Your Brain Has Many Pathways, And TMS Can Now Use Them
We always thought that certain parts of your brain are simply "out of reach" without surgery or heavy medications. A new study from the University of Iowa confirms what we’ve observed with fMRI-guided treatment of neurological conditions using transcranial magnetic stimulation (TMS).
Deep inside your brain sits the hippocampus, a small structure that serves as your command center for memory, learning, and emotional regulation. When it malfunctions, the consequences can include Alzheimer's disease, depression, PTSD, anxiety, and even migraine. Traditionally, directly influencing the hippocampus required invasive surgery or medications that flood the entire brain rather than targeting the problem.
Neuroscientists at the University of Iowa have now shown that TMS, the noninvasive technology we use in our practice, can reliably reach and modulate the hippocampus from outside the skull.
TMS delivers magnetic pulses through the scalp to stimulate brain cells on the outer surface. The hippocampus sits too deep for the magnetic field to reach directly. But the Iowa team discovered that by using advanced brain imaging (fMRI) to map each person's unique neural "highways," they could find the exact spot on the brain's surface that acts as a remote control for the hippocampus. Stimulate that spot, and the signal travels down the tracks to the deep brain.
An important finding is that it only works when the treatment is personalized. Every person's brain wiring is as unique as a fingerprint. When researchers used a generic, one-size-fits-all spot, the hippocampus barely responded. When they mapped each patient's individual connectivity, the deep brain lit up with clear, measurable changes. This was confirmed by internal electrodes in neurosurgical patients and validated in 79 healthy volunteers.
Single-pulse TMS is already FDA-cleared for migraine, both for stopping attacks and preventing them. In our practice, we use repetitive TMS, which delivers thousands of pulses directed at sites identified by fMRI. This differs from the single-pulse TMS devices cleared for migraine, which deliver a few pulses at a time directed at the occipital cortex.
TMS is an established treatment for depression, OCD, and even smoking cessation, with growing evidence in PTSD, anxiety, brain fog, long COVID, post-concussion syndrome, and Alzheimer 's-related cognitive decline.
Researchers at Stanford, led by Dr. Nolan Williams, developed an accelerated fMRI-guided TMS protocol that achieved remission rates as high as 86% in treatment-resistant depression in initial studies, far exceeding the roughly 30% remission rate seen with standard TMS protocols
This new research suggests that by mapping each patient's unique brain connectivity, we could make TMS even more precise and effective across all of these conditions.
At our clinic, we have access to both TMS and fMRI, which means we are uniquely positioned to deliver this personalized, connectivity-guided approach to our patients with migraines and many other neurological disorders. Studies like this one reinforce what we believe: the future of brain health is noninvasive, personalized, and grounded in understanding how each individual's brain is wired.