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bioRxiv2026May 6, 2026Journal Article

Whole-brain mapping of TMS-induced discomfort with large-scale concurrent TMS-fMRI.

Zhuoran Li1,2,3, Yong Jiao1,2,3, Yu Zhang4,5,6, Nandi Zhang1, Amit Etkin7, Aaron D Boes1,2,3,8, Desmond J Oathes9,10,11,12, Jing Jiang1,2,3
1University of Iowa Stead Family Department of Pediatrics, Iowa City, IA, 52242, USA.
2University of Iowa Department of Psychiatry, Iowa City, IA, 52242, USA.
3Iowa Neuroscience Institute, Iowa City, IA, 52242, USA.
4Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94304, USA.
5Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, 94304, USA.
6Stanford Institute for Human-Centered Artificial Intelligence, Stanford, CA, 94304, USA.
7Alto Neuroscience, Mountain View, CA, 94041, USA.
8University of Iowa Department of Neurology, Iowa City, IA, 52242, USA.
9Center for Brain Imaging and Stimulation, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
10Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
11Penn Brain Science, Translation, Innovation, and Modulation Center, University of Pennsylvania, Philadelphia, PA, 19104, USA.
12Departments of Neuroscience, Bioengineering, Neurology and Neurosurgery, Perelman School of Medicine; University of Pennsylvania, Philadelphia, PA, 19104, USA.
PubMed PMC DOI PDF

Abstract

Transcranial magnetic stimulation (TMS) is a cornerstone tool for causal inference in human brain function and an increasingly used neuromodulation therapy, yet it induces well-recognized discomfort that may systematically bias measured outcomes. Despite its ubiquity, a critical gap remains in understanding how TMS-induced discomfort is represented across the brain and to what extent it contribute…

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