on October 26, 2026
Brain health as a multidisciplinary challenge
The brain is not an organ isolated from the rest of the body. Cognitive functions, emotions, behavior, movement, sleep, and relational skills are the result of the continuous interaction between neural networks, sensory systems, metabolism, the endocrine system, immunity, and the environment.
For this reason, the management of neurological and psychiatric conditions increasingly requires collaboration among different areas of expertise.
Neurologists, psychiatrists, neuropsychologists, psychotherapists, physiatrists, physical therapists, occupational therapists, and digital technology professionals can each contribute, according to their expertise, to the development of an individualized treatment plan.
Technology does not replace this complexity: however, it can become a tool to make it more effective.
Among the most extensively studied innovations are Transcranial Magnetic Stimulation (TMS), digital therapies, virtual reality, and rehabilitation robotics. Their value does not simply lie in being technologically advanced tools, but in the possibility of intervening on specific brain circuits, behaviors, and impaired functions, incorporating them into personalized treatment plans.
TMS: modulating the activity of brain circuits
Transcranial Magnetic Stimulation uses magnetic pulses to temporarily alter the excitability of the cortical areas beneath the stimulation coil.
In repetitive TMS, or rTMS, the administration of pulse sequences can produce changes in neuronal excitability that persist beyond the stimulation period. Protocols can be excitatory or inhibitory and are chosen based on the brain area and therapeutic goal.
The biological rationale is linked to brain plasticity, that is, the ability of neural networks to change their functional organization in response to experience and stimulation.
TMS therefore does not act like a drug circulating in the body, but as a neuromodulation tool capable of directly intervening on the activity of specific circuits.
Major depression, especially in forms resistant to conventional treatments, represents one of the best-studied clinical applications.
A recent systematic review with a dose-response meta-analysis analyzed 108 randomized controlled trials, involving a total of 5,621 participants, showing a non-linear relationship between stimulation parameters and antidepressant efficacy. The results suggest that indefinitely increasing the number of pulses or sessions does not necessarily lead to greater benefit and that there is a treatment window in which efficacy tends to be maximized. This finding is particularly important for personalized neuromodulation medicine.
Deep TMS, which uses coils designed to reach deeper cortical regions and broader networks, has also been studied in treatment-resistant depression. A meta-analysis of five randomized trials, including 507 patients, found a higher probability of response and remission compared to controls, with a comparable safety profile between the groups.
Not all TMS is the same
It is important to avoid talking about TMS as if it were a single therapy.
There are different stimulation modes, frequencies, intensities, number of sessions, coils, and anatomical targets. There are also neuronavigated protocols and techniques such as theta-burst stimulation.
The choice of protocol can therefore significantly change the outcome.
This explains why personalization is one of the most important aspects of neuromodulation: it is not enough to establish that a person has a certain diagnosis, but it is necessary to consider the brain circuit involved, the clinical phenotype, comorbidities, and the response to previous treatments.
Obsessive-compulsive disorder and other psychiatric applications
TMS has also been studied in obsessive-compulsive disorder, especially in resistant forms.
A 2024 meta-analysis of deep TMS included four randomized controlled trials involving a total of 252 patients with treatment-resistant obsessive-compulsive disorder. Active stimulation showed a higher probability of response compared to sham stimulation, with effects maintained even one month after treatment.
However, these results must be interpreted by considering the type of TMS used. A more recent review of 14 randomized trials, focused exclusively on conventional non-neuronavigated low-frequency rTMS, did not find a statistically significant advantage over sham.
The difference is important: the results of a given protocol cannot be generalized to all forms of TMS.
TMS and Alzheimer's disease: a promising but still evolving perspective
In neurodegenerative diseases, neuromodulation represents one of the most interesting areas of research.
In Alzheimer's, the goal is not only to stimulate a single brain area, but to try to modulate networks involved in memory and cognitive functions.
Particular interest has been paid to the dorsolateral prefrontal cortex and the networks connected to the hippocampus.
A meta-analysis of 25 randomized controlled trials conducted in people with mild cognitive impairment and Alzheimer's disease found improvements in several cognitive measures, including MMSE, MoCA, and ADAS-Cog. The studies also showed a generally favorable tolerability profile, although with significant heterogeneity among protocols and populations.
A randomized controlled trial also evaluated personalized rTMS targeted at the functional network of the hippocampus in people with early Alzheimer's, simultaneously exploring cognitive performance, functioning, and brain connectivity.
These results are important, but they do not yet authorize defining TMS as a therapy capable of biologically stopping or slowing the progression of Alzheimer's.
The hypothesis of a neuroprotective effect is interesting and is being studied through several mechanisms, including synaptic plasticity, modulation of neural networks, and neurotrophic factors. However, the improvement of a cognitive test does not automatically equate to demonstrating a disease-modifying effect.
It is this distinction between functional improvement and disease modification that must guide proper scientific communication.
Parkinson's: modulating motor circuits
In Parkinson's disease, rTMS is also being studied as a complementary treatment.
The rationale stems from the possibility of modulating altered motor circuits and their plasticity, with the goal of improving certain clinical manifestations.
An updated meta-analysis from 2025 collected 20 randomized controlled trials involving a total of 693 participants. rTMS was found to be associated with a significant improvement in the UPDRS-III motor score. However, the effects on cognition and mood were more variable.
A subsequent meta-analysis in 2026, including 12 studies and 457 patients, confirmed an improvement in motor symptoms compared to sham stimulation and found a possible maintenance of the effect at one month.
However, in this case too, the results do not demonstrate that TMS can modify the dopaminergic degeneration at the base of the disease.
Its possible usefulness is therefore interpreted mainly as a tool for symptomatic and rehabilitative neuromodulation, to be integrated into the treatment plan when indicated.
Brain plasticity: from mechanism to function
Brain plasticity constitutes one of the central concepts of modern neurorehabilitation.
The brain has the ability to change the strength of synaptic connections, reorganize network activity, and use alternative circuits when a function is compromised.
TMS can modulate cortical excitability and, in certain protocols, facilitate plasticity processes. This mechanism is also being studied in combination with physical exercise, cognitive rehabilitation, occupational therapy, and behavioral training.
The goal should therefore not simply be to "stimulate the brain," but to stimulate the brain while the person performs a therapeutically meaningful activity.
This integration is particularly interesting because it allows neuromodulation to be associated with experience and learning, two fundamental elements of neuronal plasticity.
Digital Therapeutics: when software becomes part of the therapy
Digital Therapeutics (DTx) are software-based therapeutic interventions developed to prevent, manage, or treat specific medical conditions through structured interventions supported by clinical evidence.
Not every smartphone application is a Digital Therapeutic.
A DTx must have a defined therapeutic purpose and must undergo an evaluation of efficacy and safety consistent with the indication for which it is used.
Applications can include programs based on cognitive-behavioral therapy, attention training, interventions for insomnia, symptom management programs, and rehabilitation tools.
An umbrella review published in 2025 synthesized evidence from meta-analyses of randomized trials on digital technologies applied to mental disorders, showing an overall favorable landscape, but one characterized by considerable heterogeneity among pathologies, interventions, and delivery methods.
Digital technology, therefore, does not automatically constitute an effective therapy: the quality of the intervention depends on the therapeutic content, clinical validation, adherence, and the correct selection of patients.
Digital therapies and ADHD
ADHD represents one of the fields in which digital technologies have been most extensively studied in childhood.
A meta-analysis of randomized studies found that digital therapies based on video games can produce small improvements in attention and hyperactivity/impulsivity compared to controls, while pharmacological treatments showed superior effects on certain outcomes.
A randomized trial conducted on 348 children also evaluated a structured digital intervention based on a video game-like interface, highlighting an improvement in objectively measured attention compared to the digital control.
More recent studies also confirm the growing interest in these technologies, but emphasize the need to distinguish effects on cognitive functioning from those on overall clinical symptoms.
The fundamental principle therefore remains that of integration: a digital therapy can represent an additional tool, but it must not automatically be considered a substitute for clinical evaluation, psychotherapy, or, when indicated, pharmacological therapy.
Virtual reality: training the brain through experience
Virtual reality allows for the creation of controlled environments in which the patient can be progressively exposed to specific situations.
This feature is particularly interesting in anxiety disorders, where exposure techniques represent a central element of cognitive-behavioral therapy.
A 2023 meta-analysis had highlighted favorable results especially when virtual reality was compared with passive controls, while the comparison with active interventions was less clear.
A more recent meta-analysis of 26 randomized trials, including 1,649 participants, found significant effects of Virtual Reality Exposure Therapy on phobic, anxiety, and post-traumatic symptomatology.
Virtual reality can therefore become a kind of therapeutic laboratory in which the patient gradually faces difficult stimuli and situations in a controlled environment.
Robotics and neurorehabilitation
Robotics applied to rehabilitation represents another frontier of personalized medicine.
Robotic devices can allow movements to be repeated numerous times, modulate exercise intensity, and provide quantitative feedback on performance.
This possibility is particularly important after a stroke, when intensive repetition and feedback can promote the recovery of motor functions.
A 2025 meta-analysis including 13 randomized studies and 424 patients highlighted an improvement in motor functions after robotic rehabilitation compared to conventional rehabilitation, with particularly evident effects in the acute and subacute phases.
An even more recent review, including 36 randomized studies and 1,941 patients, confirmed the benefits of robot-assisted training on upper limb motor function and activities of daily living, although it did not demonstrate a significant advantage for balance.
The analysis of neuroplasticity biomarkers is also a subject of research, but the evidence remains limited and does not allow these biomarkers to be used as definitive proof of brain "regeneration".
Integration is more important than any single technology
The real paradigm shift does not consist in using an isolated technology, but in combining it with the other components of rehabilitation and care.
A person with a neurological condition can, for example, benefit from a plan in which clinical evaluation, pharmacological therapy when indicated, neuromodulation, physical exercise, cognitive rehabilitation, psychological support, and digital technologies are organized according to shared goals.
TMS can modulate a circuit.
Rehabilitation can transform that modulation into learning.
A digital platform can increase training continuity.
Virtual reality can make controlled exposure possible.
Robotics can increase the quantity and precision of motor repetition.
The result does not necessarily stem from the mechanical sum of the tools, but from their coherence within an individual therapeutic project.
Personalization as the new frontier
Every brain is different.
Age, biological characteristics, disease severity, comorbidities, cognitive reserve, physical activity, sleep, emotional state, medications taken, and the ability to adhere to treatment can alter the therapeutic response.
Personalization therefore requires integrating different types of data: clinical, neuropsychological, behavioral, and, where appropriate, neurobiological.
This approach is particularly important in neuromodulation, where the choice of the area to stimulate, the intensity, the frequency, and the number of sessions can influence the outcome.
Personalization can also become central in digital therapies: difficulty levels, exercise duration, frequency, and feedback modalities can be adapted to the user's characteristics.
The future of neuroinnovation may therefore not be a single "revolutionary therapy," but the ability to build dynamic pathways in which different technologies are continuously adapted to the response of the individual.
From technology to the person
The brain medicine of the future will have to address a challenge broader than a purely technological one.
It will not be enough to have tools capable of stimulating the brain, collecting data, or producing digital exercises. It will be necessary to understand when to use them, for whom, with what goal, and at what stage of the disease.
TMS currently has significant clinical evidence, especially in certain psychiatric conditions, while in neurodegenerative diseases it represents a promising but still evolving field.
Digital Therapeutics are introducing software into medicine, but they require clinical validation and appropriate use.
Virtual reality can enhance specific psychological and rehabilitative pathways, while robotics can increase the intensity and precision of motor training.
True innovation, however, emerges when these technologies are incorporated into a multidisciplinary, personalized, and person-centered medicine.
The brain is not merely an organ to be stimulated: it is a complex biological network, embedded in an organism, in a personal history, and in an environment.
For this reason, the most important neuroinnovation may be precisely that capable of uniting the precision of technology with the complexity of the human being.
Scientific bibliography
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