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

BackgroundTranscranial 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. MethodsA 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. ResultsMeta-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. ConclusionsThe 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.