Clinical development and guiding theory of transcranial magnetic stimulation: a literature review

Transcranial magnetic stimulation (TMS) is widely used as a painless, non-invasive, and well-tolerated neuromodulation technique for various psychiatric and neurological disorders. Evidence from reviews, clinical trials, and basic research indicates a promising future for this approach. However, individual differences and the complexity of these disorders often lead to TMS failing to achieve the desired therapeutic effect. The key to overcoming this limitation lies in optimizing TMS parameters, including stimulation mode, target location, pulse number, frequency, coil, and the connectivity of the target brain network. Nevertheless, most studies have focused on one or a few parameters and have yet to provide comprehensive guidance for clinical practice.

This review aims to trace the developmental trajectory of TMS, outlining the primary stimulation types and parameters, coils, theoretical models, target sites, targeting techniques (particularly personalized targeting techniques), among others, with a view to providing assistance to clinical practice and future research.

PubMed, Web of Science, and Google Scholar databases were searched for articles on the clinical evidence and methodology of TMS from inception to August 2025. The search terms included 'Transcranial magnetic stimulation', 'TMS', 'Stimulus type', 'parameters', 'theoretical model', 'coils', 'target' or 'personalied positioning', etc.

We have identified the primary TMS modalities, stimulation parameters, coil types and orientations, theoretical models, target sites, and targeting techniques that have been developed. These findings may provide valuable insights for broader TMS applications, and future research on personalized TMS targeting techniques and their accuracy/reproducibility warrants further investigation.

A comprehensive understanding of TMS is essential for overcoming challenges in its clinical application. Optimizing the selection of coils, stimulation protocols, theoretical frameworks, and target sites is critical to enhancing treatment efficacy. Given the persistent inter- and intra-individual variability observed in current studies, future research should focus on precise targeting, elucidating therapeutic mechanisms, and improving reproducibility.