Comprehensive Summary
This review paper systematically examines the concept of neuroenhancement through repetitive transcranial magnetic stimulation (rTMS) applied to the dorsolateral prefrontal cortex (DLPFC) in healthy adults. While rTMS has traditionally been used for rehabilitation and the treatment of psychiatric disorders, the authors highlight a growing body of research exploring its capacity to enhance cognitive functions in individuals without neurological disease. The review emphasizes that cognitive domains such as working memory, attention, processing speed, learning, decision-making, and cognitive control may be modulated through targeted stimulation of the DLPFC, a brain region closely associated with executive function and higher-order cognition. The authors conducted a comprehensive systematic review and meta-analysis of peer-reviewed randomized controlled trials published between 2013 and 2023. Studies were rigorously screened using standardized inclusion criteria, focusing on offline rTMS interventions with behavioral and cognitive outcomes. Particular attention was given to stimulation parameters, including low-frequency (LF), high-frequency (HF), and theta burst stimulation (TBS) protocols, with an emphasis on intermittent TBS (iTBS) due to its physiological similarity to natural neural firing patterns. The findings suggest that rTMS, especially when applied to the DLPFC using optimized parameters, can yield measurable cognitive improvements compared to sham or control conditions, although substantial inter-study variability remains. Importantly, the review identifies navigation strategy, precise stimulation site, and protocol selection as major contributors to heterogeneity in outcomes. Neuroimaging and electrophysiological tools such as EEG, fMRI, and fNIRS are discussed as critical methods for assessing neural changes underlying behavioral improvements. After excluding statistical outliers, the meta-analysis supports the conclusion that rTMS has genuine neuroenhancement potential in healthy adults, while also underscoring the need for standardized methodologies and clearer definitions of cognitive enhancement.
Outcomes and Implications
Although this review focuses on healthy individuals, its findings have significant implications for clinical neuroscience and translational medicine. The demonstrated ability of rTMS to enhance executive functions via DLPFC modulation reinforces its therapeutic relevance for neurological and psychiatric conditions characterized by cognitive deficits, including depression, mild cognitive impairment, schizophrenia, ADHD, and age-related cognitive decline. The evidence suggests that protocols refined in healthy populations may serve as foundational models for optimizing rTMS interventions in clinical settings. Furthermore, the documented efficacy of theta-burst stimulation highlights its potential as a time-efficient, patient-tolerable alternative to conventional rTMS, particularly for populations unable to tolerate longer stimulation sessions. This has practical implications for expanding access to non-invasive neuromodulation therapies in both outpatient and rehabilitative contexts. Beyond traditional medicine, the authors note potential applications in high-risk professions such as firefighting, military service, and surgery, where enhanced attention, decision-making, and cognitive control could improve safety and performance. Overall, the review supports the cautious integration of rTMS-based neuroenhancement into future therapeutic frameworks, provided ethical considerations, long-term safety, and individual variability are carefully addressed.