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The temporal shape of a pulse in transcranial magnetic stimulation (TMS)influences which neuron populations are activated preferentially as well as thestrength and even direction of neuromodulation effects. Furthermore, variouspulse shapes differ in their efficiency, coil heating, sensory perception, andclicking sound. However, the available TMS pulse shape repertoire is still verylimited to a few pulses with sinusoidal or near-rectangular shapes. Monophasicpulses, though found to be more selective and stronger in neuromodulation, aregenerated inefficiently and therefore only available in simple low-frequencyrepetitive protocols. Despite a strong interest to exploit the temporal effectsof TMS pulse shapes and pulse sequences, waveform control is relativelyinflexible and only possible parametrically within certain limits. Previouslyproposed approaches for flexible pulse shape control, such as through powerelectronic inverters, have significant limitations: Existing semiconductorswitches can fail under the immense electrical stress associated with freepulse shaping, and most conventional power inverter topologies are incapable ofgenerating smooth electric fields or existing pulse shapes. Leveragingintensive preliminary work on modular power electronics, we present a modularpulse synthesizer (MPS) technology that can, for the first time, flexiblygenerate high-power TMS pulses with user-defined electric field shape as wellas rapid sequences of pulses with high output quality. The circuit topologybreaks the problem of simultaneous high power and switching speed into smaller,manageable portions. MPS TMS can synthesize practically any pulse shape,including conventional ones, with fine quantization of the induced electricfield.

Modular Pulse Synthesizer for Transcranial Magnetic Stimulation with Flexible User-Defined Pulse Shaping and Rapidly Changing Pulses in Sequences