Closing the Loop in Neuromodulation: A Review of Machine Learning Approaches for EEG-Guided Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) combined with electroencephalography (EEG) provides a powerful framework to probe and modulate human cortical and corticospinal excitability. In recent years, brain state-dependent EEG–TMS paradigms have gained increasing interest by synchronizing stimulation to ongoing neural activity. However, traditional approaches relying on single oscillatory features or fixed thresholds have yielded heterogeneous and often inconsistent results, motivating the adoption of machine learning (ML) and artificial intelligence (AI) methods to model brain state in a multivariate, data-driven manner. This review synthesizes current ML and deep learning (DL) approaches aimed at predicting cortical and corticospinal excitability from pre-stimulus EEG. We contextualize these methods within brain state-dependent EEG–TMS frameworks based on oscillatory phase, power, and network-level features, and within evolving definitions of brain state that move beyond local biomarkers toward distributed, large-scale, and dynamically evolving neural representations. The reviewed studies span feature-engineered models, data-driven decoding approaches, and emerging adaptive closed-loop frameworks. Finally, we discuss key methodological challenges, translational barriers, and future directions toward personalized, interpretable, and fully closed-loop neuromodulation systems.