Consensus guidelines for the use of concurrent TMS-fMRI in cognitive and clinical neuroscience

Alexandra Woolgar^#¹, Eva Feredoes^#², Moataz Assem³, Yasmine Bassil⁴, Til O Bergmann^{5

6}, Lysianne Beynel⁷, Michael Burke⁸, Robin F H Cash⁹, Roch M Comeau¹⁰, Marta M Correia³, Erhan Genc^{8

11}, Gesa Hartwigsen^{12

13}, Jade B Jackson³, Matthias Kienle¹⁴, Patrik Kunz¹⁵, Olga Leticevscaia², Bruce Luber⁷, Maximilian Lueckel^{5

6}, Claus Mathiesen¹⁴, Elizabeth Michael³, Ole Numssen¹³, Desmond J Oathes¹⁶, Allyson C Rosen¹⁷, Teresa Schuhmann¹⁸, Anna-Lisa Schuler¹³, Catriona L Scrivener¹⁹, Axel Thielscher^{20

21}, Martin Tik^{17

22}, Yordan Todorov¹⁴, Maria Vasileiadi²², Christian Windischberger²², Molly S Hermiller²³, Alexander T Sack¹⁸

Affiliations

¹ University of Cambridge, Cambridge, UK. alexandra.woolgar@mrc-cbu.cam.ac.uk.
² University of Reading, Reading, UK.
³ University of Cambridge, Cambridge, UK.
⁴ Emory University, Atlanta, GA, USA.
⁵ Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany.
⁶ Leibniz Institute for Resilience Research (LIR), Mainz, Germany.
⁷ National Institutes of Health, Bethesda, MD, USA.
⁸ Leibniz Research Center for Working Environment and Human Factors, Dortmund, Germany.
⁹ University of Melbourne, Melbourne, Victoria, Australia.
¹⁰ Rogue Research Inc., Montréal, Québec, Canada.
¹¹ Technical University of Dortmund, Dortmund, Germany.
¹² Cognitive and Biological Psychology, Wilhelm Wundt Institute for Psychology, Leipzig University, Leipzig, Germany.
¹³ Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
¹⁴ MagVenture, Inc., Farum, Denmark.
¹⁵ Localite GmbH, Bonn, Germany.
¹⁶ University of Pennsylvania, Philadelphia, PA, USA.
¹⁷ Stanford University School of Medicine, Stanford, CA, USA.
¹⁸ Maastricht University, Maastricht, The Netherlands.
¹⁹ University of Edinburgh, Edinburgh, UK.
²⁰ Technical University of Denmark, Kongens Lyngby, Denmark.
²¹ Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
²² Medical University of Vienna, Wien, Austria.
²³ Florida State University, Tallahassee, FL, USA.

^# Contributed equally.

PMID: 40555803
DOI: 10.1038/s41596-025-01182-4

Review

Consensus guidelines for the use of concurrent TMS-fMRI in cognitive and clinical neuroscience

Alexandra Woolgar et al. Nat Protoc. 2025.

. 2025 Jun 24.

doi: 10.1038/s41596-025-01182-4. Online ahead of print.

Authors

Affiliations

¹ University of Cambridge, Cambridge, UK. alexandra.woolgar@mrc-cbu.cam.ac.uk.
² University of Reading, Reading, UK.
³ University of Cambridge, Cambridge, UK.
⁴ Emory University, Atlanta, GA, USA.
⁵ Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany.
⁶ Leibniz Institute for Resilience Research (LIR), Mainz, Germany.
⁷ National Institutes of Health, Bethesda, MD, USA.
⁸ Leibniz Research Center for Working Environment and Human Factors, Dortmund, Germany.
⁹ University of Melbourne, Melbourne, Victoria, Australia.
¹⁰ Rogue Research Inc., Montréal, Québec, Canada.
¹¹ Technical University of Dortmund, Dortmund, Germany.
¹² Cognitive and Biological Psychology, Wilhelm Wundt Institute for Psychology, Leipzig University, Leipzig, Germany.
¹³ Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
¹⁴ MagVenture, Inc., Farum, Denmark.
¹⁵ Localite GmbH, Bonn, Germany.
¹⁶ University of Pennsylvania, Philadelphia, PA, USA.
¹⁷ Stanford University School of Medicine, Stanford, CA, USA.
¹⁸ Maastricht University, Maastricht, The Netherlands.
¹⁹ University of Edinburgh, Edinburgh, UK.
²⁰ Technical University of Denmark, Kongens Lyngby, Denmark.
²¹ Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
²² Medical University of Vienna, Wien, Austria.
²³ Florida State University, Tallahassee, FL, USA.

^# Contributed equally.

PMID: 40555803
DOI: 10.1038/s41596-025-01182-4

Abstract

Concurrent transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (TMS-fMRI) provides a step-change in the toolkit of neuroscience research. TMS enables the noninvasive perturbation of ongoing human brain activity, and when coupled to fMRI for the simultaneous read-out of its effects across the brain, concurrent TMS-fMRI enables studies aimed at determining the causal inference of human brain-behavior relationships, with implications for both fundamental research and clinical application. Many of the technical barriers to TMS-fMRI implementation, such as hardware design and setups, have now been overcome, and the research community in the field is rapidly growing. Here, we present the guidelines set by an international consensus, from researchers at all levels and across the fields of cognitive and applied human neuroscience, for the experimental design and practical considerations of concurrent TMS-fMRI via 12 detailed use cases. These guidelines may facilitate the uptake of this approach and simplify the experimental design and planning stages.

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Conflict of interest statement

Competing interests: A.T.S. is Chief Scientific Advisor of PlatoScience Medical and Alpha Brain Technologies, Chief Executive Officer of Neurowear Medical and Director of the Clinical TMS Certification Course ( www.tmscourse.eu ) and received equipment support from MagVenture, MagStim and Deymed. C.W. is a member of the scientific advisory board of Brightmind.AI GmbH and a shareholder of ALSIX GmbH, supplier of tailored MR hardware. P.K. is employed by Localite GmbH, manufacturer of TMS neuronavigation devices. M.K., C.M. and Y.T. are employees of MagVenture, suppliers of TMS-fMRI solutions. R.M.C. is an employee of Rogue Research Solutions, supplier of TMS neuronavigation devices.

References

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Consensus guidelines for the use of concurrent TMS-fMRI in cognitive and clinical neuroscience

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Consensus guidelines for the use of concurrent TMS-fMRI in cognitive and clinical neuroscience

Authors

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Abstract

Conflict of interest statement

References

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