.. include:: ../links.inc

Magstim BiStim²
===============

The `BiStim²`_ is a paired-pulse stimulator combining 2 monophasic stimulators to
deliver paired pulses through 2 separate or through a single :term:`coil`. The paired
pulses can be delivered with independent stimulation intensities and variable
inter-pulse intervals.

Magstim devices share common features that are detailed in the
:ref:`common features section of the guidelines <tms/guidelines:Magstim devices>`.

.. image:: ../_static/magstim/bistim-system.png
    :align: center
    :class: img-with-border
    :width: 400

Start-up
--------

The `BiStim²`_ can be started by (1) setting the power switch to ``ON`` behind both
units, and (2) pressing the power button on the front panel of both units.

.. note::

    Contrary to the `Super Rapid² Plus¹`_, the `BiStim²`_ power consumption is handled
    through a single power outlet.

Coils
-----

.. tab-set::

    .. tab-item:: Type of coils

        TODO

    .. tab-item:: Connections

        To use the `BiStim²`_ as a paired-pulse stimulation with a single :term:`coil`,
        the 2 stimulators must be connected to the appendix on the left side of the
        stimulator ``A``, and the :term:`coil` must be connected to the same appendix.

        .. image:: ../_static/magstim/bistim-coil-connection.png
            :align: center
            :class: img-with-border
            :width: 500

        .. important::

            If the coil(s) are connected to a stimulator directly, the stimulators
            work independently one from another.

Settings
--------

When both stimulators are connected to the same :term:`coil`, the stimulator ``A``
controls the intensity of both pulses (and stimulators) and the inter-pulse interval.
The pulses can be set to different intensities.

Press on the nob to circle between the 3 settings and turn the nob to set the desired
value.

.. image:: ../_static/magstim/bistim-settings.png
    :align: center
    :class: img-with-border
    :width: 100%

.. tab-set::

    .. tab-item:: Intensity

        Intensity is set as a percentage of the maximum stimulator output. The intensity
        should be defined based on
        :ref:`the individual motor threshold <tms/guidelines:Motor threshold>`.

    .. tab-item:: Inter-pulse interval

        The inter-pulse interval is set in milliseconds and defines the delay between
        the pulse delivered by both stimulators.

        .. attention::

            Using both `BiStim²`_ stimulators connected to the same :term:`coil` with an
            inter-pulse interval set to ``0`` is not equivalent to using a single
            `BiStim²`_ stimulator. This mode of operation is **not recommended**.

    .. tab-item:: Mode ε (``E``)

        When setting the inter-pulse interval to ``0``, then pressing the red button and
        turning the nob counter-clockwise, the `BiStim²`_ will enter mode ``ε``,
        displaying an ``E`` in the inter-pulse interval display. In this mode, the pulse
        delivery is controlled by the triggers only. The first trigger will deliver a
        pulse on stimulator ``A``, the second trigger will deliver a pulse on stimulator
        ``B``.

        .. image:: ../_static/magstim/bistim-settings-epsilon.png
            :align: center
            :class: img-with-border
            :width: 100%

        .. tip::

            To exit the mode ``ε``, press the red button and turn the nob clockwise.

        .. important::

            The `BiStim²`_ stimulators need time to recharge between pulses. Thus, after
            a pulse has been delivered on a stimulator, it is up to the user to ensure
            no new trigger attempts to deliver a pulse on the same stimulator before it
            is ready. Usually, the stimulator requires around 1 second to recharge
            (depends on the pulse intensity).

            If a trigger is sent to a stimulator that is not ready, the `BiStim²`_ will
            wait until it is recharged before delivering the pulse. Thus, the
            inter-pulse interval will **not** be respected.

Datasheets & Manuals
--------------------

.. list-table::
   :widths: 100
   :header-rows: 1

   * - Manual
   * - .. image:: ../_static/icons/pdf.png
           :align: center
           :alt: Manual
           :target: ../_static/downloads/manuals/magstim-bistim.pdf
           :width: 100