with password Hospital Neurosoft company Program start No action required Create new treatment Open Treatment manager After closing of treatment No action required Create new treatment Open Treatment manager Close application Database v Use data compression for archiving H w Maximum number of opened treat
57. log box with a query for report name and comment will be displayed before creating a new treatment report Show glossary with report If the corresponding checkbox is checked the glossary window will be displayed each time you open a treatment report Copy reports to the folder If the corresponding checkbox is checked the treatment reports are simultaneously copied to the indicated folder on the computer disk when you save the treatment Work with Program Report name template The file name template for the treatment report In this tem plate you can use the same tags as in the treatment report It allows making the file name clearer For example in this case 6NAME_ ID_ SHORTDATE_ TIME the file name will consist of a patient s name an ID date and time of treatment crea tion Font The default font of the treatment report The same font is used by default in Clinical info and Conclusion windows The Repot templates button Changing of the treatment report templates Treatment manager page Fig 64 Setup General Treatment manager Soft ae Data transfer Hardware Folder for temporary storage Report Treatment manager dm Administration Maximum disk size a Upgrade CD 650 MB z atl 650 bl mg GDT View Show only compatible treatments lt Back Next gt OK Cancel Fig 64 Treatment manager setting page
58. lude any information in the report if the condition is not fulfilled To add the conditional element to the report template click on If then element lo cated in the left part with the left mouse button Fig 53 and then click on the place of possible element location at the editor template with the left mouse button Fig 54 The element settings Fig 55 will appear at the right part of the window Patient photo Y Treatment mf Treatment algorithm AM Treatment history Fig 53 Selection of If then element Report template editor SS as eS ge EN Current Snipa Comprehensive g At ay i alge Segoe UI g 10 id B I U A 4 S Hospital dnas sjuawayy alii Tih Hlth Tk Treatment report Patient Name Age Date LongDate Y If Comment then Comment Y If Doctor then Doctor Doctor Treatment algorithm M Treatment algorithm d 9 Course Number of sessions MT update period d a Sessions 1 N d m Program Stimulation site MT Cancel _ Fig 54 Insertion of If then element Work with Program setup q Xx Operator If General If then If true l Edit If false edit From new line Ignore formatting User tags l Create Fig 55 If then element settings Let us consider the above mentioned example concerning the information about diag nosis Fig 56 If then
59. lute amplitude 4 45 ma Stimulation type Ar Biphasic i i i j Stimulation site Right hand motor cortex C3 v Lj _ Recording site m abductor pollicis brevis MT Enn 7 B ca N Lat ms Ampl mV Dur ms a 1 20 5 1 66 17 0 z e i Bg d 2 20 5 1 31 17 0 so a yie as F a 3 20 5 1 23 17 0 CN 2 eee 4 20 5 1 56 17 0 5 20 5 0 957 17 0 oe oN Ampl mV 1 23 Lat ms 20 5 Dur ms 17 0 A 100 5 5 a E EY ka es Bea a Le a UE Ready A 35 C GS di dt 67 8 A ps Ampl 45 Fig 26 Single pulse mode MT page To change a trace position shifting it upward and downward on the screen drag the button with the trace name by the mouse Place the mouse cursor on the button press the mouse left button and holding it drag the button to the right place and then release the mouse button Moreover the position of traces on the screen can be changed by View Traces menu command In fact any selected trace can be deleted by Trace Delete Ctrl Del menu com mand To delete several traces simultaneously click on them with the left mouse but ton holding the Ctrl key and then select Trace Delete menu command It is also possible to delete all the traces except selected ones by Trace Delete all except se lected menu command The above mentioned actions are duplicated with buttons at the bott
60. m A 100 50 2005 x 40 50 pulses 5 0 Hz 2000 pulses nii 40 7 00 1 9 32 Stimulation type Ar Biphasic v Absolute amplitude iisi 50 Relative amplitude ie 100 E Pulses frequency in train Hz Pe 5 0 ae Pulses in train iii 50 ee Number of trains alia 40 iui Pause between trains s 20 0 R b b bE ESES Q Ready S AE di dt 67 4 A ps Ampl 45 Fig 11 The Stimulation algorithms page lf you did not choose treatment template while creating the new treatment then the program would open the Stimulation algorithms tab in order to let user to prepare stimulation algorithm manually The program offers two operation modes Course and Program Course mode is the main treatment mode formed on the basis of medical protocol This mode im plies several procedures Programs mode is the special treatment mode It allows performing stimulation on one or more programs and implies only one procedure To switch between modes use Treatment Course Programs menu command or toolbar button On the Stimulation algorithms page you can change treatment structure easily and quickly You can find more information about organization and editing of treatment algorithms in corresponding chapters of the user manual see Course Templates chapter to find information about Course mode and Program Templates chapter to find infor mation about Programs mode 2 9 Single Pul
61. ments 4 Next gt a OK A Cancel Fig 60 General page User Login The user name to login Each user has his her own settings e g the possibility to change toolbar settings to connect databases etc which does not influence the settings of any other user To change a user or to add a new one press Change button After that the program will be restarted Password A password required at each program start Keep in mind that it will be impossible to restore the password in case you forget it You can leave this field emp ty log on without password Request login and password If the checkbox is checked user login and password will be required after the program startup Protect settings with password If the checkbox is checked you are allowed to change the program settings only after the password entering 51 Neuro MS NET version 2 User Manual Hospital a name of medical establishment indicated in the treatment report SHos pital tag value Program start Action carried out automatically after the program startup After closing of treatment Action carried out automatically after the treatment clos ing Database Use data compression for archiving You can compress data to save the space on a disk but it can slows down the operation with archives Maximum number of opened treatments Limit of treatment number to be opene
62. n the stimulator is controlled via computer the biphasic stimulation when the series of the biphasic pulses with high frequency up to 100 Hz and decreasing amplitude are generated instead of single pulse Fig 3 The amplitude of the first pulse is specified for this stimulus After delivering the first stimulus the residual charge of the capacitor is used to generate the next stimulus Coil current Time Fig 3 The biphasic burst waveform Train pulse series the definite number of pulses generated by the magnetic stimulator with the specified frequency and amplitude Stimulation subprogram set of pulse series trains and pauses characterized by Fig 4 e order number 1 e stimulation type 2 e stimulation amplitude intensity 3 e number of pulses or bursts in train 4 4a e pulses or bursts frequency in train 5 5a e total number of trains 6 Neuro MS NET version 2 User Manual e pause between trains 7 e number and frequency of pulses in burst during the stimulation of burst type 8 and 9 respectively e time to the next stimulation subprogram 10 e duration in pulses 11 in hh mm ss 11a Jii 5 pulses 50 Hz iUs 50 pulses 5 0 Hz 20 bursts 1 0 Hz 2000 pulses 00 19 33 1000 pulses 4 5 6 11 4a 5a 11a Fig 4 Stimulation subprograms Stimulation program the series of pulses trains and pauses prescribed by a doctor for the concrete stim
63. nd Randomized Placebo controlled Trial 73 4 5 If You Have No Dedicated Keyboard cccccseecseeeceeeeceeeseuseseeeeeseesaeeess 75 FICIGNON CGS nicorae ia 76 Neuro MS NET version 2 User Manual Attention If you purchased computer separately install the Neuro MS NET software before starting to work If you will work with program using touchscreen it is necessary to calibrate it see the touchscreen user manual Before the first exam you must execute the menu command Setup Change and on the Hardware page check whether the power frequency corresponds to that of your region for Russian Federation 50 Hz If main window menu is hidden click on application main window icon If activation i e the file with license key is needed while working with the magnetic stimulator it is necessary to contact your dealer or Neurosoft Company and provide them with the magnetic stimulator serial number to get the license key This file can be saved either in work directory of the program or in root directory of any computer disc You can install the program and license key on any number of computers without restrictions If the magnetic stimulator has been changed a new activation i e a new file with license key will be necessary In case several Neurosoft devices are used on one computer you will need several files with license key as well one file for one device Do not start working with ma
64. ng ones import the templates from files export the templates to files for exam ple to copy to another computer and rename them Work with Program The combo box of the available report templates is located to the right After the se lection of the required report template from this list you can start its editing The win dow of the template manager is divided into three parts The left part contains the list of the information available for inclusion to the report list of elements or blocks All the report elements are divided into groups which names are indicated on the tabs To select the active tab click it with the left mouse button To include the required ele ment to the report template drag it with the mouse to the middle part of the window The report template editor is located at the middle part of the window It contains the elements which are to be included in the treatment report It is possible to change the report template using the keyboard and by adding the elements blocks from the list The list has a tree structure i e some elements can contain other elements You can add some report data for example name and age of a patient using tags in the report template text When generating the report all tags will be replaced by its values The examples of tag usage Name Age are shown in Fig 34 In this case after report generation patients name appears instead of Name tag and patient s age appears instead of A
65. om of the screen 0 tty place traces closer to each other Ea place traces distant from each other e EA make all traces visible within the window e E3 set the default distance between traces e A superimpose all traces Work with Program Ax delete selected trace traces x e delete all traces exept selected To review the zoom in trace fragments use the magnifier mode To activate this mode press and hold Ctrl and Alt keys on the keyboard The magnifier will ap pear on the screen Fig 27 You can shift the magnifier by moving the mouse keep ing Ctrl and Alt keys pressed If you release the keys the magnifier will disap pear To change the ratio of magnifier zoom in use mouse scroll z gt 0o o PN f j y F J J z ps TRDO 5 al cae baa H Fig 27 Magnifier mode To change the scales of traces use following commands Table 1 Table 1 Commands to change trace scales Parameter Menu command Hotkey To increase sensitivity View Sensitivity Increase Grey vertical scale To decrease sensitivity View Sensitivity Decrease Grey vertical scale To increase sweep View Sweep Increase Grey horizontal scale To decrease sweep View Sweep Decrease Grey horizontal scale To specify scale scale factor of a grid
66. on Start Pause Enter Middle Stimulation Pause Tab Right Stimulation Stop Esc The footswitch can be custiomized see Hardware and Sorftware Configuration Set tings chapter Hardware page 72 Appendix 4 4 Performing of Double blind Randomized Placebo controlled Trial Placebo controlled trial is a comparative study in which the effectiveness of full course of magnetic therapy is compared with placebo where amplitude of repetitive stimulation is reduced by several times Randomized trial is a trial in which patiens are randomly assigned to any of the groups special randomization procedure is used and have equal chances to take a full course of magnetic therapy or therapy with reduced amplitude of repetitive stimu lation placebo Double blind trial is a trial in which patient and doctor have no information about group experimental or control to which the patient belongs to Neuro MS NET software provides the opportunity to perform double blind ran domized placebo controlled trial using magnetic stimulator with not lower than 25 firmware version and standard not placebo coil Scheme Researcher gt Doctor gt Patient A researcher has sole rights to setup parameters start and end placebo tri als and get trial results In this scheme doctor and patient should follow software instructions only To open the window of placebo trial setup use Setup Edit menu command the Soft ware tab the
67. patients between groups The number of patient took part in placebo trial by this course template is displayed in the top right corner of the window e Factor for decreasing amplitude of repetitive stimulation the factor for imitative decreasing of repetitive stimulation amplitude for the imitation of placebo treatment 0 1 1 e Report the possibility to generate a report by each course template included in to a placebo trial Click on the 74 Appendix The Min number of patients and the Factor for decreasing amplitude of repetitive stimulation becomes unavailable for changing if at least one pa tient have already took part in placebo trial by corresponding course tem plate If you want to have an exclusive access to the window of placebo trial setup you can protect it with password using the A button To save changes click on the Vv button to chancel the x button Work with Neuro MS NET software within the frameworks of placebo trial has some slight differences If the patient is ordered to take a course of treatment from the list of course templates and this template is included into the protocol of placebo trial the program makes the treatment algorithm unavailable for changing Before the repetitive stimulation start the program will ask you to use earplugs for patient and doctor to pro tect placebo trial privacy In other aspects the work of Neuro MS NET soft
68. s manager can contain information not only about treatments performed by Neuro MS NET but also about examinations performed by other Neurosoft pro grams Treatment manager Database Data View TCMS S amp EA Q E bd Ey y DF Name Type Creation d Treatment A i 08 re on Gren cont te TANNE Ts Inspector Report Conclusion 7 x la pacnH E B Kypc Depressio 30 09 2011 l l k 4 i John Smith 34 years 27 11 2012 D John Smith Kypc Depressio 28 10 2011 E Clinical Info John Smith Course Depress 27 11 2012 Single pulse mode MT ial Netpos A H Kypc flenpeccu 13 12 2011 M Stimulation algorithms S Netpos A H Kypc Aenpeccn 13 12 2011 Repetitive session mode History z english_Test Mporpammpt D 28 03 2012 l Conka Conclusion il emulation Kypc Jlenpeccu 18 06 2012 4 i Reports Comprehensive bing Search templates New Cancel Extended search c cardbasemdb Fig 22 Treatments manager dialog To open the treatment select it in the list and press button or double click the patient s surname 28 Work with Program p To create a new treatment for selected patient press button This button cor responds to Treatment New menu command The difference is that you select the patient from the list To switch between Patients and Treatments view modes in Treatments manager dialog use context menu Fig 23
69. se Mode MT Single pulse mode MT page Fig 12 helps to perform single pulse stimulation and to detect motor threshold MT on the defined area of body Work with Program i John Smith 33 years 12 13 2011 Course Depression 5Hz base course Session 1 Neuro MS NET x Ie BMS ree mye _ ad j rd M Stimulation algorithms iL Single pulse mode MT T Repetitive session mode History 7 xX bi 7 5ms MEP 1 5mV 7 Absolute amplitude 4 45 Stimulation type A Biphasic v Stimulation site Recording site MT Right hand motor cor m abductor pollicis b k oT a 2 et f i i aa T A CR ae as k a 7 f 4 jJ ae Rr H H ani P e pike htt hii We UE Ad bed be AN Q Ready 23 C di dt 67 6 A ps Ampl 45 i ich lig Fig 12 The Single pulse mode MT page This technique is based on acquisition of bioelectrical responses of nervous system to the magnetic stimulus Before MT detecting make sure that you choose the appropriate treatment algorithm see Treatment Algorithm chapter in order to find possible ways to record motor evoked potential stimulation site recording site At the left part of this window you can see motor evoked potential acquisition area At the right part of
70. such data in the treatment features and usually doctors have no wish to enter data to the report manually it is easy to forget about In this case you can apply user tags AS soon as you press Greate button Fig 36 the following dialog box appears on the screen Fig 37 User tag list x Tag name Tag description Tag type Add OK Cancel Fig 37 The list of user tags Press _Add__ button specify 6Temperament tag name enter Temperament tag description and select List tag type Fig 38 41 Neuro MS NET version 2 User Manual User tag list x Tag name Tag description E Temperament Tempe rament dara reg hs Number String List Fig 38 Type of user tag In the appeared User tag setup window Fig 39 create the list of four temperament types User tag setup Tag values list Sanguine Ad Choleric _ Phlegmatic P Melancholic Change Delete Fig 39 User tag setup When you close these dialog boxes the editor settings Fig 36 will change the fol lowing way Fig 40 Besides the new Temperament tag will appear in the list of available tags activated by means of Ctrl Space key combination or by pressing the button Setup f xX Template Comprehensive User tags Temperament Fig 40 Template editor settings 42 Work with Program Now this tag can be used in the report template for example this
71. t In case you activate Coil replacement process during the performing of the stimulation program the program execution will be paused and will be continued automatically after the coil replacement Work with Program 2 11 History History page Fig 21 contains information about stimulation history The history contains data about fixed motor threshold including traces and about performed stimulation programs On the basis of the history Neuro MS NET define executed and unexecuted programs and the necessity to update MT value At the left part of the page the list of events by date is represented At the right part of the page you can see the detailed description of every event from the left part of the page You can delete the event using button and confirming deletion Keep in mind that element deletion influence the whole treatment For example the execut ed program will become unexecuted in case you delete the corresponding element from history To work with traces received during MT fixation you can use all facilities described in the Working with Traces chapter i John Smith 33 years 12 13 2011 Course Depression 5Hz base course Session 7 Neuro MS NET x ya e mt J fa ZS mi M Stimulation algorithms y Il Single pulse mode MT y M Repetitive session mode Wl History 7 xX bi Sut 450 Ring 150 gt e lie i eg gt vw a J Fix MT Traces 1 3 37 35 PM Stimulation site Dorsolat
72. t 27 11 2012 4 i John Smith 34 years 27 11 2012 Clinical Info Single pulse mode MT Stimulation algorithms Repetitive session mode History Conclusion 4 i Reports Comprehensive v Find Search templates New Cancel Extended search c cardbasemdb Fig 24 Patient card Using Treatments manager you can create not only card files of any nesting level _ cfile button but also new patient cards _ _ button To configure data presen tation at the right part of the dialog use button Treatments can be exported to the external archive for example to be moved to another computer using button a and imported from the archive using button To connect existing database or to create new one use EN button By default the program creates MDB Microsoft Access database in C cardbaseMdb directory folder You can create not only MDB but also Microsoft SQL and MySQL databases To find patient or treatment use search field located in the bottom left corner of Treatments manager dialog Fig 25 You can type only the part of the name diag nosis or other data and press Search button In this case the program will display all treatments which contain this string Depresq v Find Search templates Extended search c cardbasemdb Fig 25 Search field Work with Program On treatment course opening the first unexecuted session will
73. t New Ctrl N or press toolbar button Treatment Patient info Additional Card file TCMS ID Name Sex Birth date Male Female input date Department Diagnosis Template Course v Undefined Doctor Assistant Nurse Fig 9 The new treatment window Change Add photo Standard diagnoses In the appeared Treatment dialog box Fig 9 enter patient s data optional e enter the patients name e choose the patient sex e Enter the patient s date of birth by pressing numeric keys separated by a delimiter character it is or symbol depending on language specified in Windows Most computers follow a four digit format mm dd yyyy For example if your patient was born on the 21st of May 1956 it is enough to enter 21 05 56 The date format specified in your Windows system is used That is why in some countries other se quence than day month year can be applied e enter the department the number of ward hospital etc e enter a provisional diagnosis if it is nesessary e choose treatment type and template if it is nesessary Neuro MS NET version 2 User Manual e to enter the additional data e g policy number address telephone number etc go to Additional tab and continue data entry The database does not contain card files by default all treatments are saved togeth er You can press the but
74. t comment Diagnosis String Preliminary diagnosis Anamnesis String Clinical Info Conclusion String Conclusion CurDate String Current date Fig 35 List of available tags To format the template text use corresponding buttons they are standard for most text editors located over the editor Also among these buttons you can find the follow ing ones the button to insert the table container to the template the button to insert the image from file the buttons to move the selected fragment one position forward and backward os Besides you can copy insert insert image from file and insert table container using the context menu of the editor The right part of the editor contains the settings properties panel of the current report element Each element has its own settings using them you can change the appear ance of the information included in the report The default settings of the editor itself are shown in Fig 36 Work with Program Setup 1 x Template Comprehensive User tags Greate Fig 36 Template editor settings The user tags could be created by report template developer These tags as already mentioned ones can be inserted to any part of treatment report However their real values are requested from a user during the generation of treatment report Let us see the example Suppose that it is required to add the information about a patient s temperament type to the report There are no
75. tes To edit the program templates use Program templates command in the menu Setup Treatment templates 64 Treatment Templates Program templates setup page Fig 75 has two parts The left part contains the tree list of programs devided into groups and at the right part of the page you can edit cor responding settings Group of programs element contains programs grouped on the bases of com mon feature Editable properties are name and comment Program element PLL contains the list of stimulation subprograms organized in such a way to be executed in consecutive order Stimulation program can include one sub program simple stimulation program or several subprograms complex stimulation program Editable properties are name comment stimulation site for MT detection and stimulation site for performing the treatment Fig 75 Two last parameters will be set on the bases of preformed stimulation site list see Stimulation Sites chapter Also you can set the side of stimulation for each stimulation site Program template setup a inh Depressions Name Complex program test gt N Depression 1Hz Comment amp D a Ml Depression 5Hz Stimulation site MT o 1 m A 100 50 0z 200s 40 Name Right hand motor cortex C3 x 4 gt 4 nw Complex program test Side Not defined v 1 m A 100 50 94 2205 x 40 Stimulation site treatment 2 100 g 70 Hz 20
76. tion at the editor template with the left mouse button Fig 48 The settings of Treatment algorithm el ement will appear at the right part of the window Fig 49 gt General Treatment Treatment algorithm m Treatment history Peg Fig 47 Selection of Treatment algorithm element Report template editor p 2 j g ge EY Current template Comprehensive x AL E us E Ge e AR Segoe UI z beta Treatment algorithm Show pictures in items Indent a 40 o Patient Name Age Font gt General Y Treatment M Treatment algorithm JW Treatment history Date LongDate If Diagnosis then Diagnosis Di y If Doctor then Doctor Doctor Segoe UI Font size 4 10 gt Treatment algorithm Subprogram parameters Detailed description Graphic representation Scale 4 0 80 gt Treatment history M Treatment history Cancel Fig 48 Insertion of Treatment algorithm element 45 Neuro MS NET version 2 User Manual 46 Setup ax Treatment algorithm Show pictures in items Indent 4 AQ j Font at ee o a Subprogram parameters _ Detailed description Graphic representation Scale 4 0 80 gt Fig 49 Treatment algorithm setup During the report generation the treatment algorithm icon Fig 48 will be replaced
77. tion press X but ton 3 4 Course Templates To edit the course templates use Course templates command in the Set up Treatment templates menu Course templates setup page Fig 78 has two parts The left part contains the tree view of cources devided into groups and at the right part of the page you can edit cor responding settings Group of courses element if contains courses grouped on the bases of common feature Editable properties are name and comment Course template setup v 4 mn Depressions Comment g Depression 1Hz base course Session repetition 20 session s course 4 gY Depression 5Hz base course Enter numbers or session ranges separated by commas For example 1 3 5 12 4 s Sessions 1 20 type 1 nan Yes No a JIL Depression 5Hz Available properties 1 m A 100 50 209s x 40 4 g Complex course d Sessions 1 20 type 1 4 MUl Program 1 1 m Ar 100 5070 Hz 200s x 40 4 a Sessions 6 14 type 2 4 ill Program 2 1 Ime A 100 2570042 2005 x 40 Y Depression 10Hz 100 base course g Depression 10Hz 120 base course g Depression 20Hz base course Mt Hallucinations G Experimental Soeic Fig 78 Course templates setup page Es By Lv Jl Course element D contains treatment session types and helps to create simple and complex treatment courses In addition to course name and comment you can ed it two following prop
78. tomatically only if all MT values are detected and valid If the Possibility to set M wave search range checkbox is marked the EA button appears in Single pulse mode window Use this button to set the M wave search range by time duration and amplitude Trace review group box helps to setup the appearance of acquisition window the actions with traces at signal acquisition marker names and visibility Placebo controlled trial placebo controlled trial setup Default treatment report Binding of Report New report 1 and Report New report 2 menu commands with the certain report templates In the example Fig 61 the treatment report will be generated according to Comprehensive template if Re port New report 1 menu command is selected Autosave on new treatment If the checkbox is checked the Treatment Save com mand is executed automatically after the new treatment creation Open clinical info in new treatment If the corresponding checkbox is checked the window to enter patient s clinical information is opened just after a new treatment cre ation Hardware page Fig 62 Setup General Hardware Software Power supply Hardware ee Power supply frequency Hz 50 x Report am Treatment manager Wireless keyboard Administration Press BT button to connect keyboard in wireless mode need to do only one time BT Upgrade GDT Footswitch unit Single pulse mode
79. ton and create new card file or select the other one which already exists lf a patient has already been examined or received treatment and his her card already exists in the database then a patient with the most appropriate name will be offered while entering the name If a patient card already exists in the database then a new treatment will be saved to the existing patient card To add patient s photo click on the square at the right side of the dialog box and indi cate the image graphic file Besides you can type your name in Doctor input box assistant s name and techni cian s name in the Assistant and Nurse input boxes correspondingly If you want to perform treatment according to choosen treatment template scenario then choose the appropriate template You can find more information in the Treatment Templates chapter To create treatment on the basis of entered data press the v_ button If the magnetic stimulator is plugged in and is connected to the computer USB port then it would be switched on automatically after the new treatment creation or existed treatment opening Digital EMG and EP system could be used only with magnetic stimulator Devices could be switched on using menu command Hardware Device re set Ctrl Shift Del To switch off the device use Hardware Turn device off menu command or button on the front panel of the magnetic stimulator case lf some patient s det
80. u use it button on the amplifier front panel if you use digital EMG and EP system with keyboard canais button of the functional Bluetooth keyboard if you use it If you use digital EMG and EP system to detect MT remember that active electrode should be connected to the negative terminal usually black on the amplifier and ref erence electrode should be connected to the positive terminal usually red Do not Work with Program forget to attach ground general electrode on the patient the terminal of the ground electrode on the amplifier is usually green If you won t use ground electrode noise level could be extremely high and it will be difficult to receive signal of high quality 2 2 Scale and Touch style Neuro MS NET interface provides an opportunity to use touch input i e touching the monitor screen with the finger Program provides e An opportunity to use special style Touch style to display main application win dows To activate or to deactivate Touch style use Setup Use Touchscreen style menu command Touch style is active by default e An opportunity to set the appropriate scale for all interface elements To change the scale use Setup Scale menu command and choose the appropriate scale value Default scale value is 1 3 If you use Touch style use the main application window icon to show or to hide menu Fig 5 E Neuro MS NET KR Click the icon to show hide menu mti jo p
81. ual 58 GDT page Fig 67 Setup General GDT ani Folder for incoming data Hardware Report Treatment manager Folder for outcoming data Administration Upgrade Write text to file GDT m Coding System y lt Back OK Hi Cancel Fig 67 GDT setting page The folder names with input and output data to synchronize the treatments and GDT integration protocol of a hospital are entered on this page 2 19 Toolbar The toolbars with buttons are intended to speed up an access to some menu com mands The program has flexible system of toolbar setup This system allows custom izing toolbars and assigning hotkeys to the menu commands Besides you can drag the toolbars with the mouse and position them at any convenient place along the pe rimeter of main program window To set up the toolbar click the right mouse button on it and select Setup local menu command Fig 68 After that Toolbar setup window Fig 69 will appear on the screen g Neuro MS NET ery a ioy adsuy Fig 68 Toolbar setup local menu Work with Program x Toolbar setup Toolbars Commands Toolbars View J Device J Basic Ctrl N Text cog T Icon size J B 36 Text width F 4 75 EA V Show hotkeys F Apply to all toolbars Reset settings l Reset hotkeys Cancel Fig 69 Toolbar setup window Toolbars page
82. ulation point The stimulation program can consist either of one subprogram simple stimulation program or several subprograms complex stimulation program Treatment session the base unit of the treatment course As a rule one treatment session is equal to one visit to a doctor The treatment session consists of the stimulation programs Treatment course the set of treatment sessions prescribed for a patient by a doctor Stimulation program and treatment course templates data structures to create stimulation programs and treatment courses respectively Practically treatment course template is medical protocol Quick Start In this chapter you can find brief instructions which describe the standard treatment procedure performed with the use of Neuro MS NET 1 10 11 Connect the required coil to the magnetic stimulator Make sure that power con nector is inserted firmly and the spring lock is locked Connect the magnetic stimulator to the power supply 220B and to the computer USB port Switch on the magnetic stimulator using Mains power switch on the back panel by setting it to I position Power state indicator will be highlight ed yellow If you will use digital EMG and EP system connect it to the computer USB port Run Neuro MS NET see Neuro MS NET Run chapter In the program main window press New treatment button on the toolbar or use Treatment New Ctrl N main menu
83. us J countdown a Number of current subprogram 00 18 57 m 1 1 78 2000 Number of delivered pulses J Fig 19 Information about stimulation process The stimulation process is shown on the stimulation subprogram graph by changing background color Fig 20 Fig 20 The stimulation subprogram graph After the finishing of each stimulation program if all subprograms were fulfilled it would be marked automatically as Executed and corresponding data would be saved in history Then the program goes automatically to the next unexecuted program tests it and if the stimulation site has not changed will continue the stimulation Stimulation programs can be executed in consecutive order automatically only in Course mode To mark the program as Executed manually click the left mouse button in the Exe cuted field and confirm your actions To run again the executed program uncheck the Executed option In that case the corresponding information would be erased from the history In Course mode after the last stimulation program fulfillment the program will ask you to finish the session In case you agree the program will go automatically to the next session If the coil is overheated and you have a reserve coil you can use the quick coil re placement function You can do it using Hardware Coil replacement menu command or by sressing El button in the beginning and in the end of replacemen
84. ware does not differ 4 5 lf You Have No Dedicated Keyboard To facilitate the initiation of stimulation program and work with traces Neuro MS NET offer to use an extra dedicated keyboard This keyboard can be placed near the patient to provide the opportunity to perform necessary actions quickly and cor rectly If you use the amplifier unit which has no built in keyboard Neuro MEP Neuron Spectrum Neuro EMG etc it is strongly adviced to use wireless Bluetooth key board manufactured by Neurosoft Ltd 19 Neuro MS NET version 2 User Manual References 76 Eric M Wassermann Risk and safety of repetitive transcranial magnetic stimula tion report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation June 5 7 1996 Hallett M Chokroverty S Magnetic Stimulation in Clinical Neurophysiology 2005 Marcolin M A Padberg F Transcranial Brain Stimulation for Treatment of Psy chiatric Disorders 2007 Wassermann E M Epstein C M Ziemann U Walsh V Pus T Lisanby S H The Oxford Handbook of Transcranial Stimulation 2008

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