Mobile Application for Adaptive Threshold Hunting in Transcranial Magnetic Stimulation

Application of transcranial magnetic stimulation (TMS) is expanding with many studies applying adaptive threshold hunting to determine a motor threshold (MT). In addition to being a measure of corticospinal excitability, the MT is used as a baseline stimulation intensity (SI) to which following investigative or modulatory SIs are referenced to. Currently available tools for determining MTs include system-integrated tools and third-party stand-alone software. System-integrated MT-tools are still rarely available and the stand-alone software usually demand a separate computer, and hence possess additional space-requirements. I introduce and validate a free Android-based mobile application (ATH-tool) for adaptive threshold hunting of the MT. The objective is to allow for a simple and validated recording of MTs with sharing capabilities for logs. For comparison, I applied Motor Threshold Assessment Tool 2.0, to compare the MT-values determined with the new application, as it applies closely the same routine. Computational validation with known true threshold values confirmed that the new application captured the true MT at high precision (error <= 0.9%). Previously published data on motor evoked potentials (MEPs) were used to simulate realistic response occurrence by considering experimental data from 15 healthy subjects at different stimulation intensities. The MTs of the different methods agreed well (ICC >= 0.971, p < 0.001). There was no significant difference between the MTs determined with the different methods (p >= 0.151). The novel mobile application should make it easier for researchers and clinicians to determine MTs and log the results.