Search Results (483)

Background: We synthesized evidence from randomized clinical trials (RCTs) published between 2019 and 2025 on repetitive transcranial magnetic stimulation (rTMS) in post-stroke cognitive impairment (PSCI) and compared different stimulation parameters, cortical targets, and combinations with rehabilitation interventions. Methods: A systematic review according to PRISMA guidelines examined the RCTs applying rTMS in adults with PSCI compared with control or sham groups. The primary outcome was improvement in cognitive function and functional outcomes measured with standardized scales. Results: Fifteen studies, involving a total of 732 patients, were included. The most frequently investigated were high-frequency (≥10 Hz) stimulation protocols of the left dorsolateral prefrontal cortex, with treatment cycles ranging from 2 to 6 weeks. Overall, rTMS was generally safe and well tolerated, with rare and mild adverse events. Several studies reported improvements in cognitive performance following rTMS, although effects were variable across trials and need caution in light of heterogeneity in stimulation protocols, sample sizes, outcome measures, and methodological quality. In most cases, rTMS or intermittent theta burst stimulation combined with structured cognitive training yielded greater cognitive and functional gains than stimulation or rehabilitation alone. This suggests a positive interaction between rTMS and cognitive training, although current evidence does not yet allow definitive conclusions. Conclusions: rTMS appears to be a promising strategy for post-stroke cognitive rehabilitation, particularly for attention and executive functioning. However, heterogeneity in stimulation protocols and outcome measures, along with limited sample sizes and short follow-up, reduces the certainty and comparability of current evidence. The widespread reliance on global screening tools may further underestimate domain-specific effects. Future multicentre trials with standardized protocols and more sensitive cognitive assessments are needed to clarify efficacy and guide further clinical application of rTMS in PSCI. Full article

Background/Objectives: Tobacco use is a leading cause of preventable death worldwide and is linked to major health and economic burden. Many smokers attempt to quit, yet long-term success rates with current medicines and counseling are still modest. Long-term nicotine exposure distorts brain systems involved in reward, craving, and self-control. These changes weaken inhibitory control and strengthen responses to smoking cues, which increases the risk of relapse. Transcranial magnetic stimulation (TMS) is a non-invasive technique that delivers magnetic pulses to specific cortical regions, most commonly the dorsolateral prefrontal cortex, to influence neural activity. This narrative review explored how transcranial magnetic stimulation may aid smoking cessation by acting on neural circuits linked to nicotine dependence. Methods: Five major databases were searched for studies published between 2015 and 2026. After removal of duplicates and screening, a total of 34 studies were included in this narrative synthesis. Randomized controlled trials, clinical studies, and neuroimaging investigations involving adults with nicotine dependence were included. A thematic narrative method was employed to synthesize findings due to the differences in study designs, protocols, and outcome measures. Results: TMS has been shown to attenuate cravings, decrease daily cigarette consumption, and decrease nicotine dependence in various studies. Several trials reported higher abstinence rates with active stimulation compared with sham treatment. Meta-analytic findings indicate stronger effects with 10 Hz stimulation and treatment courses of 20 sessions or more. Neuroimaging studies report changes in functional connectivity within reward, executive control, and salience networks, suggesting partial restoration of disrupted circuits. Treatment response varies according to age, educational level, baseline dependence, and stimulation parameters. Conclusions: These findings support transcranial magnetic stimulation as a promising brain-based approach for smoking cessation, while further well-designed trials with longer follow-up are still needed. Full article

Selectively modulating specific brain-rhythm bands with physical stimuli helps both to reveal neural mechanisms and to provide non-pharmacological treatment avenues for brain disorders. This study proposes and implements a multi-channel transcranial magneto-acoustic stimulation driving system based on amplitude-modulated (AM) sine waves (AM-TMAS) intended to supply a reliable hardware platform for noninvasive, focal low-frequency rhythmic electrical stimulation of deep-brain structures. The driving system implements a 64-channel AM module based on an FPGA plus high-speed DACs. Multi-channel precision is achieved via a unified high-speed clock and a global UPDATE trigger. To overcome the large separation between envelope and carrier frequencies, we developed a high-fidelity AM waveform generation method based on DDS + LUT + envelope multiplication. The algorithm first centers the carrier samples to preserve waveform symmetry, then applies LUT-based envelope coefficients and fixed-point envelope multiplication, enabling high-precision AM outputs with carrier frequencies from 100 kHz to 2 MHz and envelope frequencies from 0.1 Hz to 100 kHz. We tested the system’s rhythmic multi-channel AM output performance across frequencies and also measured magneto-acoustic-coupled rhythmic electrical signals produced by the AM-TMAS driving setup. Any single channel reliably produced high-fidelity AM waveforms with a 500 kHz carrier and 8 Hz/40 Hz envelopes; the measured carrier was 499.998 kHz with excellent frequency stability. Both envelope and carrier frequencies are flexibly tunable. At the nominal 500 kHz carrier, envelope fidelity was further quantified: the extracted envelopes achieved NRMSEs of 1.0795% (8 Hz) and 1.9212% (40 Hz), confirming high-fidelity AM synthesis. Under a 0.3 T static magnetic field, the AM-TMAS driving system generated rhythmic electrical responses in physiological saline that carried the expected 40 Hz envelope. The proposed AM-TMAS driver achieves high accuracy in AM waveform generation and robust multi-channel performance, and—when combined with an external static magnetic field—can produce rhythmically modulated magneto-acoustic electrical stimulation. This platform provides a practical technical tool for brain-function research and the development of rhythm-targeted neuromodulation therapies. Full article

Low-field magnetic stimulation (LFMS) has been proposed as a non-invasive approach for modulating cortical oscillations through electromagnetic coupling. Frequency-aligned enhancement of alpha-band activity is of interest due to its association with cortical inhibitory balance and relaxed wakefulness. This study investigates whether a 10 Hz LFMS applied to the occipital area can induce measurable alpha-band modulation. Electromagnetic simulations were performed to determine magnetic flux distributions within a simplified spherical head model with magnetic susceptibility, which was approximating the brain’s parameters. The 10 Hz stimulation waveform—a positive ramp sawtooth—was analyzed in both time and frequency domains. Electroencephalographic (EEG) recordings were obtained before and after stimulation, and spectral analyses of relevant occipital channels were used to quantify the power redistributions. Simulations indicated localized magnetic field gradients in the occipital region. Post-stimulation EEG recordings showed a redistribution of spectral power toward the alpha-band, representing approximately 50% of total occipital spectral power, with relative increases exceeding 140% across the analyzed channels. These combined modeling and electrophysiological findings provide preliminary proof-of-concept evidence that frequency-aligned LFMS is associated with a redistribution of spectral power toward the alpha-band. Full article

Effective rehabilitation tools are essential for improving language outcomes in chronic aphasia. Speech entrainment is a behavioral treatment that has shown promise in enhancing speech output in nonfluent aphasia, potentially by acting as an external mechanism to synchronize anterior and posterior language regions in the left hemisphere. Transcranial alternating current stimulation has been hypothesized to enhance functional connectivity between brain regions by amplifying endogenous oscillations. This proof-of-concept study explored whether high-definition tACS (HD-tACS) could improve speech fluency in nonfluent aphasia when paired with speech entrainment. In a double-blind, pseudorandomized study, 1 mA of HD-tACS at 7 Hz was applied to anterior and posterior left-hemisphere regions of individuals with nonfluent aphasia (N = 13). Stimulation was applied under three conditions: in-phase, anti-phase, and sham, and paired speech entrainment. Three outcome measures were examined: (1) number of words produced; (2) number of errors, and (3) ‘entrainment’ to the speech entrainment model. Group-level analyses for two of the three outcome measures reveal statistically significant differences between the experimental conditions. In-phase alternating current stimulation yielded more words and better entrainment to the audiovisual model than the sham condition. This study provides promising evidence that HD-tACS could improve speech production in individuals with nonfluent aphasia. These results contribute to growing evidence supporting the therapeutic potential of non-invasive brain stimulation approaches as an adjuvant to traditional behavioral speech-language therapy in stroke survivors. Full article

Background/Objectives: Mild cognitive impairment (MCI) is common in Parkinson’s disease (PD) and significantly impacts quality of life. Non-invasive brain stimulation (NIBS) techniques have emerged as potential therapeutic interventions. This systematic review analyzes the current evidence regarding the efficacy of Transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES) on cognitive domains in patients with PD-MCI. Methods: A systematic search was conducted across the PubMed, Scopus, Web of Science, and Medline Ultimate databases up to 20 November 2025. We included studies investigating the effects of NIBS compared to sham stimulation on neuropsychological outcomes in diagnosed PD-MCI patients. Results: Eight studies involving different stimulation protocols were included. Interventions primarily used TMS or tES targeting the left dorsolateral prefrontal cortex (DLPFC). Episodic memory and global cognition were the most responsive domains, assessed with specific neuropsychological scales. Findings for executive functions and attention were heterogeneous, while visuospatial abilities generally showed limited immediate response. Conclusions: NIBS represents a promising but low-certainty-evidence adjunctive therapy for PD-MCI, with improvements found in memory and global cognition. Future research should prioritize larger sample sizes, combined interventions (NIBS plus cognitive rehabilitation), and extended follow-ups to evaluate long-term neuroplasticity. Full article

Background: Non-invasive brain stimulation (NIBS) is increasingly used as an adjunctive option in late-life depression (≥60 years), a condition frequently complicated by multimorbidity and incomplete response to standard treatments. Comparative real-world evidence between repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS), particularly including functional outcomes, remains limited. Methods: We conducted a retrospective, naturalistic comparative study of 104 depressed inpatients (≥60 years), either unipolar or bipolar, treated with rTMS (n = 48) or tDCS (n = 56) as part of routine care. Depression severity was assessed with the 21-item Hamilton Depression Rating Scale (HDRS21) at baseline, 2 weeks, and 1 month; response was defined as ≥50% HDRS21 score reduction and remission as HDRS21 < 7 at 1 month. Global Assessment of Functioning (GAF) was assessed at admission and discharge (baseline and 1 month). Longitudinal changes were examined using covariate-adjusted mixed-effects models; categorical outcomes were compared using χ² tests. Propensity score matching was applied as an additional approach to reduce confounding due to the observational design. Results: At 1 month, response and remission rates were significantly higher in the rTMS group than in the tDCS group (87.5% vs. 55.4%, p < 0.001; 62.5% vs. 41.1%, p = 0.047, respectively). rTMS showed greater HDRS21 score reductions at 2 weeks and 1 month (Time × Treatment, p < 0.001). GAF scores significantly improved over time in both groups (Time effect, p < 0.001) without between-technique differences (Time × Treatment, p = 0.56), and GAF scores did not differ by response/remission status. Conclusions: In this cohort of inpatients aged ≥ 60 years with depressive episodes, rTMS was associated with greater short-term reductions in HDRS21 scores compared with tDCS, whereas both modalities showed comparable improvements in GAF from admission to discharge. Full article

Human physiology is among the most complex systems in nature, characterized by intricate structural and functional networks and rich temporal dynamics. Electrophysiological signals produced by different tissues/organs reflect physiological activity, and are inherently non-stationary, non-linear, and noisy. This work focuses on fractal analysis, a framework that captures the self-similar and scale-free properties of electrophysiological signals, which is considered to act as an output of complex physiological structures that generate complex processes. Central to this approach is the principle of ‘decomplexification’, whereby aging and disease are associated with a loss of physiological complexity. We discuss key algorithms, particularly Higuchi’s fractal dimension, which is often combined with other nonlinear measures and machine-learning models for real-time analysis of electrophysiological signals. Evidence shows that fractal metrics enable the early detection and monitoring of neurological and psychiatric disorders, outperforming traditional spectral measures. In movement disorders and mood disorders, fractal and nonlinear features show high diagnostic accuracy. Beyond diagnostics, we discuss therapeutic applications, including the prediction of responsiveness to non-invasive brain stimulation. Here, we envisage the evolution of one fractal or nonlinear measure use, to several measures applied, then use it as a feature for machine learning, and then realize that a whole cluster of biomarkers must be used to reflect the state of autonomic profile, which then can be used for ontology-based application profiles that can be machine-actionable. In addition, we discuss the fractal and fractional description of transport processes, which offer innovative improvement for a much more accurate description of physiological reality as a prerequisite for further modeling: for example, this is needed for digital twins to support the clinical translation of fractal analysis for personalized medicine. In essence, if one is trying to mathematically describe or quantify structures or processes in human physiology, fractal and fractional are the supreme and adequate approach to accurately model that reality. Full article

Alzheimer’s disease (AD) is a serious medical challenge, representing an incurable and insidious disease. Current treatments can slow AD progression but cannot cure it. Promising new methods for AD therapy are essential for addressing the growing number of people with dementia, especially after the COVID-19 pandemic. The review highlights pioneering approaches to AD treatment based on innovative methods for the stimulation of brain drainage and clearance, in which the meningeal lymphatic vessels (MLVs) play a key role. Clinically promising noninvasive technologies using photobiomodulation for the effective clearance of metabolites, including amyloid beta (Aβ), and for the improvement of cognitive impairment during AD progression are discussed. An interesting part of the review is its analysis of innovative methods of improving the efficacy of anti-Aβ immunotherapy by stimulating MLV growth. The review is also focused on lifestyle, including sleep and physical exercises, discussing their support for the efficient lymphatic removal of waste products from the brain. Overall, the review provides an important, informative platform to excite the interest of a wide range of readers in the development of promising and clinically significant strategies for the treatment of AD, based on new strategies for the stimulation of brain drainage and clearance. Full article

Major depressive disorder (MDD) is one of the most prevalent mental illnesses and, despite the availability of multiple treatment options, remains difficult to treat for a substantial proportion of patients. Repetitive transcranial magnetic stimulation (rTMS) is an important therapeutic approach for depression, modulating brain activity through targeted magnetic pulses in a non-invasive manner. This review examined scientific evidence from clinical trials, large-scale analyses, and laboratory investigations regarding the effectiveness and safety of rTMS, as well as its role within contemporary therapeutic strategies for depression. In addition to conventional rTMS, the review addresses theta-burst stimulation (TBS), deep TMS, and various approaches aimed at enhancing treatment efficacy or accelerating clinical response, while also discussing the practical utility of different stimulation devices. rTMS applied to specific regions of the prefrontal cortex has demonstrated significant antidepressant effects, and intermittent theta-burst stimulation (iTBS) appears to achieve comparable outcomes within a shorter time frame. Research further indicates that rTMS is associated with neurobiological changes in brain connectivity, modulation of neurotransmitter systems, and the promotion of neuroplasticity. Across studies, rTMS is generally considered safe, with reported adverse effects being mild and transient. However, further research is needed to optimize stimulation protocols, clarify medium and long-term effects, individualize treatment approaches, and determine the durability of therapeutic benefits. Full article

Benign prostatic hyperplasia (BPH) is a significant health issue among ageing men, with ongoing research focused on elucidating its underlying mechanisms and improving experimental models. Testosterone Propionate (TP) is the first line of choice for the induction of BPH in experimental rodent models. However, TP’s controlled status as a Schedule III drug in the United States and a Class C drug in the UK presents challenges in obtaining TP for experimental use, giving preference to the sulpiride model since it is easily obtained as an alternative for the induction and study of BPH. A comprehensive literature search was conducted across multiple electronic databases, including PubMed/MEDLINE, Embase, and Web of Science. The primary PubMed search strategy included combinations of Medical Subject Headings (MeSH) and free-text terms: (“Benign prostatic hyperplasia induction” OR “and rodent models’’) AND (“Testosterone Propionate model”) AND (“sulpiride model”). Studies were included if they induced BPH (using testosterone or sulpiride models). Titles and abstracts were screened for relevance; eligible articles underwent full-text review, with data extracted thematically. No formal risk-of-bias scoring was used due to the narrative approach; instead, studies were appraised by design, rigor, plausibility, and evidence. This study reviewed published and publicly available data, so no ethical approval was required. Although both TP and sulpiride induce BPH via various mechanisms, this review provides a comparative analysis of these two commonly utilised models for studying BPH. In the TP approach, castrated rodents receive daily subcutaneous injections for 4 weeks, resulting in dihydrotestosterone (DHT)-mediated epithelial hyperplasia predominantly affecting the ventral prostate lobes. Conversely, the sulpiride model is non-invasive, employs intact animals treated with sulpiride, and induces hyperprolactinemia-mediated BPH via interactions with androgen and oestrogen receptor pathways that stimulate prostatic stromal and epithelial proliferation, particularly in the lateral and dorsal lobes, representing an alternative method. We also highlight the strengths and limitations of TP and sulpiride in replicating clinical symptoms and examine the toxicological effects of sulpiride on the kidney, testis, liver, and brain. We recommend the sulpiride model for the induction and studying of BPH, as it is readily accessible and closely mimics the pathogenesis of BPH in humans, unlike the TP model, which requires castration. Full article

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by impairments in social communication, reciprocity, and adaptive behavior. Converging neurobiological evidence suggests that these clinical features arise from aberrant connectivity and dysregulated neuronal oscillations across distributed brain networks. In particular, dysfunction within the mirror neuron regions, concentrated in the inferior frontal gyrus (IFG) and inferior parietal lobule (IPL), has been implicated in deficits of imitation, empathy, and social cognition in ASD. Non-invasive neuromodulation using repetitive transcranial magnetic stimulation (rTMS) has shown modest behavioral benefits in ASD. However, most studies apply the conventional protocols targeting the dorsolateral prefrontal cortex. The effects of intermittent theta-burst stimulation (iTBS), a potent excitatory rTMS protocol targeting the mirror neuron regions, on the oscillatory dynamics in ASD remain largely unexplored. Objective: To investigate whether iTBS targeting the bilateral IFG and IPL modulates EEG-derived oscillatory activity in adolescents with ASD and to explore the relationship between oscillatory changes and social reciprocity. Methods: Six adolescents with Level I or II ASD (ages 13–18) underwent bilateral iTBS targeting the IFG and IPL using a figure-of-eight coil and standardized theta-burst parameters. Participants were randomized to receive either 18 active iTBS sessions or a waitlist-controlled crossover design (9 sham followed by 9 active sessions). Standard 21-channel EEG recordings were obtained during the first (EEG-1) and final (EEG-2) active stimulation sessions, including pre- and post-stimulation epochs. Power spectral analyses were conducted across frequency bands (delta through gamma). Behavioral outcomes were assessed using the Childhood Autism Rating Scale, Second Edition (CARS2), administered pre- and post-intervention. Results: All participants tolerated the intervention without adverse effects. Behavioral analysis demonstrated a significant reduction in CARS2 scores following iTBS and is reported in detail in our prior clinical outcomes manuscript, consistent with improved social reciprocity (p < 0.001). EEG analysis revealed an immediate post-stimulation increase in gamma-band power during EEG-1 in five of six participants, whereas lower-frequency bands exhibited variable responses. In contrast, EEG-2 showed no consistent post-stimulation gamma enhancement. Net comparisons between EEG-1 and EEG-2 demonstrated attenuation of the initial gamma response in the same five participants. At the group level, gamma percent change did not reach statistical significance at EEG-1 (p = 0.12) or EEG-2 (p = 0.66), and exploratory comparisons between the 9-active versus 18-active arms did not reach statistical significance. While ipsi-directional changes in gamma power and CARS2 scores were observed in four participants, correlation was not identified in this pilot sample. Conclusions: Bilateral iTBS targeting the IFG and IPL induces a transient enhancement of gamma oscillations in adolescents with ASD that attenuates with repeated stimulation. This pattern is consistent with adaptive homeostatic plasticity (metaplasticity) within excitatory–inhibitory circuits, potentially mediated by GABAergic interneurons. These findings support the feasibility of EEG as an objective biomarker of neuromodulatory engagement in ASD and highlight the importance of network-level and oscillatory mechanisms in interpreting therapeutic responses. Larger, sham-controlled studies incorporating multimodal biomarkers are warranted to clarify clinical relevance and optimize personalized neuromodulation strategies. Full article

Background/Objectives: Transcranial direct current stimulation (tDCS) is increasingly used by athletes, yet sport-performance-enhancement findings are mixed and often small, with outcomes depending on stimulation target, timing, and task demands. Aim: This scoping review mapped and synthesized the soccer-specific trial evidence to identify (i) which tDCS targets and application schedules have been tested in soccer players, (ii) which soccer-relevant outcomes show the most consistent immediate (minutes–hours) or training-mediated benefits, and (iii) where evidence gaps persist. Methods: We conducted a scoping review of clinical trials in footballers, following review best-practice guidance (PRISMA-informed) and a preregistered protocol. Searches (August 2025) spanned PubMed/MEDLINE, ResearchGate, Google Scholar, and Cochrane, using combinations of “football/soccer” and “tDCS/transcranial direct current stimulation,” with inclusion restricted to trials from 2008–2025. Dual independent screening was applied. Of 47 records identified, 21 studies met the criteria. Across these, the total N was 593 (predominantly male adolescents/young adults; wide range of levels). Results: Prefrontal protocols—most commonly left-dominant dorsolateral prefrontal cortex (DLPFC) (+F3/−F4, ~2 mA, ~20 min)—most consistently improved post-match recovery status/well-being (e.g., fatigue, sleep quality, muscle soreness, stress, mood), and when repeated and/or paired with practice, shortened decision times and promoted more efficient visual search. Effects on classic executive tests were inconsistent, and bilateral anodal DLPFC under fatigue increased risk-tolerant choices. Motor-cortex targeting (C3/C4/Cz) rarely changed rapid force–power performance after a single session—e.g., multiple well-controlled trials found no immediate CMJ gains—but when paired with multi-week training (core/lumbar stability, plyometrics, HIIT, sling), it augmented strength, jump height, sprint/agility, aerobic capacity, and task-relevant EMG. Autonomic markers (exercise HR, early HR recovery) showed time-dependent normalization without specific tDCS effects in single-session, randomized designs. In contrast, a season-long applied program that added prefrontal stimulation to standard recovery reported significantly reduced creatine kinase. Across studies, protocols and masking were athlete-friendly and rigorous (~2 mA for ~20 min; robust sham/blinding), with only mild, transient sensations reported and no serious adverse events. Conclusions: In soccer players, tDCS shows a qualified pattern of benefits that follows a specificity model: prefrontal stimulation can support post-match recovery status/well-being and decision efficiency, while M1-centered stimulation is most effective when coupled with structured training to bias neuromuscular adaptation. Effects are generally modest and heterogeneous; practitioners should treat tDCS as an adjunct, not a stand-alone enhancer, and align montage × task × timing while monitoring individual responses. Full article

Background/Objectives: Parkinson’s disease (PD) is associated with alterations in resting-state Electroencephalogram (EEG) biomarkers. Identifying stimulation protocols that reliably shift these biomarkers toward healthy-like patterns is essential for developing personalized neuromodulation strategies. This study introduces a rapid, biomarker-driven framework for screening the EEG effects of diverse Galvanic Vestibular Stimulation (GVS) waveforms in PD. Methods: More than 300 subthreshold GVS stimuli were delivered during resting-state EEG to PD (n = 5) subjects and Healthy Controls (n = 5). A composite biomarker score that included spectral, cross-frequency, aperiodic, and complexity measures quantified stimulation-related changes. A linear classifier and multi-criteria decision analysis were used to evaluate and rank stimuli. Results: Stimulation produced consistent improvements in the composite biomarker score, with the strongest effects observed for beta-range sinusoids, multisine waveforms, frequency-modulated stimuli with a 75 Hz carrier, and PAC-modulated signals. No significant post-stimulation carryover effects were detected. Conclusions: While preliminary, this exploratory framework enables rapid, interpretable profiling of EEG responses to non-invasive stimulation in PD. By prioritizing candidate GVS protocols based on biomarker shifts rather than behavioural endpoints, the approach provides a practical foundation for future personalized neuromodulation strategies. Full article

Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation tool for investigating the neurophysiology of different neurological and neuropsychiatric disorders, including Parkinson’s disease (PD) and other parkinsonian syndromes and movement disorders. Briefly, TMS enables targeted stimulation of specific cortical regions through externally applied magnetic pulses, avoiding surgical intervention (as it occurs in deep brain stimulation) and making it a safe, repeatable, and well-tolerated approach. Over the past two decades, extensive research has explored the clinical utility of TMS in PD, with particular emphasis on motor cortex excitability, synaptic plasticity, and functional connectivity, which are central contributors to both motor and non-motor symptoms in PD patients. In addition, repetitive TMS and related stimulation paradigms have been shown to positively modulate cortical plasticity, i.e., the brain’s capacity to reorganize neural circuits, suggesting potential benefits for longer-term non-pharmacological management and rehabilitation protocols. More recently, studies have also investigated the role of TMS in atypical and secondary parkinsonisms, indicating that it may help characterize distinct neurophysiological abnormalities and provide symptomatic improvement in selected patients. This narrative expert review provides a comprehensive summary of TMS applications across the wide spectrum of parkinsonian syndromes, highlighting not only clinical potential, but also methodological limitations and future research directions. Full article