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Updated: May 19, 2026
Individualized rTMS Treatment for Depression using an fMRI-Based Targeting Method
Published on: August 2, 2021
Illuminating posterior targets for TMS beyond the prefrontal cortex
Daniel M McCalley1,2, Lauren L Sanderson3,4, Logan T Dowdle5,6
1Veterans Affairs Palo Alto Healthcare System, Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Palo Alto, CA.
Abstract:
Transcranial Magnetic Stimulation (TMS) is rapidly developing as a therapeutic tool for multiple psychiatric disorders. All current FDA-cleared TMS indications for psychiatric illness target the frontal lobes. Historically, TMS target selection was based on reports of brain lesion locations that cause illness or functional neuroimaging correlates within the prefrontal cortex. In addition to prefrontal targets, however, these neuroimaging studies have also consistently implicated posterior brain regions in a variety of psychiatric disorders. To date, these posterior regions have rarely been tested in TMS clinical trials. In this perspective, we consider the role of posterior regions in psychiatric disorders such as the occipital cortex, precuneus, inferior parietal lobules (IPL), and cerebellum. We synthesize preliminary evidence across few existing TMS trials targeting posterior regions and consider the risks and benefits of stimulating posterior targets for the treatment of psychiatric illness.
Insights
Transcranial Magnetic Stimulation (TMS) shows promise for psychiatric disorders beyond the frontal lobes. This perspective explores the potential of targeting posterior brain regions, like the occipital cortex, for novel therapeutic approaches.
Area of Science:
- Neuroscience
- Psychiatry
- Neuromodulation
Background:
- Transcranial Magnetic Stimulation (TMS) is an emerging therapy for psychiatric disorders.
- Current FDA-cleared TMS psychiatric indications focus on frontal lobe targets.
- Historically, TMS targets were based on lesion studies and prefrontal cortex imaging.
Purpose of the Study:
- To explore the role of posterior brain regions in psychiatric disorders.
- To review preliminary evidence for TMS targeting posterior regions.
- To consider the risks and benefits of stimulating posterior brain areas.
Main Methods:
- Literature review of neuroimaging studies implicating posterior regions.
- Synthesis of preliminary data from existing TMS trials targeting posterior areas.
- Perspective on the potential therapeutic applications of posterior TMS.
Main Results:
- Neuroimaging studies consistently implicate posterior regions (occipital cortex, precuneus, IPL, cerebellum) in psychiatric disorders.
- Few TMS clinical trials have targeted these posterior regions to date.
- Preliminary evidence suggests potential but requires further investigation.
Conclusions:
- Posterior brain regions may represent novel targets for TMS therapy in psychiatry.
- Further research is needed to evaluate the efficacy and safety of posterior TMS.
- Expanding TMS targets beyond the frontal lobes could broaden therapeutic options for psychiatric illness.
