{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T05:06:29Z","timestamp":1789189589884,"version":"build-2803163510"},"reference-count":92,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Hub Life Science- Advanced Diagnosis","award":["PNRR PNC-E3-2022-23683266 PNC-HLS-DA"],"award-info":[{"award-number":["PNRR PNC-E3-2022-23683266 PNC-HLS-DA"]}]},{"name":"INNOVA\u2014CUP","award":["E63C22003780001\u00bb"],"award-info":[{"award-number":["E63C22003780001\u00bb"]}]},{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","award":["PNC-E.3"],"award-info":[{"award-number":["PNC-E.3"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001711","name":"Swiss National Science Foundation","doi-asserted-by":"crossref","award":["P500-3_239275"],"award-info":[{"award-number":["P500-3_239275"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"crossref"}]},{"award":["P500-3_239275"],"award-info":[{"award-number":["P500-3_239275"]}],"id":[{"id":"https:\/\/ror.org\/00yjd3n13","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002661","name":"Fonds de la Recherche Scientifique","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002661","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/03q83t159","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100022601","name":"Fondation M\u00e9dicale Reine Elisabeth","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100022601","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/02z24na70","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Bando SFPR 2022, SABES-ASDAA"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Transcranial magnetic stimulation (TMS) enables non-invasive, focal modulation of cortical circuits by inducing electric currents in the brain through electromagnetic induction, thereby influencing neuronal excitability and synaptic plasticity. High inter- and intra-individual variability has led, however, to moderate efficacy and reproducibility of stimulation and treatment protocols, motivating a shift toward brain-state-dependent stimulation. Over the past decade, real-time phase-triggered EEG-TMS has established the oscillatory phase\u2014particularly focusing on the sensorimotor mu rhythm\u2014as a key determinant of cortical excitability and plasticity modulation. The field, however, remains largely confined to univariate, sensor-space analyses of local mu-rhythm phase, missing large-scale network dynamics. Recent advances in online EEG source reconstruction and multivariate machine and deep learning (ML\/DL) approaches have begun to move beyond local phase toward whole-brain, network-level state estimation, achieving encouraging preliminary accuracies in predicting trial-by-trial cortical excitability, with promising applications in network-dysregulation conditions such as chronic pain. Integrating source-space reconstruction and individual biological variability, and adaptive ML\/DL pipelines into closed-loop frameworks promises to move beyond generic stimulation protocols toward selective, network-targeted neuromodulation tailored to the individual\u2019s dynamic brain state. Against this background, this review provides a critical overview of current achievements and limitations, while highlighting emerging methodological directions toward fully brain-state-adaptive and network-targeted EEG-TMS. We further present an illustrative use case of adaptive EEG-TMS for pain modulation, where treatment responses remain heterogeneous and the relevant dynamics are distributed across networks, and which therefore stands to gain most from individualized, network-targeted protocols.<\/jats:p>","DOI":"10.3390\/bioengineering13091054","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:11:22Z","timestamp":1789049482000},"page":"1054","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From Oscillations to Brain States: Real-Time EEG-TMS for Adaptive Neuromodulation"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4147-7214","authenticated-orcid":false,"given":"Melissa","family":"Null","sequence":"first","affiliation":[{"name":"Center for Mind\/Brain Sciences\u2014CIMeC, University of Trento, 38068 Rovereto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4579-6129","authenticated-orcid":false,"given":"Elena","family":"Mongiardini","sequence":"additional","affiliation":[{"name":"Center for Mind\/Brain Sciences\u2014CIMeC, University of Trento, 38068 Rovereto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3524-2195","authenticated-orcid":false,"given":"Chiara","family":"Leu","sequence":"additional","affiliation":[{"name":"Center for Interdisciplinary Pain Medicine, Department of Neurology and TUM-Neuroimaging Center, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany"},{"name":"Institute of Neuroscience, Universit\u00e9 Catholique de Louvain, 1200 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Liberati","sequence":"additional","affiliation":[{"name":"Institute of Neuroscience, Universit\u00e9 Catholique de Louvain, 1200 Brussels, Belgium"},{"name":"Psychological Sciences Research Institute, Universit\u00e9 Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9290-1804","authenticated-orcid":false,"given":"Paolo","family":"Belardinelli","sequence":"additional","affiliation":[{"name":"Center for Mind\/Brain Sciences\u2014CIMeC, University of Trento, 38068 Rovereto, Italy"},{"name":"Department of Neurology & Stroke, University of T\u00fcbingen, 72074 T\u00fcbingen, Germany"},{"name":"Hertie Institute for Clinical Brain Research, University of T\u00fcbingen, 72074 T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.brs.2017.11.016","article-title":"Real-time EEG-defined excitability states determine efficacy of TMS-induced plasticity in human motor cortex","volume":"11","author":"Zrenner","year":"2018","journal-title":"Brain Stimul."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1016\/j.brs.2020.09.005","article-title":"Induction of LTD-like corticospinal plasticity by low-frequency rTMS depends on pre-stimulus phase of sensorimotor \u03bc-rhythm","volume":"13","author":"Baur","year":"2020","journal-title":"Brain Stimul."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.brs.2022.02.006","article-title":"Prefrontal theta phase-dependent rTMS-induced plasticity of cortical and behavioral responses in human cortex","volume":"15","author":"Gordon","year":"2022","journal-title":"Brain Stimul."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"103139","DOI":"10.1016\/j.brs.2026.103139","article-title":"Single-trial assessment of gamma-frequency brain oscillations and their modulation using transcranial alternating current stimulation (tACS)","volume":"19","author":"Jonany","year":"2026","journal-title":"Brain Stimul."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1016\/j.biopsych.2007.01.018","article-title":"Efficacy and Safety of Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: A Multisite Randomized Controlled Trial","volume":"62","author":"Solvason","year":"2007","journal-title":"Biol. 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