How fMRI-guided TMS therapy works

What is fMRI-guided TMS therapy?

fMRI-guided TMS therapy brings two technologies together: functional brain imaging and transcranial magnetic stimulation.

Resting-state functional MRI (rsfMRI) captures changes in blood flow associated with brain activity while you’re at rest. This allows our team to study functional connectivity, or how activity in one area of your brain relates to activity in another.

We analyze that information using Neurotherapeutix’s patented computational brain mapping technology. The resulting map helps your team determine the location of targets to be treated and parameters for TMS treatment.

TMS then uses a magnetic coil, computer-guided for precise placement outside the head, directing to targets inside the brain to deliver repeated magnetic pulses to the selected target.

What an fMRI-guided TMS therapy session feels like

Once your treatment plan has been established, TMS therapy sessions are straightforward and fully outpatient.

You’ll sit comfortably while the TMS coil is positioned against your scalp. During stimulation, you’ll hear a series of clicks from the device and may feel a tapping or knocking sensation beneath the coil.

You remain awake and able to speak with your treatment team throughout the session. TMS therapy does not require anesthesia or sedation, so there is no anesthesia recovery period afterward.

How long each session lasts depends on the stimulation protocol selected for you. Your team will explain your schedule and what you can expect before treatment begins.

The step-by-step fMRI-guided TMS therapy process at Neurotherapeutix

Each stage of the Neurotherapeutix process builds on the information collected in the one before it, moving from functional brain activity to a treatment target that can be precisely located during every session.

Step 1: fMRI scan to measure your brain’s networks

The process begins with resting-state functional MRI.

While you rest inside the MRI scanner, fMRI measures changes in blood flow associated with activity throughout the brain. Because no task is required, clinicians can observe patterns of activity occurring across functional networks in their resting state.

These networks support different aspects of cognition, emotion, attention, memory, and behavior.

Instead of producing only a picture of brain anatomy, the scan gives Neurotherapeutix functional data that can be analyzed to understand relationships among different brain regions.

Step 2: Clinical and neuroscience analysis of connectivity patterns

After your scan, the functional MRI data undergoes computational analysis to examine communication patterns between different brain regions.

This analysis uses changes in blood-oxygen-level-dependent (BOLD) signals to assess functional connectivity, helping our team understand how activity across interconnected brain networks relates to one another.

Our clinical and scientific teams review these findings alongside your symptoms, medical history, previous treatments, and clinical evaluation.

Particular attention may be given to networks involved in emotional regulation, attention, memory, and cognitive control, including:

• Default mode network (DMN): Supports self-reflection, autobiographical memory, and internally focused thought.
• Salience network (SN): Helps the brain recognize important information and coordinate responses to internal and external stimuli.
• Central executive network (CEN): Supports attention, working memory, decision-making, and cognitive control.

Changes in communication within or between these networks have been associated with various psychiatric and neurological conditions. However, the specific connectivity patterns and their clinical significance can vary between individuals.

By considering these findings alongside your clinical presentation, our team can identify functional connectivity patterns that may help inform individualized treatment planning.

Step 3: fMRI-based computational brain mapping to define targets and parameters

Next, Neurotherapeutix’s patented computational brain mapping technology processes the functional imaging data to create your unique brain map.

The analysis examines functional connectivity and helps identify the precise location where TMS stimulation should be directed.

This information can help your team determine treatment parameters, including:

• Target location
• Target depth
• Coil position and orientation
• Stimulation frequency
• Stimulation intensity

This is the bridge between understanding how your brain networks are functioning and determining where treatment should be delivered.

The output isn’t simply an image for clinicians to review. It becomes actionable information used to plan your TMS treatment.

Step 4: Treatment delivery with neuronavigation for consistent targeting

A precise target is only useful if clinicians can reliably locate it during treatment.

That’s where neuronavigation comes in.

Your imaging data and treatment coordinates are incorporated into a neuronavigation system that helps your team locate the planned target and position the TMS coil accordingly.

Neuronavigation also helps maintain consistent placement from one treatment session to the next.

Once positioning is confirmed, the coil delivers the magnetic pulses prescribed in your treatment protocol. Your team monitors treatment and your response throughout your course of therapy.

How fMRI-guided TMS therapy differs from standard TMS therapy

Standard TMS therapy and fMRI-guided TMS therapy both use magnetic pulses to stimulate selected areas of the brain. The primary difference lies in how treatment targets are identified and incorporated into treatment planning.

Traditional TMS protocols commonly use standardized anatomical locations or scalp-based measurements to identify stimulation targets. Some conventional approaches also use structural MRI-guided neuronavigation to improve positioning.

These methods can be effective for established indications, but anatomical targeting alone does not necessarily account for differences in how an individual’s functional brain networks are connected.

At Neurotherapeutix, fMRI-guided TMS therapy incorporates resting-state functional MRI and patented computational brain mapping to examine each patient’s functional connectivity patterns.

This information helps our clinical and scientific teams identify potential stimulation targets based on individual brain network organization rather than relying solely on standardized anatomical locations.

During treatment, neuronavigation helps position the TMS coil according to the planned target and supports consistent placement across sessions.

By combining functional imaging, computational analysis, and neuronavigation, Neurotherapeutix offers an individualized approach to TMS treatment planning.

Although research continues to explore whether connectivity-informed targeting improves outcomes for different conditions, this approach provides additional functional information that may help guide treatment decisions.

For a deeper side-by-side look at targeting, treatment planning, and other differences, explore personalized TMS therapy vs. standard TMS therapy.

Protocol basics: how stimulation is chosen

Finding the target is only one part of treatment planning.

Your team must also determine the pattern of magnetic stimulation to deliver at that location.

TMS therapy can be delivered at different frequencies. Depending on the treatment goal and targeted network, clinicians may use stimulation patterns intended to increase or decrease activity.

Your protocol may include decisions about:

• Stimulation frequency
• Intensity
• Number and pattern of pulses
• Treatment duration
• Frequency of treatment sessions

These decisions are made using your brain mapping results together with your clinical needs and response to treatment.

What fMRI-guided TMS therapy is designed to support: neuroplasticity

Your brain can adapt and reorganize throughout life. This ability is known as neuroplasticity.

TMS therapy generates magnetic pulses that induce small electrical currents in targeted brain tissue. Repeated stimulation is intended to influence activity within that area and the broader networks to which it is connected.

Over time, repeated stimulation supports changes in how these networks function and communicate.

Research has examined how TMS target connectivity relates to treatment response and how repeated stimulation may alter functional connectivity.

These findings support the scientific rationale for considering both where stimulation is delivered and how that location connects with the rest of the brain.

Neurotherapeutix applies this network-based understanding through functional imaging and computational targeting before treatment begins.

Treatment isn’t intended to “rewire” your brain in a single session. It uses repeated, targeted stimulation over time to support neuroplastic changes in the networks being treated.

Conditions Neurotherapeutix commonly supports with fMRI-guided TMS therapy

Neurotherapeutix uses fMRI-guided TMS therapy for appropriate patients with a range of psychiatric, cognitive, and neurological conditions, including:

• Depression
• Anxiety
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Bipolar disorder
• ADHD
• Autism spectrum disorder
• Traumatic brain injury
• Stroke and other brain lesions
• Certain neurocognitive and neurological conditions

Whether TMS therapy is appropriate depends on more than a diagnosis. Your clinical team will review your symptoms, history, previous treatments, safety considerations, and other relevant factors before recommending treatment.

Frequently asked questions

Is fMRI-guided TMS therapy safe for everyone?

fMRI-guided TMS therapy is non-invasive and generally well tolerated.

Before treatment begins, your Neurotherapeutix team reviews your medical history, medications, implanted devices, and other relevant factors to make sure both MRI and TMS are appropriate for you.

This clinical and safety screening is an important part of creating a treatment plan designed around your individual needs.

How long does a typical session take?

There is no single session length for every patient because treatment time depends on the protocol being delivered.

Your team will explain the expected duration and frequency of your sessions when reviewing your treatment plan.

How soon will I notice improvements?

Treatment response and timing vary by patient. Some people may notice changes during their treatment course, while others experience improvement more gradually.

Your team monitors your symptoms and clinical progress throughout treatment to understand how you are responding.

Can fMRI-guided TMS therapy be combined with other treatments?

Yes, when clinically appropriate.

TMS therapy can be incorporated into a broader treatment plan that may include medication management, psychotherapy, rehabilitation, or other interventions.

Neurotherapeutix also provides full psychiatric services and mental health coaching for patients who may benefit from additional support.

Are there side effects?

fMRI-guided TMS therapy is generally well tolerated. Common side effects may include temporary headache or discomfort at the stimulation site. Some patients may also experience temporary tingling or facial muscle sensations during stimulation.

Your team will discuss potential side effects and relevant risks with you before treatment.

Do I need an MRI before I can start?

Yes. Functional MRI is fundamental to fMRI-guided TMS therapy at Neurotherapeutix.

The resting-state fMRI provides the functional data used in computational brain mapping. That analysis allows your team to identify the individualized treatment target used for neuronavigated TMS.

Is fMRI-guided TMS therapy FDA-cleared?

TMS devices are FDA-cleared for specific indications. fMRI-guided targeting itself is a clinical methodology rather than a separately FDA-cleared device category.

Neurotherapeutix combines TMS technology with its patented functional imaging and computational brain mapping methodology to determine individualized treatment targets.

Your clinician can explain the regulatory status of TMS for your particular condition, including when treatment may involve an off-label use.

See how precision becomes treatment

At Neurotherapeutix, your brain scan isn’t simply something we review. It becomes part of how treatment is planned and delivered.

From functional imaging and computational analysis to treatment targeting and neuronavigation, each step is designed to carry information about your individual brain into the treatment room.

Ready to find out whether fMRI-guided TMS therapy may be right for you?ut whether this groundbreaking treatment may be appropriate for you.