RU2822811C1 - Method of brain stimulation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neurology, and can be used for brain stimulation for ideomotor trainings. Point of stimulation application is determined – dorsolateral prefrontal cerebral cortex. Transcranial magnetic stimulator inductor coil is installed directly on this point and excitatory transcranial magnetic stimulation is performed with frequency of 5–20 Hz, with stimulus intensity 90–120% of motor excitability threshold with number of stimuli in one stimulation session not less than 1,800 units. Then, ideomotor training is performed. At the moment of ideomotor training, cerebral activity patterns are recorded and analysed. As an objective measure of the speed of imaginary movements, the averaged time over attempts of occurrence of sensorimotor rhythm desynchronization, ΔDT, is used.

EFFECT: method provides reducing the delay time between the presentation of the stimulus on the beginning of the task and the moment of generation of sensory rhythm desynchronization patterns, increased speed of motor imagination, improved quality of reproduction of imaginary movements and increased efficiency of ideomotor trainings for the purpose of recovery of motor activity of upper extremities.

9 cl, 2 dwg, 1 tbl, 1 ex

Description

The present invention relates to the field of medicine, to neurology, and concerns a method of brain stimulation, which can be used during their rehabilitation in conjunction with ideomotor or classical training to restore motor activity of the upper extremities after a stroke.

After a stroke, the main problem that greatly affects the quality of life is the loss of control over skeletal muscles. As a special case, partial or complete loss of motor activity in one of the upper limbs results in the inability to use everyday things. Modern methods of restorative medicine aimed at the rehabilitation of post-stroke patients are based on brain-computer interface technology. Ideomotor training using electroencephalography is a promising method of rehabilitation, but the formation of physiological patterns during training is difficult, which is reflected in the low accuracy of their classification.

There are methods aimed at restoring motor activity of the upper limbs after a stroke, using similar methods for recording brain activity.

There is a known method for the treatment of ischemic strokes of the brain (RU 2157265 C1, cl. A61N2/00, A61N2/02, published on October 10, 2000), which includes stimulation of the motor centers of the cerebral cortex by sequential impact first on a point in the motor zone of the right hand, with In this case, the center of the magnetic coil is placed 3 cm to the left of the Cz electrode location area, then the impact is carried out on the second point - the motor zone of the left hand, with the magnetic coil center placed 3 cm to the right of the Cz electrode location area and stimulation of these two points is carried out for 5 minutes with a pulsed magnetic field of 1.5 - 3 Tesla, then the third point of stimulation of the motor zone of the lower limb is affected by placing the center of the magnetic coil 4 cm frontal and 1 cm to the left of the location of the electrode Cz, and the fourth point of stimulation is the motor zone of the left lower limb , in this case, the center of the magnetic coil is placed 4 cm frontally and 1 cm to the right from the location of the Cz electrode, and stimulation of these zones is carried out for 5 minutes with a pulsed magnetic field of 2 - 4.5 Tesla. After the procedure for stimulating the motor centers of the brain is completed, electromagnetic stimulation of the spinal cord is carried out by influencing the roots of the cervical enlargement with the center of the coil located first above the spinous process of the C7 vertebra, and then by influencing the roots of the lumbar enlargement with the center of the coil above the spinous process of the L5 vertebra. In this case, the impact on the roots of the cervical thickening is carried out for 5 minutes with a pulsed magnetic field of 1.5 - 3 T, and on the roots of the lumbar thickening - with a pulsed magnetic field of 2 - 4.5 T for 5 minutes, then after the TCM session the next day Additionally, audiovisual stimulation (AVS) is carried out with a frequency of audiovisual signals from 8 Hz and with a smooth increase to 15 Hz and a session duration of 15 minutes, and in the presence of irritation - from 10 Hz with a smooth decrease to 5 Hz for 20 minutes. The course of treatment consists of 14 daily alternating sessions of TCM and ABC. The stimulation threshold for each patient at all stimulation points is determined by increasing the stimulus intensity by 10%, starting from 30% of the maximum stimulation power of 5 Tesla until the point at which half of the stimuli produce motor evoked potentials, and treatment is carried out with a subthreshold pulse that is 10 - 20% below the threshold. The method allows to reduce neurological deficit and increase the adaptive activity of large ones.

There is a known method for the rehabilitation of patients after a stroke or injury using a robotic complex, including an exoskeleton of a human limb, controlled through a brain-computer interface through the imagination of movements (RU 2622206 C2, class A61B 5/0476, publ. 06/13/2017), according to which they are presented to the patient a task on kinesthetic imagination of the movement of a limb, analyze the patterns of the patient’s brain activity that arise during the imaginary movement, transmit data to the computer to isolate the signals responsible for the imagination of the movement, present to the patient, using visual feedback, the results of recognizing the task being performed in the form of a mark on the screen, by changing the mark determine the correctness of the task. In this case, the results of recognizing the task being performed by kinesthetic imagination of the movement of the paretic limb are additionally presented using tactile and proprioceptive feedback through an exoskeleton worn on the patient’s paretic limb. If the task being performed is correctly recognized, the exoskeleton moves the limb in the direction of the imaginary movement, and if the result is incorrect, it moves in the opposite direction. The method allows to increase the effectiveness of treatment, which is achieved through the additional involvement of tactile proprioceptive sensitivity in the restoration of motor functions.

The demonstrated results of classification accuracy when reading patterns within 3-10 seconds averaged 50% across three actions. The data provided is above random response, which indicates that the system is working, but only in 50% of cases did the subjects receive the feedback necessary to reinforce the training.

There is a known method for the rehabilitation of patients who have suffered a stroke (RU 2523349 C1, class A61B 5/0476, A61B 5/0482, published on July 20, 2014), according to which training is carried out by presenting the patient with the task of imagining the movement of a paretic limb with subsequent control of the imaginary movements. In this case, the EEG is recorded, the received data is transferred to a computer for synchronous processing, and the sensorimotor rhythm desynchronization reaction signals responsible for the imaginary movement are isolated using an EEG pattern classifier using the Bayesian method. The results of recognition of the mental task being performed are presented to the patient using visual feedback in the form of a mark on the monitor screen. By changing the position of the mark, the correctness of the task is determined. The movement imagery task is presented for 10 seconds. The training course is 6-12 days, one workout per day, lasting 20-30 minutes with intervals between workouts from 1 to 4 days. The method makes it possible to increase the effectiveness of rehabilitation, which is achieved by conducting training using feedback, in conditions that allow the patient to visually control the execution of an imaginary movement with a paretic limb.

The disadvantage of this method is the long duration of the rehabilitation course and the fact that the results of training depend on a person’s individual abilities to imagine movements and the degree of damage to his brain due to illness or injury, which can make it difficult for a person to reproduce imaginary movements.

The objective of the invention is to create a new method of brain stimulation that provides a reduction in the delay time between the presentation of the stimulus about the beginning of the task and the moment of generation (formation) of the sensory rhythm desynchronization pattern, which is an indicator of the performance of motor imagination, identified by the electroencephalogram, at the time of ideomotor training, which does not depend on a person’s individual abilities to form a motor image.

The technical result from the use of the claimed invention is to increase the speed of motor imagination, improve the quality of human reproduction of imaginary movements and increase the effectiveness (efficiency) of ideomotor training in order to restore motor activity of the upper extremities.

This task is achieved by the fact that the method of brain stimulation includes determining the point of application of stimulation - the dorsolateral prefrontal cortex of the brain, after finding which the inductor coil of the transcranial magnetic stimulator is installed directly on this point and excitatory transcranial transcranial magnetic stimulation of the dorsolateral prefrontal cortex of the brain is carried out with a frequency of 5 -20 Hz, with a stimulus intensity of 90-120% of the motor excitability threshold, obtained individually by generating evoked motor responses, with the number of stimuli in one stimulation session of at least 1800 units, then ideomotor training is carried out, in which the person is presented with a task to imagine the movements of the limbs , at the time of ideomotor training, the patterns of human brain activity that arise when he imagines movement are recorded and analyzed; electrical activity recorded using an encephalograph or hemodynamic activity recorded using emitters and receivers located on the surface are used as the recorded brain activity head, as an objective measure for assessing the speed of performing imaginary movements, we used the time of occurrence of desynchronization of the sensorimotor rhythm ΔDT, averaged over attempts, which for each subject is determined as the average moment of reaching the first local minimum of the energy of the sensorimotor rhythm, or desynchronization after the presentation of a visual stimulus; to determine the point of application of stimulation, a navigation system is used, including a camera and reflective marks to determine the location of the inductor coil of the transcranial magnetic stimulator relative to the human head, which allows you to combine a three-dimensional model of the midbrain or an individual model of the subject’s brain, obtained using MRI, with a given point of stimulation; use navigation systems from Localite or Nexstim; the stimulation application point can be selected according to the MNI coordinate system and corresponds to coordinates 79, 46, 51, mm, ctf, or according to a similar Talairach coordinate system; to carry out excitatory transcranial magnetic stimulation, use the transcranial magnetic stimulator MagVenture, or MagPro X100, or Magstim, or The Magstim Rapid, or the Neuro-MS/D or NEURO-MSX device; ideomotor training includes 20 tasks of two types: imaginary movement with the right hand and rest, while the tasks are presented on the monitor for 5 seconds in the form of white arrows to the right for imaginary movement and a cross for rest on a gray background, the tasks are randomized, and a gap is maintained between each task rest 3 seconds; in the case of recording electrical activity, electroencephalographs are used; the electroencephalogram is recorded using 16, 32 or 64 electrodes in a 10-10 system located on the surface of the head, under each of which a special gel is applied to improve contact with the surface of the head, while also recording motor imagination for EEG, electrodes C3 and C4 are required according to the 10-10 system; additionally, electrodes can be installed around C3 - C5, C2, CP3, FC3, and around C4 - C2, C6, CP4, FC4, according to the 10-10 system; 8 use BrainProducts electroencephalographs - BrainAmp system, or Nihon Kohden - NEUROFAX EEG-1200K, NBL640, or NVX 52; in the case of recording electrical activity, the electroencephalogram is recorded using 14 electrodes in the electroencephalographic helmet EMOTIV EPOC X from Emotiv, which has a wireless connection with a computer; in the case of recording hemodynamic activity, a near-infrared spectrometer fNIRS is used.

In fig. Figure 1 shows an averaged topogram of the desynchronization pattern of the sensorimotor rhythm on the human cerebral cortex with a diagram of the installed EEG electrodes according to example 1.

In fig. Figure 2 shows the dynamics of the formation of a pattern of desynchronization of the sensorimotor rhythm, which is an indicator of the success of executing an imaginary movement.

The proposed method of brain stimulation is carried out as follows.

First, the point of application of stimulation is determined on the person’s head - the dorsolateral prefrontal cortex of the brain. For this purpose, for example, a navigation system is used, including a camera and reflective marks to determine the location of the transcranial magnetic stimulator (TMS) inductor relative to the human head. The capabilities of this system make it possible to combine a three-dimensional model of the midbrain or an individual model of the subject’s brain (obtained using MRI) with a given stimulation point. For the needs of the present invention, for example, navigation systems offered by Localite (Germany), Nexstim (Finland) can be used. Also, the point of application of stimulation can be selected, for example, according to the MNI coordinate system and corresponds to coordinates (79, 46, 51) [mm, ctf], or according to a similar Talairach coordinate system.

After finding the point of application of stimulation on the person’s head, install the inductor coil of the transcranial magnetic stimulator (TMS) directly on this point and carry out excitatory transcranial (transcranial) stimulation of the dorsolateral prefrontal cortex of the brain. Excitatory transcranial stimulation of the dorsolateral prefrontal cortex is carried out, for example, using magnetic stimulation, which is a rhythmic sequence of magnetic pulses, or using electrical stimulation. Moreover, with magnetic stimulation, the intensity of the stimuli is 90-120% of the motor threshold of excitability, obtained individually by generating evoked motor responses (EMR), the frequency of stimulation is in the range of 5-20 Hz, the number of stimuli in one stimulation session is at least 1800 units. Stimulation with an intensity of less than 90% is not enough to excite the human cerebral cortex, and with a power of more than 120% it is excessive and can lead to excitation of the ternary nerve. Stimulation with a frequency of less than 5 Hz is inhibitory and has a suppressive effect, while stimulation of more than 20 Hz is redundant and is the maximum feasible for most devices.

A wide class of commercially available transcranial magnetic stimulators (TMS) are suitable for the needs of the present invention, capable of providing rhythmic stimulation with a frequency of 5-20 Hz and with a stimulus intensity of 90-120% of the motor threshold of excitability, obtained individually by generating evoked motor responses (MER). On average for the subjects, 90-120% of the excitability threshold was 0.94 ± 0.15 T (mean ± standard deviation). For example, for the needs of the present invention, TMS for neurophysiological studies offered by MagVenture (Farum, Denmark) - MagPro X100, Magstim (Whiteland, UK) - The Magstim Rapid can be used. These systems are capable of performing high-frequency stimulation with a choice of stimulus power and have the ability to programmatically configure the device. Domestic systems of this class are Neuro-MS/D or NEURO-MSX devices from Neurosoft (Russia).

After conducting excitatory transcranial (transcranial) stimulation of the dorsolateral prefrontal cortex, ideomotor training is carried out, during which a task for imagining limb movements is presented. In this case, a person mentally imagines a given movement, imitating tactile and proprioceptive signals from muscles, skin and joints, giving the brain information about the relative position of body parts and their movement, providing the same feeling of one’s own body that occurs when actually performing an imaginary movement, which leads to activation of brain activity in the motor areas of the cerebral cortex.

At the time of ideomotor training, the patterns of human brain activity that arise when imagining movement are recorded and analyzed.

The recorded brain activity is, for example, electrical activity recorded using an encephalograph. Electroencephalogram recording is carried out using electrodes located on the surface of the head. A special gel is applied under each electrode to improve contact with the surface of the head. A wide range of commercially available electroencephalographs are suitable for the purposes of the present invention. For example, electroencephalographs offered by BrainProducts (Munich, Germany) - BrainAmp system, and Nihon Kohden (Tokyo, Japan) - NEUROFAX EEG-1200K for BCI studies can be used. Domestic systems of this class are devices NBL640 (NeuroBioLab, Russia) and NVX 52 (ISS, Russia).

The placement and number of electrodes used for EEG recording may vary. For example, 32 electrodes can be used, arranged according to the 10-10 system (Zenkov L. R. Clinical electroencephalography (with elements of epileptology). A guide for doctors. 3rd ed., M: MEDpressinform, 2004, 368 pp). To record EEG, it is worth using full coverage of the entire head, for example, 16, 32 or 64 electrodes in a 10-10 system. To record motor imagination on the EEG, electrodes C3 and C4 are needed according to the 10-10 system. Additionally, but not necessarily, electrodes can be installed around C3 - C5, C2, CP3, FC3, and around C4 - C2, C6, CP4, FC4, according to the 10-10 system (Fig. 1).

In some embodiments of the present invention, other arrangement systems and a different number of electrodes may be used, for example, the arrangement of 14 electrodes in the EMOTIV EPOC X electroencephalography helmet from Emotiv (San Francisco, USA), which has a wireless connection with a computer.

In some embodiments, hemodynamic activity recorded using a near-infrared spectrometer (fNIRS) may be used as the recorded brain activity. Such spectrometers, as a rule, have clinical certification, which means there is a confirmed absence of negative effects of radiation on the patient. Registration of hemodynamic activity using near-infrared spectroscopy (NIRS) is based on the measurement of local concentrations of oxyhemoglobin and deoxyhemoglobin, which change in the case of evoked or voluntary activity of neurons in the area under consideration. These concentrations are measured by the degree of absorption of thermal radiation with a wavelength of 690 and 830 nm (for deoxy- and oxyhemoglobin, respectively). Registration of hemodynamic activity is carried out using emitters and receivers located on the surface of the head.

The formation of desynchronization of the sensorimotor rhythm is observed in the areas under the electrodes.

The time of occurrence of sensorimotor rhythm desynchronization (ΔDT), averaged over attempts, was used as an objective measure for assessing the speed of performing imaginary movements. ΔDT was determined for each subject as the average moment of reaching the first local minimum energy of the sensorimotor rhythm (desynchronization) after the presentation of a visual stimulus (Pfurtscheller G. et al. Mu rhythm (de) synchronization and EEG single-trial classification of different motor imagery tasks //NeuroImage. – 2006. – T. 31. – No. 1. – P. 153-159) (Fig. 2).

The difference in the power of the theta rhythm signal of the right precuneus (ΔP) was calculated using the formula:

ΔP = (PMI2 – PR2) – (PMI1 – PR1), where

PMI1 – spectral power of the theta rhythm in the region of the right precuneus after presentation of a visual command to the subject in the first experimental session,

PR1 – spectral power of the theta rhythm in the area of the right precuneus before the presentation of a visual command to the subject in the first experimental session, PMI2 – spectral power of the theta rhythm in the area of the right precuneus after presentation of the visual command to the subject in the second experimental session, PR2 – spectral power of the theta rhythm in the area of the right precuneus before presenting the visual command to the subject in the second experimental session.

Exciting transcranial (transcranial) stimulation of the dorsolateral prefrontal cortex reduces the delay time between the presentation of the stimulus about the beginning of the task and the moment of generation (formation) of sensory rhythm desynchronization patterns, which is an indicator of the performance of motor imagination, identified by the electroencephalogram, at the time of ideomotor training . This, in turn, increases the speed of motor imagination, which can improve the quality of a person’s reproduction of imaginary movements and increase the effectiveness (efficiency) of ideomotor training in order to restore motor activity of the upper limbs. Moreover, the proposed method does not depend on a person’s individual abilities to perform an imaginary movement, which provides a wide range of possibilities for its use, including for people with serious brain damage due to illness or injury.

Below is an example of a specific implementation of the invention.

Example 1.

2 groups of healthy volunteers were formed, 6 people in each, aged from 18 to 34 years. Group 1 was stimulated in the dorsolateral prefrontal cortex with the specified characteristics. In Study 2, the group received placebo stimulation with a TMS inducer coil placed on its edge, at a 90-degree angle to the subject's head.

To increase the rate of formation of patterns of human brain activity that occurs when imagining movements, a complex consisting of the following elements was used:

- 52-channel electroencephalograph NVX 52 manufactured by Medical Computer Systems, Russia;

- personal computer (Windows 7 operating system) for synchronous data transfer, isolating EEG performance indicators, classifying signals to recognize patterns of EEG activity corresponding to motor imagination, and analyzing the spectral power of the signal;

- transcranial magnetic stimulator Neuro-MS/D manufactured by Neurosoft, Russia.

To fix the stimulation point of the dorsolateral prefrontal cortex with coordinates (79, 46, 51) [mm, ctf] according to the MNI coordinate system, TMS Navigator (LOCALITE, Germany) was used. Reflective marks were attached to the subject's forehead, the TMS inductor, and the subject's head was calibrated using a pointer. The technical equipment of the navigator made it possible to combine a three-dimensional model of the subject’s brain with the marked stimulation point.

Then, transcranial magnetic stimulation of the human dorsolateral prefrontal cortex was performed using a double-angle inductor with a focus of 3 cm from the point of contact with the head.

The intensity of the stimuli was 90–120% of the motor excitability threshold, obtained individually by generating evoked motor responses (EMRs) in the flexor digitorum superficialis of the right hand. At the same time, the primary motor cortex was stimulated in the projection of the innervation of the hands, contralateral to the right hand. The threshold intensity of the magnetic pulse, depending on the individual characteristics of the patients, varied from 0.72 T to 1.15 T (stimulus power 29-46% of the maximum TMS power).

Stimulation of the dorsolateral prefrontal cortex was carried out using a transcranial magnetic stimulator “Neuro MS/D therapeutic extended” (Neurosoft, Russia). A double angle inductor (IDU-02-100-O, 100 mm) was used for rhythmic stimulation with a frequency of 5 Hz for 360 s.

After stimulation, both groups underwent ideomotor training, which included 20 tasks of two types: imaginary movement of the right hand and rest. The tasks were presented on the monitor for 5 seconds, in the form of white arrows to the right (for imaginary movement) and a cross (for rest) on a gray background. The tasks were randomized, and there was a 3-second rest period between each task.

Before the start of ideomotor training, all necessary equipment was connected to the subject. 32 Cl/Ag electrodes were installed according to the 10-10 system (Fp1, Fp2, F3, Fz, F4, Fc1, Fc2, F7, Ft9, Fc5, F8, Fc6, Fc10, T7, Tp9, T8, C3, Cz, C4 , Cp5, Cp1, Cp2, Cp6, Cp10, P7, P3, Pz, P4, P8, O1, Oz, O2), the grounding electrode was fixed on the forehead, the referents on the ears. Electrodes were placed on the subject's forearms to record EMG from the superficial flexor muscles of the fingers. Registration from all electrodes was carried out using a certified amplifier NVX 52 (Medical Computer Systems LLC, Russia).

The formation of desynchronization of the sensorimotor rhythm was observed in areas under the electrodes, for example, under electrodes C3 and CP1 (Fig. 1).

As an objective measure for assessing the speed of performing imaginary movements, we used the time of onset of desynchronization of the sensorimotor rhythm (ΔDT) averaged over attempts (Fig. 2). ΔDT was determined for each subject as the average moment of reaching the first local minimum energy of the sensorimotor rhythm (desynchronization) after the presentation of a visual stimulus and was calculated using the formula: ΔP = (PMI2 – PR2) – (PMI1 – PR1), where

PMI1 – spectral power of the theta rhythm in the region of the right precuneus after presentation of a visual command to the subject in the first experimental session,

PR1 – spectral power of the theta rhythm in the area of the right precuneus before the presentation of a visual command to the subject in the first experimental session, PMI2 – spectral power of the theta rhythm in the area of the right precuneus after presentation of the visual command to the subject in the second experimental session, PR2 – spectral power of the theta rhythm in area of the right precuneus before presenting a visual command to the subject in the second experimental session.

Thus, this value demonstrates a change in power after stimulation in the first group of subjects and without stimulation in the second group of subjects.

The first group of subjects showed the presence of a statistically significant (p=3*10 ^-4 ) correlation between the power of the EEG theta rhythm in the Precuneus area and the time point of desynchronization generation. It was revealed that when the threshold power level of ΔP=0.1 is reached, the desynchronization generation time decreases. The second group did not demonstrate similar results; there was no correlation (p=0.256). The individual results of the subjects are shown in Table 1.

Table 1

Individual results of subjects

TMS subjects, group 1 Subjects Placebo, group 2 Test
Tuned No. TMS stimulation power, T Stimulus intensity as a percentage of the individual motor excitability threshold ΔDT, s ΔP Test
Tuned No. ΔDT, s ΔP 1 1.15 120% -0.636 0.35 1 -0.208 -0.15 2 0.92 96% -0.876 0.24 2 0.308 0.02 3 0.94 110% -0.056 0.14 3 0.6 0.03 4 0.86 103% -0.012 0.09 4 0.7 -0.13 5 1.06 117% -0.36 0.18 5 -0.052 0.16 6 0.72 90% -0.172 0.14 6 0.048 -0.10

ΔDT is the difference in the time of appearance of the motor imagery pattern in sessions before and after stimulation, a negative value means an increase in the speed of appearance; ΔP is the difference in the power of the theta rhythm in the area of the right precuneus in sessions before and after stimulation. All results are presented as average values.

The results obtained confirm that after stimulation of the dorsolateral prefrontal cortex, along with an increase in the power of the theta rhythm in the area of the right precuneus of the cerebral cortex, corresponding to the area of the dorsolateral prefrontal cortex, the emergence of a pattern of motor imagination in response to an external command accelerates.

Claims (9)

1. A method of brain stimulation for ideomotor training behavior, including determining the point of application of stimulation - the dorsolateral prefrontal cortex of the brain, after finding which the inductor coil of the transcranial magnetic stimulator is installed directly at this point and excitatory transcranial transcranial magnetic stimulation of the dorsolateral prefrontal cortex of the brain is carried out at a frequency 5-20 Hz, with a stimulus intensity of 90-120% of the motor excitability threshold, obtained individually by generating evoked motor responses, with the number of stimuli in one stimulation session of at least 1800 units, then ideomotor training is carried out, in which the person is presented with a task to imagine movement limbs, at the time of ideomotor training, they register and analyze the patterns of human brain activity that arise when he imagines movement; as the recorded brain activity, electrical activity is used, recorded using an encephalograph, or hemodynamic activity, recorded using emitters and receivers located on the surface of the head, as an objective measure of the speed of performing imaginary movements, we used the time of occurrence of desynchronization of the sensorimotor rhythm ΔDT, averaged over attempts, which for each subject is determined as the average moment of reaching the first local minimum of the energy of the sensorimotor rhythm, or desynchronization after the presentation of a visual stimulus. 2. The method according to claim 1, characterized in that to determine the point of application of stimulation, a navigation system is used, including a camera and reflective marks to determine the location of the inductor coil of the transcranial magnetic stimulator relative to the human head, which allows you to combine a three-dimensional model of the midbrain or an individual model of the subject’s brain , obtained using MRI, with a given stimulation point. 3. The method according to claim 2, characterized in that they use navigation systems from Localite. 4. The method according to claim 1, characterized in that the point of application of stimulation can be selected according to the MNI coordinate system and corresponds to coordinates 79, 46, 51, mm, ctf. 5. The method according to claim 1, characterized in that the Neuro-MS/D transcranial magnetic stimulator is used to carry out excitatory transcranial magnetic stimulation. 6. The method according to claim 1, characterized in that ideomotor training includes 20 tasks of two types: imaginary movement with the right hand and rest, while the tasks are presented on the monitor for 5 seconds in the form of white arrows to the right for imaginary movement and a cross for rest on gray background, tasks are randomized, and between each task there is a rest period of 3 seconds. 7. The method according to claim 1, characterized in that electrical activity recorded using an electroencephalograph is used as the recorded brain activity. 8. The method according to claim 1, characterized in that the electroencephalogram is recorded using 32 electrodes according to the 10-10 system: Fp1, Fp2, F3, Fz, F4, Fc1, Fc2, F7, Ft9, Fc5, F8, Fc6, Fc10 , T7, Tp9, T8, C3, Cz, C4, Cp5, Cp1, Cp2, Cp6, Cp10, P7, P3, Pz, P4, P8, O1, Oz, O2, located on the surface of the head, under each of which a gel is applied to improve contact with the surface of the head. 9. The method according to claim 7, characterized in that an NVX 52 electroencephalograph is used.