Repetitive transcranial magnetic stimulation (rTMS) triggers dose-dependent homeostatic rewiring in recurrent neuronal networks.

The cellular and molecular mechanisms of clinically employed repetitive transcranial magnetic stimulation (rTMS) protocols remain not well understood. However, it is clear that stimulation outcomes depend heavily on protocol designs. Current protocol designs are mainly based on experimental studies that explored functional synaptic plasticity, such as long-term potentiation of excitatory neurotransmission. Using a computational approach, we sought to address the dose-dependent effects of rTMS on the structural remodeling of stimulated and non-stimulated connected networks. Our results suggest a new mechanism of action-activity-dependent homeostatic structural remodeling-through which rTMS may assert its lasting effects on neuronal networks.We showed that the effect of rTMS on structural plasticity critically depends on stimulation intensity, frequency, and duration and that recurrent inhibition can affect the outcome of rTMS-induced homeostatic structural plasticity. These findings emphasize the use of computational approaches for an optimized rTMS protocol design, which may support the development of more effective rTMS-based therapies.