Understanding Individualized TMS Targeting
Individualized TMS targeting is an approach that aims to tailor transcranial magnetic stimulation treatments to each patient’s unique brain patterns. Instead of placing the TMS coil using only physical landmarks, clinicians can use functional brain imaging to guide where stimulation might be most effective. This strategy may be especially important for people with treatment resistant depression, since standard targeting does not always engage the right brain circuits for every patient.
A recent study explored how different brain connectivity models influence the repeatability of these personalized maps. Repeatability is an important concept in individualized TMS targeting because a treatment plan needs to be reliable across imaging sessions. If the target location changes too much between scans, it becomes difficult to design a stable and effective treatment course.
How Cingulo Opercular Regions Strengthen Targeting Consistency
The new research compared several targeting methods that focused on the dorsolateral prefrontal cortex, a key region involved in mood regulation. The team included methods based on subgenual anterior cingulate cortex connectivity, right anterior insula connectivity, and a newer depression core network model.
The depression core network model, particularly its seeds in the cingulo opercular system, produced the most consistent target maps. This suggests that the cingulo opercular network may provide a more stable signature related to depression symptoms. Using these seeds resulted in high repeatability whether scans were done during rest or while watching a short movie.
This finding matters because consistency in individualized TMS targeting directly influences how well clinicians can reproduce the same target across multiple sessions. More reliable maps support safer and more precise stimulation plans, which may ultimately produce stronger treatment outcomes.
Can Naturalistic Movie Stimuli Improve Scan Quality
The study also tested whether a movie can improve data quality during imaging. Watching a movie helped participants stay alert and reduced head motion, which is often a major challenge during functional MRI. Although the movie condition did not significantly increase statistical repeatability, it offered practical advantages that make personalized scans easier to collect.
For clinicians and clinics, this hints at the value of more engaging scan environments. Reduced movement means cleaner data, fewer unusable scans, and potentially a smoother workflow when developing individualized TMS targeting plans.
What This Means For The Future Of TMS Care
The results support expanding research on multiseed connectivity approaches. Incorporating several stable brain regions at once could offer a more complete picture of depression related circuits and provide more reliable guidance for individualized TMS targeting.
Moving forward, precision TMS may shift toward models that combine advanced imaging, naturalistic stimuli, and connectivity patterns that remain stable across time. The cingulo opercular network stands out as a promising focus, especially for people whose depression does not respond to standard treatment approaches.
For patients, this research signals progress toward TMS treatments that are more personalized, more consistent, and potentially more effective. For providers, it highlights how imaging based guidance, new computational models, and creative scanning techniques can enhance the feasibility of precision neuromodulation.
As interventional psychiatry continues to evolve, individualized TMS targeting will likely become a key component of next generation depression care.
Citations
- Komulainen E, Salminen AS, Aydogan DB, Pamilo S, Raij TT. Cingulo opercular connectivity enhances the repeatability of transcranial magnetic stimulation target maps. Neuromodulation. 2025. https://doi.org/10.1016/j.neurom.2025.09.316
- Chen X et al. Subgenual anterior cingulate cortex functional connectivity abnormalities in depression. Sci Bull. 2025. https://doi.org/10.1016/j.scib.2025.05.042