Source 1review2026MED
Toolkit/repetitive transcranial magnetic stimulation
repetitive transcranial magnetic stimulation
Also known as: rTMS
Taxonomy: Mechanism Branch / Architecture. Workflows sit above the mechanism and technique branches rather than replacing them.
Summary
We conducted a systematic review and NMA... including nine repetitive TMS (rTMS) protocols... All protocols except low-frequency rTMS over the left dorsolateral prefrontal cortex (DLPFC) showed higher response rates than sham. ... bilateral rTMS (OR: 5.75, 95% CI: 3.29-10.07)...
Usefulness & Problems
No literature-backed usefulness or problem-fit explainer has been materialized for this record yet.
Published Workflows
Objective: Synthesize and compare efficacy, safety, and stimulation-parameter evidence across non-invasive neuromodulation modalities for drug-resistant epilepsy.
Why it works: The protocol uses a consistent review process across all relevant non-invasive brain and nerve stimulation methods so that results can be rigorously compared and pooled. Subgroup and sensitivity analyses are included to investigate heterogeneity, parameter optimization, and robustness.
database searchingindependent study screeningdata extractionrisk-of-bias assessmentmeta-analysissubgroup analysissensitivity analysis
Stages
- 1.Literature search across bibliographic databases(in_silico_filter)
To identify the body of eligible literature across multiple databases before screening and synthesis.
Selection: Studies investigating efficacy and safety of non-invasive nerve and brain stimulation techniques for management of drug-resistant epilepsy.
- 2.Independent study screening(broad_screen)
To filter search results to relevant studies using independent reviewers.
Selection: Relevant studies identified from database searches.
- 3.Data extraction and risk-of-bias assessment(functional_characterization)
To collect outcome data and assess study quality before quantitative synthesis.
Selection: Screened-in relevant studies.
- 4.Meta-analysis of primary outcome(confirmatory_validation)
To quantitatively assess the primary efficacy outcome across included studies.
Selection: Extracted primary outcome data on seizure reduction.
- 5.Subgroup analysis for heterogeneity and protocol settings(secondary_characterization)
To investigate why results differ across studies and to identify optimal stimulation parameters for each intervention where possible.
Selection: Included studies and pooled outcome data.
- 6.Sensitivity analysis for robustness(decision_gate)
To test whether the synthesized results remain stable under alternative analytical assumptions or study subsets.
Selection: Meta-analytic and subgroup-analysis results.
Steps
- 1.Search bibliographic databases for relevant DRE neuromodulation studies
Identify studies on efficacy and safety of non-invasive nerve and brain stimulation techniques for drug-resistant epilepsy.
Relevant literature must be assembled before screening, extraction, and synthesis can occur.
- 2.Independently screen retrieved studies in Covidence
Determine which retrieved studies are relevant for inclusion.
Screening follows retrieval so irrelevant records can be removed before detailed extraction.
- 3.Resolve screening discrepancies with a third reviewer
Adjudicate disagreements in study selection.
Discrepancy resolution is needed after independent screening and before final inclusion decisions.
- 4.Extract study data and assess risk of bias
Collect outcome and study-quality information needed for synthesis.
Quantitative synthesis depends on having extracted outcomes and quality assessments from included studies.
- 5.Perform meta-analysis on seizure reduction outcomes
Quantitatively assess the primary efficacy outcome across included studies.
Meta-analysis follows data extraction because pooled estimates require harmonized outcome data.
- 6.Run subgroup analyses to examine heterogeneity and optimal settings
Identify potential sources of heterogeneity and optimal protocol settings for each intervention.
Subgroup analysis is performed after pooled analysis so differences across studies and parameter regimes can be interpreted in context of overall results.
- 7.Conduct sensitivity analyses to test robustness
Evaluate how robust the synthesized results are.
Robustness testing follows the main and subgroup analyses so conclusions can be checked before final interpretation.
Taxonomy & Function
Primary hierarchy
Mechanism Branch
Architecture: A delivery strategy grouped with the mechanism branch because it determines how a system is instantiated and deployed in context.
Techniques
Functional AssayTarget processes
signalingInput: Magnetic
Validation
Cell-freeBacteriaMammalianMouseHumanTherapeuticIndep. Replication
Supporting Sources
Source 2review2019The Cerebellum
Source 3primary paper2025MED
Source 4primary paper2025MED
Source 5primary paper2026MED
Source 6review2025MED
Source 7review2025MED
Source 8review2018Molecular Neurobiology
Ranked Claims
Bilateral rTMS was among the top-performing strategies and was effective for general depression and treatment-resistant depression.
confidence interval 95 3.29-10.07odds ratio response vs sham 5.75 OR
Bilateral TBS was among the top-performing strategies and was effective for general depression and treatment-resistant depression.
confidence interval 95 2.51-11.36odds ratio response vs sham 5.37 OR
In this network meta-analysis, all reviewed neuromodulation protocols except low-frequency left-DLPFC rTMS showed higher response rates than sham.
tFUS had the highest response rate among compared noninvasive neuromodulation strategies in the network meta-analysis.
confidence interval 95 1.35-38.47odds ratio response vs sham 7.24 OR
Most studies included in the review were rated as having low or unclear risk of bias.
included patients 7667 patientsincluded rcts 129 RCTsstudies low or unclear risk of bias percent 87.6 %treatment arms 272 arms
ECT, rTMS, tES, and FUS are reviewed as plasticity-inducing non-surgical neuromodulations for late-life depression.
Bilateral rTMS was the most effective strategy when used as add-on therapy.
Bilateral TBS showed the highest response rate when administered as monotherapy.
These neuromodulation strategies could promote cortical plasticity and improve network connectivity and prefrontal function, potentially reducing cognitive decline.
The growing evidence base suggests that newer non-invasive brain stimulation techniques could transform treatment of psychiatric conditions and support integration into clinical practice.
Among the reviewed non-invasive neurostimulation modalities for drug-resistant epilepsy, rTMS and tDCS have the strongest evidence for effectiveness.
ECT remains the gold-standard neuromodulation option for severe psychogeriatric presentations such as psychosis or catatonia, but it carries cognitive risks.
ECT remains the gold-standard for severe presentations, such as psychosis or catatonia, despite its cognitive risks.
rTMS provides a strong balance of efficacy and tolerability for non-psychotic treatment-resistant late-life depression.
rTMS provides a powerful balance of efficacy and tolerability for non-psychotic TRD.
The review found insufficient data to determine effect sizes for tACS, LI-FUS, and TNS in drug-resistant epilepsy.
In the review meta-analysis, rTMS was associated with a pooled mean seizure-frequency change of -30.2% and a responder rate of 38% at end of follow-up.
95% confidence interval [-49.6, -10.7%]95% confidence interval [24, 51%]pooled mean change in seizure frequency -30.2 %responder rate 38 %
In the review meta-analysis, tDCS was associated with a pooled mean seizure-frequency change of -46.9% and a responder rate of 49% at end of follow-up.
95% confidence interval [-66.6, -27.3%]95% confidence interval [32, 66%]pooled mean change in seizure frequency -46.9 %responder rate 49 %
In the review meta-analysis, tVNS was associated with a pooled mean seizure-frequency change of -49.2% and a responder rate of 29% at end of follow-up.
95% confidence interval [-86.7, -11.8%]95% confidence interval [7, 50%]pooled mean change in seizure frequency -49.2 %responder rate 29 %
The review reported a responder rate of 42% for TNS, but effect-size estimation was limited by inadequate data.
95% confidence interval [24, 60%]responder rate 42 %
rTMS and tDCS demonstrate encouraging results with minimal side effects in the reviewed South Asian psychiatric literature.
rTMS and tDCS are the most prominent newer non-invasive brain stimulation techniques discussed for psychiatric disorders in South Asia.
A secondary aim of the planned review is to identify optimal stimulation parameters for each intervention where possible to inform future clinical trial protocols and clinical applications.
The study's secondary aim will be to identify optimal stimulation parameters to better inform future clinical trial protocols and to maximise treatment efficacy in clinical applications.
The planned systematic review and meta-analysis will evaluate efficacy and safety of multiple non-invasive brain and nerve stimulation modalities for drug-resistant epilepsy and compare intervention types where applicable.
The proposed systematic review and meta-analysis will investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), low-intensity focused ultrasound (LI-FUS), transcutaneous vagus nerve stimulation (tVNS), and trigeminal nerve stimulation (TNS) for seizure reduction amongst patients diagnosed with DRE, with comparisons also being made between intervention types where applicable.
Non-invasive VNS offers an excellent safety profile, potential for home-based administration, expanded access, and promise for cognitive indications in psychogeriatric populations.
tDCS and non-invasive VNS offer excellent safety profiles and potential for home-based administration, expanding access and showing promise for cognitive indications.
tDCS offers an excellent safety profile, potential for home-based administration, expanded access, and promise for cognitive indications in psychogeriatric populations.
tDCS and non-invasive VNS offer excellent safety profiles and potential for home-based administration, expanding access and showing promise for cognitive indications.
The supplied evidence scaffold identifies TMS, rTMS, tDCS/ctDCS, theta burst stimulation, DBS, and CBI as explicit named methods or readouts relevant to the review's cerebellar neurostimulation landscape.
Explicitly supported component/tool names in the discovered sources include transcranial magnetic stimulation (TMS), repetitive TMS (rTMS), transcranial direct current stimulation (tDCS/ctDCS), theta burst stimulation, deep brain stimulation (DBS), and cerebellar brain inhibition (CBI).
The review covers both invasive and non-invasive approaches for manipulating cerebellar circuits in humans and animal models.
We report on the most advanced techniques for manipulating cerebellar circuits in humans and animal models and define key hurdles and questions for moving forward.
The review explicitly discusses rTMS neuromodulation as a prefrontal-targeting intervention relevant to pain.
Approval Evidence
8 sources15 linked approval claimsfirst-pass slug repetitive-transcranial-magnetic-stimulation
We conducted a systematic review and NMA... including nine repetitive TMS (rTMS) protocols... All protocols except low-frequency rTMS over the left dorsolateral prefrontal cortex (DLPFC) showed higher response rates than sham. ... bilateral rTMS (OR: 5.75, 95% CI: 3.29-10.07)...
Source:
These neuromodulations include ... repetitive transcranial magnetic stimulation (rTMS)...
Source:
Among these, the most prominent techniques are Repetitive Transcranial Magnetic Stimulation (rTMS) and Transcranial Direct Current Stimulation (tDCS), both of which demonstrate encouraging results with minimal side effects.
Source:
This narrative review provides a critical synthesis of the evidence for established neuromodulation techniques ... Repetitive Transcranial Magnetic Stimulation (rTMS)... rTMS provides a powerful balance of efficacy and tolerability for non-psychotic TRD.
Source:
The proposed systematic review and meta-analysis will investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) ... for seizure reduction amongst patients diagnosed with DRE.
Source:
This review systematically appraises and compares the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS)... in drug-resistant epilepsy.
Source:
Explicitly supported component/tool names in the discovered sources include transcranial magnetic stimulation (TMS), repetitive TMS (rTMS), transcranial direct current stimulation (tDCS/ctDCS), theta burst stimulation, deep brain stimulation (DBS), and cerebellar brain inhibition (CBI).
Source:
Explicitly supported related components include medial prefrontal cortex (mPFC), dorsolateral prefrontal cortex (DLPFC), periaqueductal gray (PAG), thalamus, hippocampus, amygdala, nucleus accumbens/reward circuitry, cholinergic M1 receptor signaling, and rTMS neuromodulation.
Source:
comparative efficacysupports
Bilateral rTMS was among the top-performing strategies and was effective for general depression and treatment-resistant depression.
Source:
comparative efficacysupports
In this network meta-analysis, all reviewed neuromodulation protocols except low-frequency left-DLPFC rTMS showed higher response rates than sham.
Source:
mechanism of actionsupports
ECT, rTMS, tES, and FUS are reviewed as plasticity-inducing non-surgical neuromodulations for late-life depression.
Source:
subgroup effectsupports
Bilateral rTMS was the most effective strategy when used as add-on therapy.
Source:
therapeutic rationalesupports
These neuromodulation strategies could promote cortical plasticity and improve network connectivity and prefrontal function, potentially reducing cognitive decline.
Source:
clinical potentialsupports
The growing evidence base suggests that newer non-invasive brain stimulation techniques could transform treatment of psychiatric conditions and support integration into clinical practice.
Source:
comparative review conclusionsupports
Among the reviewed non-invasive neurostimulation modalities for drug-resistant epilepsy, rTMS and tDCS have the strongest evidence for effectiveness.
Source:
comparative rolesupports
rTMS provides a strong balance of efficacy and tolerability for non-psychotic treatment-resistant late-life depression.
rTMS provides a powerful balance of efficacy and tolerability for non-psychotic TRD.
Source:
meta analysis outcomesupports
In the review meta-analysis, rTMS was associated with a pooled mean seizure-frequency change of -30.2% and a responder rate of 38% at end of follow-up.
Source:
performance safetysupports
rTMS and tDCS demonstrate encouraging results with minimal side effects in the reviewed South Asian psychiatric literature.
Source:
prominent modalitiessupports
rTMS and tDCS are the most prominent newer non-invasive brain stimulation techniques discussed for psychiatric disorders in South Asia.
Source:
review objectivesupports
A secondary aim of the planned review is to identify optimal stimulation parameters for each intervention where possible to inform future clinical trial protocols and clinical applications.
The study's secondary aim will be to identify optimal stimulation parameters to better inform future clinical trial protocols and to maximise treatment efficacy in clinical applications.
Source:
review objectivesupports
The planned systematic review and meta-analysis will evaluate efficacy and safety of multiple non-invasive brain and nerve stimulation modalities for drug-resistant epilepsy and compare intervention types where applicable.
The proposed systematic review and meta-analysis will investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), low-intensity focused ultrasound (LI-FUS), transcutaneous vagus nerve stimulation (tVNS), and trigeminal nerve stimulation (TNS) for seizure reduction amongst patients diagnosed with DRE, with comparisons also being made between intervention types where applicable.
Source:
method landscapesupports
The supplied evidence scaffold identifies TMS, rTMS, tDCS/ctDCS, theta burst stimulation, DBS, and CBI as explicit named methods or readouts relevant to the review's cerebellar neurostimulation landscape.
Explicitly supported component/tool names in the discovered sources include transcranial magnetic stimulation (TMS), repetitive TMS (rTMS), transcranial direct current stimulation (tDCS/ctDCS), theta burst stimulation, deep brain stimulation (DBS), and cerebellar brain inhibition (CBI).
Source:
therapeutic contextsupports
The review explicitly discusses rTMS neuromodulation as a prefrontal-targeting intervention relevant to pain.
Source:
Comparisons
No literature-backed comparison notes have been materialized for this record yet.
Ranked Citations
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