Neurologist-led · MRI-guided · E-field modeled · EMG-calibrated

MRI-guided TMS,
planned around your anatomy and physiology

Our Bay Area TMS program combines patient-specific MRI navigation, E-field modeling, and EMG-calibrated dosing in one neurologist-led workflow.

See what makes our approach different
DLPFC ACC sgACC Limbic Mood Circuit Sensorimotor cortex SMA Cerebellum Motor & Sensory Circuit Parietal cortex DLPFC FEF Attention & Executive Control Angular gyrus mPFC Precuneus / PCC Default Mode Network Simplified illustration. Your clinical setup is planned separately from your own MRI and treatment protocol.

The animation illustrates how a cortical target sits within a larger brain network — and how anatomy, E-field modeling, and physiology guide treatment.

Who we treat

Focused treatment for depression.

We offer FDA-cleared protocols when the diagnosis, prior treatment, safety review, and practical plan are a good fit.

FDA-cleared · adults

Major depressive disorder

For adults whose current depressive episode has not improved sufficiently with antidepressant medication, or who cannot tolerate it. Standard rTMS and shorter iTBS protocols may be considered, individualized at consultation.

Collaborative care remains central. Your psychiatrist continues to guide diagnosis, medication, psychotherapy, and crisis care; Los Altos Neurology directs the TMS procedure, navigation, dosing, safety monitoring, and outcome tracking.
E-field modeling · EMG measurement

The magnet isn’t the treatment — the field is.

A TMS pulse works by inducing an electric field in your cortex — and that field depends on your skull, your gyral anatomy, and the coil’s exact position, angle, and tilt. We don’t estimate it. The system computes it on your own MRI, in real time, as the coil moves.

Model the field

The system calculates where the induced field peaks in your cortex, how strong it is, and its orientation across your gyri — the variables that determine whether neurons respond. This is the same computation behind the platform’s presurgical mapping clearance.

Measure the response

EMG records your motor threshold — an objective electrical readout of your own cortical excitability, not a thumb twitch judged by eye — so your dose is anchored to your physiology rather than a population average.

Reproduce the vector

Every session reproduces the full stimulation vector — location, angle, tilt, and field strength — not just a dot on the scalp.

The Los Altos Neurology difference

The platform neurosurgeons trust, brought to your treatment.

Our Nexstim NBS 6 is the only navigated TMS system with FDA clearance for presurgical mapping of the motor and speech cortices — the accuracy standard used when planning brain surgery. In therapeutic TMS, we use that same E-field navigation to plan your course on your own MRI and reproduce it at every session.

What matters Los Altos Neurology Typical TMS practice
Treatment planning Los Altos NeurologyEvery course is planned on your own brain MRI. Typical practiceTarget commonly estimated from external scalp measurements and rules of thumb.
Targeting technology Los Altos NeurologyE-field navigation models the electric field each pulse produces inside your brain — on the platform cleared for presurgical motor and speech mapping. Typical practiceUnnavigated placement, or “line” navigation that does not model the field in tissue.
Session-to-session accuracy Los Altos NeurologyNavigation and head tracking reproduce the same target, angle, and dose at every session. Typical practiceCoil position is typically re-measured externally at each visit — introducing visit-to-visit variation in where stimulation actually lands.
Dosing Los Altos NeurologyMotor threshold measured objectively with EMG recordings, and re-checked if anything changes. Typical practiceOften judged by eye — watching for a thumb twitch — which can overestimate the threshold and mean a higher dose than needed.
Clinical direction Los Altos NeurologyDirected by a neurologist — a specialist in neuroanatomy and brain MRI — who personally reviews your imaging and plans your target. Typical practiceMost TMS is provided in psychiatric settings, where planning does not typically include a review of your own brain MRI.
What treatment looks like

A course, in plain terms.

Your first visit
The mapping visit runs longer: your MRI is registered to the navigation system and small EMG sensors find your motor threshold — the lowest intensity that reliably activates a hand muscle, which sets your dose.
A typical session
You are awake in a treatment chair with hearing protection. Stimulation takes about 3 to 20 minutes depending on the protocol; you hear clicking and feel tapping or pressure. Most patients drive themselves and carry on with the day.
Standard course
36 sessions over about nine weeks — daily sessions for about six weeks, then a taper, which is part of the course.
Request a consultation Call (650) 492-7999