Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector146510.17816/ACEN.1465RVGFFXReviewsОбзорыReview ArticleEvolution of the approaches to target identification for therapeutic repetitive transcranial magnetic stimulationЭволюция подходов к определению локализации мишеней для терапевтической ритмической транскраниальной магнитной стимуляцииhttps://orcid.org/0000-0003-0716-3737BakulinIlya S.БакулинИлья Сергеевич
Russian Federation

Cand. Sci. (Med.), senior researcher, Head, Noninvasive neuromodulation group, Institute of Neurorehabilitation

канд. мед. наук, с. н. с., рук. группы неинвазивной нейромодуляции Института нейрореабилитации и восстановительных технологий

annaly-nevrologii@neurology.ruhttps://orcid.org/0000-0003-1841-1177PoydashevaAlexandra G.ПойдашеваАлександра Георгиевна
Russian Federation

Cand. Sci. (Med.), researcher, Noninvasive neuromodulation group, Institute of Neurorehabilitation

канд. мед. наук, н. с. группы неинвазивной нейромодуляции Института нейрореабилитации и восстановительных технологий

annaly-nevrologii@neurology.ruhttps://orcid.org/0000-0001-9951-9803SinitsynDmitry O.СиницынДмитрий Олегович
Russian Federation

Cand. Sci. (Physics and Mathematics), senior researcher, Noninvasive neuromodulation group, Institute of Neurorehabilitation

канд. физ.-мат. наук, с. н. с. Института нейрореабилитации и восстановительных технологий

annaly-nevrologii@neurology.ruhttps://orcid.org/0000-0002-2481-4565SergeevaAnastasia N.СергееваАнастасия Николаевна
Russian Federation

Cand. Sci. (Med.), researcher, Radiology department, Institute of Clinical and Preventive Neurology

канд. мед. наук, н. с. отдела лучевой диагностики Института клинической и профилактической неврологии

annaly-nevrologii@neurology.ruhttps://orcid.org/0000-0001-8544-3107ZabirovaAlfiia Kh.ЗабироваАльфия Ходжаевна
Russian Federation

junior researcher, Noninvasive neuromodulation group, Institute of Neurorehabilitation

м. н. с. группы неинвазивной нейромодуляции Института нейрореабилитации и восстановительных технологий

annaly-nevrologii@neurology.ruhttps://orcid.org/0000-0002-9267-8315LagodaDmitry Yu.ЛагодаДмитрий Юрьевич
Russian Federation

Cand. Sci. (Med.), researcher, Noninvasive neuromodulation group, Institute of Neurorehabilitation

канд. мед. наук, н. с. группы неинвазивной нейромодуляции Института нейрореабилитации и восстановительных технологий

annaly-nevrologii@neurology.ruhttps://orcid.org/0000-0002-9130-1292SergeevDmitry V.СергеевДмитрий Владимирович
Russian Federation

Cand. Sci. (Med.), senior researcher, Department of consciousness and memory, Institute of Neurorehabilitation, scientific secretary

канд. мед. наук, с. н. с. отдела исследований сознания и памяти Института нейрореабилитации и восстановительных технологий, учёный секретарь

annaly-nevrologii@neurology.ruhttps://orcid.org/0000-0003-3956-6362SuponevaNatalia A.СупоневаНаталья Александровна
Russian Federation

Dr. Sci. (Med.), Corr. member of RAS, Director, Institute of Neurorehabilitation

д-р мед. наук, член-корр. РАН, директор Института нейрореабилитации и восстановительных технологий

annaly-nevrologii@neurology.ruhttps://orcid.org/0000-0002-6338-0392PiradovMichael A.ПирадовМихаил Александрович
Russian Federation

Dr. Sci. (Med.), Professor, Full member of RAS, Director, Vice-President of the Russian Academy of Sciences

д-р мед. наук, профессор, академик РАН, вице-президент РАН, директор

annaly-nevrologii@neurology.ruRussian Center of Neurology and NeurosciencesРоссийский центр неврологии и нейронаук0704202620182942212202528012026Copyright ©; 2026, Bakulin I.S., Poydasheva A.G., Sinitsyn D.O., Sergeeva A.N., Zabirova A.K., Lagoda D.Y., Sergeev D.V., Suponeva N.A., Piradov M.A.Copyright ©; 2026, Бакулин И.С., Пойдашева А.Г., Синицын Д.О., Сергеева А.Н., Забирова А.Х., Лагода Д.Ю., Сергеев Д.В., Супонева Н.А., Пирадов М.А.2026Bakulin I.S., Poydasheva A.G., Sinitsyn D.O., Sergeeva A.N., Zabirova A.K., Lagoda D.Y., Sergeev D.V., Suponeva N.A., Piradov M.A.Бакулин И.С., Пойдашева А.Г., Синицын Д.О., Сергеева А.Н., Забирова А.Х., Лагода Д.Ю., Сергеев Д.В., Супонева Н.А., Пирадов М.А.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/1465

Repetitive transcranial magnetic stimulation (rTMS) has been widely used in clinical practice for therapeutic neuromodulation in a number of nervous system disorders. However, current application of this method is limited primarily by its small effect size and high variability. Among promising research directions for improving rTMS efficacy, novel approaches to target identification hold particular importance. Standard approaches involve selecting relatively large anatomical cortical areas as targets, with coil positioning based on external landmarks or craniometric measurements. However, these methods often fail to target the intended cortical area, or account for individual variations in cortical gyral anatomy and functional area localization. Neuronavigation allows high-precision positioning of the coil on the head surface relative to the cortical target based on structural and functional neuroimaging data. In recent years, approaches to rTMS target identification based on resting-state fMRI data have been particularly intensively developed; analysis of such data enables identification of areas with altered connectivity and localization of neuronal network nodes. This enables personalized determination of rTMS targets. This review discusses the main approaches to rTMS target identification, their methodological features, evidence base, key advantages, and limitations. The role of navigation for determining optimal coil orientation relative to the target cortical area and selecting stimulation intensity is separately addressed.

Ритмическая транскраниальная магнитная стимуляция (рТМС) нашла широкое применение в клинической практике для терапевтической нейромодуляции при ряде заболеваний нервной системы. Однако сегодня применение метода ограничено преимущественно небольшим размером эффекта и его высокой вариабельностью. В ряду перспективных направлений исследований по повышению эффективности рТМС особое место имеет разработка новых подходов к определению мишеней для стимуляции. Стандартные подходы предполагают выбор в качестве мишени относительно крупных анатомических областей коры с позиционированием катушки по внешним ориентирам или краниометрическим измерениям. При их использовании далеко не всегда удаётся воздействовать на таргетную зону коры, невозможно учитывать индивидуальные особенности анатомии корковых извилин и расположения функциональных зон. Использование нейронавигации позволяет высокоточно позиционировать катушку на поверхности головы относительно корковой мишени по данным структурной и функциональной нейровизуализации. В последние годы особенно интенсивно развиваются подходы к определению мишеней для рТМС на основе данных функциональной МРТ покоя, анализ которых позволяет определять зоны с изменённой коннективностью и локализацию узлов нейрональных сетей. Становится возможным персонализированное определение мишеней для рТМС. В обзоре обсуждаются основные подходы к определению мишеней для рТМС, их методологические особенности, доказательная база, основные преимущества и ограничения. Отдельно обсуждается роль навигации для определения оптимальной ориентации катушки относительно таргетной корковой зоны и выбора интенсивности стимуляции.

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