In a recent review, researchers synthesized how transcranial magnetic stimulation (TMS) is being applied to psychological and other non-motor symptoms of Parkinson’s disease (PD)—including depression, anxiety, cognitive impairment, impulse-control disorders, sleep disturbance, and psychosis. Mechanistically, TMS appears to modulate prefrontal–striatal dopamine signaling, reshape large-scale networks, and promote neuroplasticity, with frequency-dependent effects. Clinically, high-frequency repetitive TMS (rTMS) or intermittent theta burst stimulation (iTBS) over left dorsolateral prefrontal cortex (DLPFC) shows the strongest evidence for PD depression. Low-frequency rTMS or continuous TBS (cTBS) over right DLPFC and/or supplementary motor area targets anxiety and impulse-control symptoms, likely via indirect regulation of amygdala–hippocampal circuits.
For patients with mixed anxiety–depression, bilateral or alternating protocols (eg, left DLPFC high-frequency/iTBS plus right DLPFC low-frequency/cTBS) can shorten sessions and broaden benefits. The field is moving toward precision approaches—neuronavigation, connectivity-guided targeting, biomarker and genetic predictors, and maintenance schedules—while exploring deep TMS, high-definition coils, closed-loop electroencephalography-guided delivery, and home-based maintenance devices. Overall, TMS is a promising, noninvasive adjunct that can be tailored to PD’s heterogeneous neuropsychiatric profiles and may improve quality of life when integrated into comprehensive, multidisciplinary care.
Reference: Zhou XL, Li Y, Xia W, Zheng YY, Wu AP. Advances in transcranial magnetic stimulation for psychological symptom management in Parkinson’s disease. World J Psychiatry. 2025;15(9):108497. doi: 10.5498/wjp.v15.i9.108497.
