WO2009033150A1

WO2009033150A1 - Pitch, roll, and yaw motions for electromagnet arrays

Info

Publication number: WO2009033150A1
Application number: PCT/US2008/075583
Authority: WO
Inventors: M. Bret Schneider; David Mishelevich
Original assignee: Neostim, Inc.
Priority date: 2007-09-08
Filing date: 2008-09-08
Publication date: 2009-03-12

Abstract

A method for moving an array of electromagnetic coils used for Transcranial Magnetic Stimulation (TMS) in pitch, roll, or yaw modes or two or three of those in combination such that over successive firings of the magnets the neural tissues impacted are not over-stimulated and thus subject to undesirable side effects such as seizures.

Description

PITCH, ROLL, AND YAW MOTIONS FOR ELECTROMAGNET ARRAYS

CROSS REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to U.S. Provisional Patent Application Serial No. 60/970,945, filed on September 8, 2007, titled "PITCH, ROLL, AND YAW MOTIONS FOR ELECTROMAGNET ARRAYS." This application is herein incorporated by reference in its entirety.

INCORPORATION BY REFERENCE [0002] All publications and patent applications mentioned in this specification are herein incorporated by reference in their entirety to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference.

FIELD OF THE INVENTION

[0003] The devices and methods described herein relate generally to the focusing of magnetic fields generated by electromagnets used for Transcranial Magnetic Stimulation.

BACKGROUND OF THE INVENTION

[0004] Stereotactic Transcranial Magnetic Stimulation (stereotactic TMS) concentrates the effects of applied magnetic fields at a target deep in the brain. This must be done without over-stimulating the superficial brain (cortex) and causing negative side effects such as seizures. One important strategy for such deep-brain TMS stimulation is to fire the electromagnets so that the electromagnetic energy from each electromagnet passing through a given non-target point of the cortex is minimized. For example, a given steady repetition rate of firing a single electromagnet or set of electromagnets can overwhelm the non-target superficial cortex through which the electromagnet energy must pass on the way to the deeper target. [0005] One way to avoid over-stimulating these superficial non-target regions (which may elicit undesirable side-effects such as seizures) is to move the electromagnets around a subject's head while focusing their electromagnetic energy on deep targets, to avoid frequent firing through the same non-target portion of the cortex. For example, U.S. Patent Application Serial No. No. 10/821,807 to Schneider and Mishelevich describes using a gantry to which the electromagnets are attached that allows the positions of the electromagnets around the head to be moved (e.g., rotated).

[0006] An alternative approach is to this method is describe herein. In particular, described herein are TMS systems, devices and methods configured for limited rotational movements (including oscillatory movements) in of either the framework (e.g., gantry) or individual electromagnets in one or more of pitch, roll and yaw.

SUMMARY OF THE INVENTION

[0007] Described herein are systems, devices and method for Transcranial Magnetic Stimulation (TMS) in which the TMS electromagnets are configured to move in a pitch motion, a roll motion, a yaw motion, or two or three of those in combination. Moving the TMS electromagnet(s) in pitch, roll and/or yaw during treatment may avoid over-stimulating structures and causing undesirable side effects such as seizures. [0008] In general the systems described herein include a frame assembly and oneor more TMS electromagnets secured to the frame assembly, as well as actuator and associated control mechanisms configured to move the TMS electromagnet(s) in pitch, roll and/or yaw. In some variations, the TMS electromagnets included in the system may be individually moved, so that each TMS electromagnet (or some subset or sub-combination of TMS electromagnets) may be independently moved (e.g., rotated) in pitch, roll or yaw. For example, each TMS electromagnet may be connected to one or more actuators and associated control mechanisms for moving it in pitch, roll and/or yaw. In other variations, all of the TMS electromagnets (e.g., an entire array) may be moved in pitch, roll and yaw as a unit. For example, the frame assembly including an entire array of electromagnets may be moved in pitch, roll and/or yaw. [0009] The rotational motion of the TMS electromagnets in pitch, roll and yaw may mean that the overall translational movement of the TMS electromagnet relative to the subject's head may be slight. For example, moving individual (or subsets) of electromagnets in pitch, roll and yaw may result in minor rotations of the electromagnets relative to other portions of the system. [00010] As described herein, the rotational movements of the TMS electromagnets may be driven by one or more actuators that may be controlled by one or more controllers. An actuator may include any appropriate mechanism, including rotary actuators, linear actuators, magnetic actuators, geared actuators, incorporating step-motors, servo motors or the like, or any device that will provide the required motion. Any appropriate controller may be used. For example, a controller may include one or more of hardware, software, firmware or some combination thereof. For example, a controller may execute control logic for determining (e.g., calculating) the motion, including the timing of the motion, of one or more TMS electromagnets. One or more sensors, including position sensors, may be used. Sensors may provide the controller with positional information on the frame, TMS electromagnets, and/or the subject's body (e.g., head). Any appropriate sensor may be used, including optical, mechanical, etc. [00011] For example, described herein are Transcranial Magnetic Stimulation systems for stimulating a subject's neuronal system that include: a frame assembly; at least one Transcranial Magnetic Stimulation electromagnet supported by the frame; and a plurality of actuators (such as motors), wherein the actuators are configured to move the Transcranial Magnetic Stimulation electromagnet in roll, pitch and yaw. The systems may also include a controller communicating with the plurality of actuators, wherein the controller is configured to control movement of the Transcranial Magnetic Stimulation electromagnet in roll, pitch and yaw. [00012] In some variations, the systems include a plurality of Transcranial Magnetic

Stimulation electromagnets supported by the frame, wherein the plurality of actuators are configured to move the plurality of Transcranial Magnetic Stimulation electromagnets in roll, pitch and yaw. For example, the plurality of actuators may be configured to move the plurality of Transcranial Magnetic Stimulation electromagnets by moving the frame assembly in roll, pitch and yaw. Alternatively, each of the Transcranial Magnetic Stimulation electromagnets may be configured to be independently moveable in roll, pitch and yaw with respect to the other Transcranial Magnetic Stimulation electromagnets.

[00013] Also describe herein are Transcranial Magnetic Stimulation systems for stimulating a subject's neuronal system that include: a frame assembly; an array of Transcranial Magnetic Stimulation electromagnets supported by the frame; and a plurality of actuators, wherein the actuators are configured to move the array of Transcranial Magnetic Stimulation electromagnets in roll, pitch and yaw. The system may also include a controller communicating with the plurality of actuators and configured to control movement of the Transcranial Magnetic Stimulation electromagnet in roll, pitch and yaw. As mentioned, the plurality of actuators may be configured to simultaneously move the entire array of Transcranial Magnetic Stimulation electromagnets in roll, pitch and yaw by moving the frame assembly, and/or the Transcranial Magnetic Stimulation electromagnets may be configured to be independently moveable in roll, pitch and yaw with respect to the other Transcranial Magnetic Stimulation electromagnets. [00014] Also described herein are Transcranial Magnetic Stimulation systems for stimulating a subject's neuronal system including: a frame assembly; a plurality of Transcranial Magnetic Stimulation electromagnets supported by the frame; a plurality of actuators; and a controller communicating with the plurality of actuators, wherein the Transcranial Magnetic

Stimulation electromagnets is configured to be moved in roll, pitch and yaw by the actuators, so that each Transcranial Magnetic Stimulation electromagnet or a subset of the Transcranial Magnetic Stimulation electromagnets may be moved relative to the other Transcranial Stimulation electromagnets. [00015] Methods of applying TMS by rotating the TMS electromagnets in roll, pitch and/or yaw are also described herein. For example, described herein are Transcranial Magnetic Stimulation methods for stimulating a neuronal target tissue, the method comprising: positioning a frame including at least one Transcranial Magnetic Stimulation electromagnet around a subject's head; and moving the Transcranial Magnetic Stimulation electromagnet in roll, pitch and/or yaw.

[00016] The step of moving the Transcranial Magnetic Stimulation electromagnet may include moving the frame to which the Transcranial Magnetic Stimulation electromagnet(s) is attached, or moving the Transcranial Magnetic Stimulation electromagnet(s) relative to another Transcranial Magnetic Stimulation electromagnet included on the frame.

[00017] In general these systems may be configured to move the TMS electromagnets either before during or after activation of the electromagnets. For example, a treatment method may include repetitively firing the TMS electromagnet and moving one or more TMS electromagnets in roll, pitch and/or yaw during or between firing. The methods described herein may also include the step of activating the Transcranial Magnetic Stimulation electromagnet prior to moving the Transcranial Magnetic Stimulation electromagnet. In general, the method may include the step of activating one or more actuators to move the Transcranial Magnetic Stimulation electromagnet. [00018] In some variations, the step of moving the Transcranial Magnetic Stimulation electromagnet comprises moving the Transcranial Magnetic Stimulation electromagnet in roll pitch and/or yaw relative to the frame.

[00019] Also described herein are Transcranial Magnetic Stimulation methods for stimulating a neuronal target tissue, that include the steps of: positioning a frame including a plurality of Transcranial Magnetic Stimulation electromagnet around a subject's head; and moving one or a subset of the Transcranial Magnetic Stimulation electromagnets in roll, pitch and/or yaw relative to the other Transcranial Magnetic Stimulation electromagnet(s). In some variations, this method may include activating one or more of the Transcranial Magnetic Stimulation electromagnets prior to the step of moving one or a subset of the Transcranial Magnetic Stimulation electromagnets.

BRIEF DESCRIPTION OF THE DRAWINGS

[00020] FIG. IA shows one variation of an array of three double coil electromagnets supported on a three-sided frame, in which a coordinate (x, y, z) system has been overlaid. [00021] FIG. IB illustrates the frame shown in FIG. IA moving in pitch.

[00022] FIG. 1C illustrates the frame shown in FIG. IA moving in roll. [00023] FIG. ID illustrates the frame shown in FIG. IA moving in yaw.

[00024] FIG. 2 shows an array of three figure-eight, double-coil electromagnets supported on a three-sided frame.

[00025] FIG. 3 illustrates another array of electromagnets configured so that entire array may move in roll, pitch, and yaw.

[00026] FIG. 4. Illustrates one variation of single TMS electromagnet pair configured to move in pitch, roll and yaw.

DETAILED DESCRIPTION OF THE INVENTION

[00027] In general, the devices and systems described herein are configured so that one or more (e.g., an array) Transcranial Magnetic Stimulation (TMS) electromagnets in a TMS system may move in roll, pitch and/or yaw during operation of the TMS system. Any appropriate amount of motion may be used (e.g., small or incremental rotations or large rotations), and the motion may be oscillatory (e.g., repeated) or single-time. In some variations, the roll, pitch and/or yaw motions may be limited so that each electromagnet of the array has a limited range of motion. The TMS electromagnets may be moved in one or any combination of the roll, pitch and yaw motions. In some variations, an entire array of TMS electromagnets is moved through roll, pitch and/or yaw, while in some variations, subsets or individual electromagnets are configured to move in roll, pitch and yaw. These motions may be coordinated by one or more controllers, which may direct the motion, and may coordinate the activity of one or more power supplies, and one or more actuators causing the pitch, roll and yaw movements.

[00028] The three movements of pitch, roll and yaw, typically correspond to separate three-dimensional motions around a coordinate system origin. For example, FIG. IA illustrates one variation of a gantry or frame 100 having three pairs of TMS electromagnets ("figure-eight" TMS electromagnets). In FIG. IA, coordinate axes (x, y, z) are overlaid onto the frame 100. In this example, the intersection of these three axes is an origin 10 that is positioned near the center of the frame, which would be located in the patient's head when the patent is being treated by this device. Pitch, roll and yaw motion of the frame 100 occurs around this origin 10. FIGS. IBID illustrate motion in pitch, roll and yaw, respectively, of the frame 100. [00029] Pitch is typically rotation around a lateral or transverse axis, e.g., an axis running from the left to right through the device. As illustrated in FIG. IB, forward and backward rotation about the y-axis is pitch 270. Roll is typically rotation around a longitudinal axis, e.g., an axis drawn through the device from front to back. As illustrated in FIG. 1C, roll 280 is the side-to-side motion about the x-axis. Yaw is typically rotation about a vertical axis, e.g., an axis drawn from top to bottom through the device. As illustrated in FIG. ID, yaw 290 is the side-to- side motion about the z-axis.

[00030] FIG. 2 illustrates one variation of a TMS system including an array of electromagnets that are configured for motion in roll, pitch and/or yaw. In this embodiment the TMS electromagnets are connected to a three-sided frame in which the overall frame/magnet configuration includes a frame 100 consisting of frame sides 110, 120, and 130, and three pairs of coil sets 135 and 140, 145 and 150, and 155 and 160. These coil sets are figure-eight double coils. Such figure-eight double coils for TMS are well known, for instance the 70 mm double- coil configuration from Magstim (e.g., Model 9925, Wales, UK). The electromagnets can be powered by available power sources such as the "Magstim Rapid²" (Magstim Ltd., Wales, UK) that provides for pulsed magnetic fields. The system may also include one or more actuators (not shown) for moving the frame in the roll, pitch or yaw directions, as described below, as well as one or more controllers (not shown) for controlling the motion. [00031] As mentioned, the system shown in FIG. 2 is configured so that the frame and attached electromagnets may move in the pitch motion direction 270, the roll motion direction 280, and the yaw motion direction 290. Enough space must be present for any of the motions to ensure that the subject's head is not struck by the device as it moves. Thus, in some variations, the motion in one or more of these directions may be limited. [00032] In operation, a TMS system capable of moving an array of TMS electromagnets in roll, pitch and yaw may be useful for stimulating deep brain regions while minimizing or reducing the stimulation of brain regions located superficial to the deep brain target region (e.g., between the target region and the electromagnets). In particular, systems capable of moving an array of TMS electromagnets in roll, pitch and yaw may be particularly useful for stimulating deep brain target regions that spatially extend along one or more axis within the brain. The system may allow stimulation of a brain region having one or more tracts that extend longitudinally, while limiting the stimulation of superficial regions. For example, the cingulate bundle is a tract that runs anterior-posteriorly in the brain. Targeting of the tracts of the cingualate gyrus may be effectively performed by moving (e.g., by oscillating) the frame including an array of TMS electromagnets so that one or more electromagnets follows the path of the cingulated gyrus as the frame moves. Pitch (e.g., forward-backward) motion may be especially useful, although combinations of motion including components of yaw and roll may also be used. In practice, multiple motions may be more effective for various coil sizes and shapes since two or more motions can be combined. [00033] FIG. 3 illustrates another variation of a TMS system configured to move the array of electromagnets. In this example, the array of electromagnets is positioned in frame 100 that includes frame sides 110, 120, and 130. Three sets of figure-eight double coils attached. In any of the variations described herein, although figure-eight type TMS electromagnets are shown, any appropriate TMS electromagnet may be used. The system shown in FIG. 3 accommodates the pitch motion 270, the roll motion 280, and the yaw motion (290), as shown in FIGS. 1A-1D. Movement of the apparatus in pitch motion 270 in this example is accomplished by turning rings 310 and 320 via drive wheel 330 with a controlled motor (not shown). Movement of the apparatus in roll motion 280 is accomplished by turning ring 340 via drive wheel 350 with a controlled motor (not shown). Movement of the apparatus in yaw motion is accomplished by turning ring 360 via drive wheel 370 with a controlled motor (not shown). Two or more motions can be combined.

[00034] The drive wheel and motor referred to above may form part of an actuator for achieving pitch, roll, or yaw. Other actuators may be used, including rotary actuators, step- motors ("steppers") or other actuators, or the like, actuators may be coupled to the frame, or (as described in greater detail below) to individual magnets or subsets of magnets in variations in which they are individually movable in pitch, roll and yaw. Thus, any appropriate actuatorr may be used. A controller may be connected to the actuatorr to control the motion(s) output by the actuator(s). In some variations the controller includes feedback from the actuators or other portions of the device to indicate the position of the electromagnet(s) being moved. [00035] The examples shown above include systems having an array of electromagnets. In some variations, the systems described herein include only a single TMS electromagnet. Other variations typically include a plurality of electromagnets, forming an array of electromagnets that may be connected to a frame structure (or gantry). As mentioned, an array of electromagnets may have any number of electromagnets. For example, in some variations, the system has a fourth side of the frame (e.g., forming a square that is placed over the subject's head), and includes another pair of TMS electromagnets. In some variations, one or more sides have multiple electromagnets. In some variations, the top of the frame includes one or more electromagnets. For any of these variations, a configuration including one to N magnets is permissible as long as they can be physically accommodated and are of sufficient power to cause the desired effect. [00036] In some variations the frames include different shapes (e.g., round, octagonal, or triangular). Any appropriate shape may be used. The frames may be partially open or enclosed; in some variations, the frame is skeletal and/or wide enough to hold the magnets are without striking the subject. Any of these frames may include one or more electromagnets on a given side. The sizes, numbers, and shapes of magnets may vary. As mentioned above, any appropriate TMS magnet(s) may be used. Frames may include adjustments of dimensions such that different head sizes can be accommodated.

[00037] In addition to variations in which the entire array of TMS electromagnets moves in roll, pitch and/or yaw, in some variations one or more subsets or individual magnets in the array moves in roll, pitch and/or yaw. These embodiments are similar to the whole-array variations described above in function and operation.

[00038] For example, in one variation each TMS electromagnet has its own, independently functioning, roll, pitch and/or yaw mechanism enabling independent positioning of the electromagnets within the array one or more axes. This may also allow subsets of the TMS electromagnets, or individual TMS electromagnets, to scan across a brain region.

[00039] In any of the variations described herein, the position of either the entire array of

TMS electromagnets may be moved in roll, pitch and/or yaw at any point before or during the procedure. For example, all or s subset of the electromagnets may be moved prior to starting the stimulation in order to position the electromagnets on one or more targets or to better fit the subject's head. All or a subset of the TMS electromagnets may be moved during stimulation or between stimulation periods; the TMS magnets may be moved either independently of other TMS electromagnets, in a coordinated manner, as part of a synchronized movement (e.g., movement of the entire array via movement of the frame or gantry). [00040] FIG. 4 illustrates a partial view of an individual TMS electromagnet, which may be one of an array of similar TMS electromagnets on a frame that is configured for individual movement in roll, pitch and/or yaw. For example, in FIG. 4, the electromagnet is configured as a figure-8 shaped electromagnet (or pair of electromagnets) that include pivot points in the x-axis 401, 401', the y-axis (not visible) and the z-axis 403, 403' directions. These pivots may be connected to one or more actuators that allow the electromagnet to be moved in these axes. Movements in roll (e.g., x axis movement), pitch (y axis movement) and yaw (z axis movement) may be separate or combined.

[00041] In variations in which individual TMS electromagnets (or subsets of electromagnets) may move in roll, pitch and yaw, the orientation of individual TMS electromagnets or groups of electromagnets may be altered during the operation of the device. For example, a broader target region may be stimulated by moving one or more TMS electromagnets. In some variations, the TMS electromagnets may be moved so that an electromagnet (or electromagnets) may target a single deep tissue target from different positions relative to the cortical or regions of the brain superficial to the deep brain target. As described above, this may prevent stimulation of the non-target superficial (e.g., cortical) regions. [00042] In some variations, the frame or gantry is configured to move in sections, thereby moving one or subsets of electromagnets. For example one region of the frame may include multiple axes of motion (e.g., pivots) so that the region may be moved in any of pitch, roll, and/or yaw. The axes about which this motion occurs may be centered at any appropriate position, and may be different for different TMS electromagnets or subsets of electromagnets. For example, the center of rotation (the point of intersection of the x, y and z axis) may be centered in the electromagnet, as shown in FIG. 4, or it may centered at a point within the subject's head, as in FIGS. 1A-1D). [00043] In variations of the devices in which one or more individual or groups of TMS electromagnets may be moved either separately or together, one or more controllers may be used to control the motion. For example, a controller may be used to control one or more actuators that move the TMS electromagnet(s) in roll, pitch and/or yaw. The controller may coordinate the motion of different electromagnets, and my include input/feedback from the electromagnets. The controller may also calculate movement pathways in order to prevent collisions between different components of the system and the subject's head or other regions.

[00044] The various embodiments described above are provided by way of illustration only and should not be construed to limit the invention. Based on the above discussion and illustrations, those skilled in the art will readily recognize that various modifications and changes may be made to the present invention without strictly following the exemplary embodiments and applications illustrated and described herein. Such modifications and changes do not depart from the true spirit and scope of the present invention, which is set forth in the following claims.

REFERENCES

Schneider, M.B. and DJ. Mishelevich, U.S. Patent Application No. 10/821,807 "Robotic apparatus for targeting and producing deep, focused transcranial magnetic stimulation"

Mishelevich DJ, Schneider MB, U.S. Patent Application No. 11/429,504 "Trajectory-Based Deep-Brain Stereotactic Transcranial Magnetic Stimulation"

Claims

CLAIMSWhat is claimed is:

1. A Transcranial Magnetic Stimulation system for stimulating a neuronal target, the system comprising: a frame assembly configured to be placed adjacent to a subject's head; at least one Transcranial Magnetic Stimulation electromagnet supported by the frame; a roll actuator configured to move the Transcranial Magnetic Stimulation electromagnet in roll; a pitch actuator configured to move the Transcranial Magnetic Stimulation electromagnet in pitch; and a yaw actuator configured to move the Transcranial Magnetic Stimulation electromagnet in yaw.

2. The system of claim 1 , further comprising a controller communicating with the roll, pitch and yaw actuators, wherein the controller is configured to control movement of the

Transcranial Magnetic Stimulation electromagnet in roll, pitch and yaw.

3. The system of claim 1 , further comprising a plurality of Transcranial Magnetic Stimulation electromagnets supported by the frame.

4. The system of claim 3, wherein the actuators are configured to move the plurality of Transcranial Magnetic Stimulation electromagnets by moving the frame assembly in roll, pitch and yaw.

5. The system of claim 3, wherein the each of the Transcranial Magnetic Stimulation electromagnets is configured to be independently moveable in roll, pitch and yaw with respect to the other Transcranial Magnetic Stimulation electromagnets.

6. A Transcranial Magnetic Stimulation system for stimulating a subject's neuronal system, the system comprising: a frame assembly; an array of Transcranial Magnetic Stimulation electromagnets supported by the frame; and a plurality of actuators, wherein the actuators are configured to move the array of Transcranial Magnetic Stimulation electromagnets in roll, pitch and yaw.

7. The system of claim 6, further comprising a controller communicating with the plurality of actuators and configured to control movement of the Transcranial Magnetic

Stimulation electromagnet in roll, pitch and yaw.

8. The system of claim 6, wherein the plurality of actuators are configured to simultaneously move the entire array of Transcranial Magnetic Stimulation electromagnets in roll, pitch and yaw by moving the frame assembly.

9. The system of claim 6, wherein the each of the Transcranial Magnetic Stimulation electromagnets is configured to be independently moveable in roll, pitch and yaw with respect to the other Transcranial Magnetic Stimulation electromagnets.

10. A Transcranial Magnetic Stimulation system for stimulating a neuronal target, the system comprising: a frame assembly; a plurality of Transcranial Magnetic Stimulation electromagnets supported by the frame; a plurality of actuators; and a controller communicating with the plurality of actuators, wherein the Transcranial Magnetic Stimulation electromagnets is configured to be moved in roll, pitch and yaw by the actuators, so that each Transcranial Magnetic Stimulation electromagnet or a subset of the Transcranial Magnetic Stimulation electromagnets may be moved relative to the other Transcranial Stimulation electromagnets .

11. A Transcranial Magnetic Stimulation method for stimulating a neuronal target tissue, the method comprising: positioning a frame including at least one Transcranial Magnetic Stimulation electromagnet around a subject's head; and moving the Transcranial Magnetic Stimulation electromagnet in roll, pitch and/or yaw.

12. The method of claim 11, wherein the step of moving the Transcranial Magnetic Stimulation electromagnet comprises moving the frame to which the Transcranial Magnetic Stimulation electromagnet is attached.

13. The method claim 11, wherein the step of moving the Transcranial Magnetic Stimulation electromagnet comprises moving the Transcranial Magnetic Stimulation electromagnet relative to another Transcranial Magnetic Stimulation electromagnet included on the frame.

14. The method of claim 11 , further comprising activating the Transcranial Magnetic

Stimulation electromagnet prior to moving the Transcranial Magnetic Stimulation electromagnet.

15. The method of claim 11, wherein the step of moving the Transcranial Magnetic Stimulation electromagnet comprises activating one or more actuators to move the

Transcranial Magnetic Stimulation electromagnet.

16. The method of claim 11, further comprising the step of moving the Transcranial Magnetic Stimulation electromagnet prior to activating the Transcranial Magnetic Stimulation electromagnet.

17. The method of claim 11, further wherein the step of moving the Transcranial Magnetic Stimulation electromagnet comprises moving the Transcranial Magnetic Stimulation electromagnet in roll pitch and/or yaw relative to the frame.

18. A Transcranial Magnetic Stimulation method for stimulating a neuronal target tissue, the method comprising: positioning a frame including a plurality of Transcranial Magnetic Stimulation electromagnet around a subject's head; and moving one or a subset of the Transcranial Magnetic Stimulation electromagnets in roll, pitch and/or yaw relative to the other Transcranial Magnetic Stimulation electromagnet(s).

9. The method of claim 18, further comprising activating one or more of the Transcranial Magnetic Stimulation electromagnets prior to the step of moving one or a subset of the Transcranial Magnetic Stimulation electromagnets.