NONINVASIVE NEUROMODULATION (TMS AND TDCS) IN THE TREATMENT OF NEUROLOGICAL DISEASES: CLINICAL EVIDENCE, NEUROBIOLOGICAL MECHANISMS, AND PERSPECTIVES

Resumen

Non-invasive neuromodulation, particularly through transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), has emerged as a promising therapeutic strategy for neurological and neuropsychiatric disorders between 2021 and 2025. This review analyzed recent clinical evidence, underlying neurobiological mechanisms, and advances related to personalized medicine. Findings indicate that therapeutic effects vary according to clinical condition, disease stage, and patients’ neurobiological profiles, with more robust outcomes observed in early stages and when stimulation is combined with structured rehabilitation interventions. From a mechanistic perspective, neuromodulation regulates cortical excitability, promotes functional reorganization of neural networks, and modulates synaptic processes mediated by neurotrophic factors, thereby supporting adaptive neural plasticity. However, interindividual variability in treatment response remains a significant challenge, highlighting the need for individualized therapeutic strategies. In this context, neurophysiological, molecular, and neuroimaging biomarkers have emerged as relevant tools for predicting treatment response and optimizing stimulation parameters. Future perspectives include the implementation of neuroimaging-guided neuronavigation, adaptive stimulation protocols, and the integration of artificial intelligence to enhance therapeutic precision. Therefore, incorporating personalized medicine principles represents a critical step toward consolidating neuromodulation as an evidence-based, biomarker-informed intervention in contemporary clinical practice.