Cognitive effects of high-frequency repetitive transcranial magnetic stimulation: a systematic review
Open accessAbstract
Transcranial magnetic stimulation (TMS) was introduced as a non-invasive tool for the investigation of the motor cortex. The repetitive application (rTMS), causing longer lasting effects, was used to study the influence on a variety of cerebral functions. High-frequency (>1 Hz) rTMS is known to depolarize neurons under the stimulating coil and to indirectly affect areas being connected and related to emotion and behavior. Researchers found selective cognitive improvement after high-frequency (HF) stimulation specifically over the left dorsolateral prefrontal cortex (DLPFC). This article provides a systematic review of HF-rTMS studies (1999-2009) stimulating over the prefrontal cortex of patients suffering from psychiatric/neurological diseases or healthy volunteers, where the effects on cognitive functions were measured. The cognitive effect was analyzed with regard to the impact of clinical status (patients/healthy volunteers) and stimulation type (verum/sham). RTMS at 10, 15 or 20 Hz, applied over the left DLPFC, within a range of 10-15 successive sessions and an individual motor threshold of 80-110%, is most likely to cause significant cognitive improvement. In comparison, patients tend to reach a greater improvement than healthy participants. Limitations concern the absence of healthy groups in clinical studies and partly the absence of sham groups. Thus, future investigations are needed to assess cognitive rTMS effects in different psychiatric disorders versus healthy subjects using an extended standardized neuropsychological test battery. Since the pathophysiological and neurobiological basis of cognitive improvement with rTMS remains unclear, additional studies including genetics, experimental neurophysiology and functional brain imaging are necessary to explore stimulation-related functional changes in the brain.
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The DLPFC plays a critical role in emotion regulation, working memory, and executive functioning; these are impaired in individuals with a history of concussion and shown to improve after rTMS targeted at the DLPFC.
“In addition to its role in depression, the DLPFC plays a critical role in emotion regulation, working memory, and executive functioning. These are all impaired in individuals with a history of concussion and shown to improve after rTMS targeted at the DLPFC (22, 23).”
From Adaptive trial for the treatment of depressive symptoms associated with concussion using accelerated intermittent theta burst stimulation (ADEPT): rationale, design and methods (2025) · cites this paper as [22]
The Discussion (Effects on different cognitive domains; page unavailable) links working memory and executive function to the prefrontal cortex. The Results (Cognitive effects of high-frequency rTMS over the prefrontal cortex; page unavailable) report some improvements in working memory and cognitive flexibility after rTMS, but not consistent improvement across executive functions. These passages do not establish impairment or improvement in people with a history of concussion, or improvement in emotion regulation. (LLM, conf=0.88)
Experimental — accuracy not yet measurediTBS may have induced larger performance gains in lower capacity individuals, but this effect could have been averaged out by individuals with higher capacities and a greater number of epochs.
“iTBS may have induced larger performance gains in lower capacity individuals (Guse, Falkai, & Wobrock, 2010), however this effect could have been averaged out by individuals with higher capacities and a greater number of epochs.”
From Investigation of neurobiological responses to theta burst stimulation during recovery from mild traumatic brain injury (mTBI) (2023) · cites this paper as Guse, Falkai, & Wobrock, 2010
The citation is attached to the suggestion that iTBS may produce larger gains in lower-capacity individuals, not to the citing authors’ subsequent explanation about averaging. The Discussion says studies were still underway to test theta-burst stimulation’s cognitive effects; the passages found on clinical status and baseline performance do not address whether iTBS benefits lower-capacity individuals more. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Guse, B., Falkai, P., & Wobrock, T.
- Affiliations
- University of Göttingen (DE)
- Corresponding author
- Guse, Birgit
- Venue
- Journal of Neural Transmission
- Published
- 2009-10-27
- Volume
- 117
- Issue
- 1
- Pages
- 105-122
- ISSN
- 0300-9564 (ISSN-L)
- 1435-1463
- PMC
- PMC3085788
- OpenAlex
- W2084354128
- Cited by
- 340
- References
- 79
- Citations by year
- 2026: 11 · 2025: 27 · 2024: 16 · 2023: 18 · 2022: 24 · 2021: 23 · 2020: 28 · 2019: 24 · 2018: 24 · 2017: 23 · 2016: 15 · 2015: 27 · 2014: 23 · 2013: 18 · 2012: 20
- FWCI
- 0.98
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Neural Transmission (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
- GRO (submittedVersion, cc-by)
- MPG.PuRe (Max Planck Society) (submittedVersion)
- Funders
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- Sanofi
- Cilag
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Keywords
- high-frequency repetitive transcranial magnetic stimulation, cognitive effects, dorsolateral prefrontal cortex, neuropsychological outcomes, sham stimulation, mental illness, neurological disorders, motor threshold, neuromodulation
- MeSH terms
- Mental Disorders, Cognition, Humans, Prefrontal Cortex, Transcranial Magnetic Stimulation
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