Zoom TMS 101 Course – How to start and build a successful TMS Practice Learn more

Dr. Rustin Berlow discusses how to locate the DMPFC, why that area should be stimulated and the best position to stimulate from.

In between the DLPFC on the left and the DLPFC on the right, is a stimulation site in the center, at the EEG site called FZ, 30% of the way from the nasion to the inion and it is called dorsomedial prefrontal cortex. The reason for stimulating that area is that it’s involved in cognitive control, depression, mood, motivation and is a direct link to what’s called the salience network, so networks and circuits are the new targets of stimulation. So, to find an area that’s superficial that can be stimulated, which projects to deep areas, is the most current method of thinking through different locations, so DMPFC is right here (points to the location of DMPFC).

Now, of the different alternatives, one could stimulate from the top, but the accepted method is to stimulate from the side, and when you stimulate from the side like this, you want to make sure that the two sides are equally distanced from the head and also that the angle at which it is pointing is slightly to the one side if you’re doing the right and slightly to the other side if you’re doing the left. Alternatively, instead of angling at a small, small amount, what you can do is, you can move a half centimeter off the center, to the right, or a half centimeter off center, to the left, and then bilateral stimulation of DMPFC is usually what is done.

Several studies have used theta burst stimulation, others have used 10 hertz. In either case, it provides a very robust and powerful alternative to DLPFC, in the event that DLPFC doesn’t work or is not available.