Therapeutic use of transcranial magnetic stimulation (TMS) for people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): a scoping review

Sanal-Hayes, Nilihan E. M.; Slade, Kate; McLaughlin, Marie; Metcalfe, Paige; Berry, Ethan; Thornton, Eleanor J.; Hayes, Lawrence D.

Abstract

Background
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is characterised by persistent fatigue, cognitive issues, headaches, disrupted sleep, myalgias, arthralgias, post-exertional malaise (PEM), and orthostatic intolerance. Transcranial magnetic stimulation (TMS) is a non-invasive method using magnetic fields to stimulate nerve cells in the brain which shows therapeutic potential for conditions like depression, chronic pain, and cognitive impairments. However, the National Institute for Health and Care Excellence (NICE) does not recommend TMS for ME/CFS symptom management, making exploration of its therapeutic potential for people with ME/CFS (PwME) a logical step.

Objective
Our review aimed to systematically search the published literature on therapeutic use of TMS for PwME, map study characteristics and methodologies, and offer recommendations to advance research in this area.

Methods
We conducted a systematic literature search of CINAHL Ultimate, MEDLINE, ScienceDirect, and Scopus from 1st January 1985 to 16th February 2024. Only literature in English was included.

Results
Following initial database searches, 1040 articles were identified and a total of three articles met inclusion criteria and were included. This review indicated that, whilst studies indicate positive findings for fatigue-related symptoms and functional abilities, the evidence for rTMS being a promising non-invasive treatment for ME/CFS is limited by small-sample pilot data and the critical absence of control groups within the current literature.

Conclusions
Larger cohorts, control groups, and standardised protocols are needed to improve generalisability and optimise reporting. Future research on rTMS in PwME should focus on feasibility, acceptability, and longer follow-up durations to track symptom improvement.

• Journal Article Type: Review
• Acceptance Date: May 20, 2025
• Online Publication Date: Jun 4, 2025
• Deposit Date: Jun 10, 2025
• Publicly Available Date: Jun 11, 2025
• Journal: Fatigue: Biomedicine, Health & Behavior
• Print ISSN: 2164-1846
• Electronic ISSN: 2164-1862
• Publisher: Taylor and Francis
• Peer Reviewed: Peer Reviewed
• Pages: 1-20
• DOI: https://doi.org/10.1080/21641846.2025.2513807