A Protocol for Robot-assisted Neuronavigated Transcranial Magnetic Stimulation Targeting Individualized Brain Networks in Bipolar Disorder

Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation technique capable of modulating cortical plasticity and has been increasingly applied in the treatment of psychiatric disorders. However, conventional TMS often targets a single brain region and may suffer from imprecise coil positioning, potentially limiting its therapeutic efficacy. Robotic neuronavigated transcranial magnetic stimulation (RNNMS) is a precise TMS intervention modality, which is based on the structural magnetic resonance imaging (MRI) data of the human brain to formulate individualized stimulation targets and improve the accuracy of stimulation with the help of robotic arm guidance. Through brain imaging analysis, we selected stimulation target based on brain regions with abnormal functional connectivity in bipolar disorder (BD) patients, and customized intervention targets based on the structural magnetic resonance of each patient, and used robotic neuronavigated TMS to precisely intervene on the corresponding targets of the patients to reduce the possibility of ineffective stimulation due to coil shift during the whole intervention process, thus improving the cognitive impairments of the patients with BD. This protocol describes our approach to targeting patients based on their brain network images and demonstrates in detail the procedure for performing robotic neuronavigated TMS interventions on patients.