Can individualized targets for transcranial magnetic stimulation increase treatment effectiveness in psychiatric disorders? A systematic review and meta-analysis

Abstract

Background: Transcranial magnetic stimulation (TMS) techniques have developed in recent years in research and clinical treatment. The identification of targets for TMS treatment is increasingly individualized based on morphology or function; however, whether individualized TMS targets could increase the treatment effectiveness of psychiatric disorders remains controversial. Methods: A meta-analysis was conducted to explore whether individualized TMS targets are better than standard targets. A total of 3340 studies were identified in a systematic search, and twelve were included in the quantitative review. Among them, eight used a structure-based individualized target selection method, nine were on depression, and four compared unilateral and bilateral stimulant targets. Results: Meta-analyses showed that: (1) individualized TMS targets increased the effectiveness in treating psychiatric disorders; (2) structural-based TMS targets brought additional treatment effectiveness, and PET-based structural selection methods proved to be valid; (3) there was no significant increase in the treatment effects of individualized targets in EEG-based and task-fMRI-based methods; (4) updated stimulant sequences did not increase the individualized target treatment effect; (5) individualized TMS targets showed increased treatment effectiveness in depression but not in schizophrenia; and (6) bilateral stimuli did not show additional effectiveness compared with unilateral stimuli. Conclusions: The current findings revealed that individualized TMS targets show additional treatment effectiveness compared to standard targets in treating psychiatric disorders, and structure-based selection methods are effective in identifying TMS targets. The current conclusions provide directions for future TMS research and provide valuable references for clinicians treating psychiatric disorders.