Background: Multichannel transcranial magnetic stimulation (mTMS) enables electronic steering of induced electric fields across multiple cortical targets without physical coil repositioning, addressing key limitations of conventional single-channel TMS (sTMS). However, determining optimal input currents for focal stimulation remains challenging, and different mTMS systems have not been systematically compared under realistic hardware constraints. Objective: To develop an user-centric framework for optimizing and assessing mTMS focality by introducing a generic optimization algorithm, establishing meaningful focality metrics, and comparing mTMS coil arrays with traditional single-channel TMS across cortical targets. Methods: We developed a fast optimization framework incorporating target E-field constraints via parametrization of degenerated hyperellipsoids, explicitly integrating current-rate limits, for example from stimulator electronics and coil heating. Using high-resolution finite-element models of nine individual brains, we compared two mTMS designs (5-channel planar and 6/12-channel spherical systems) with standard sTMS figure-of-eight coils. Three complementary metrics quantified performance: Focality, Target2Max, and OverstimulatedArea. Results: Despite using a single optimized placement for all region-of-interest targets, mTMS achieved focality comparable to repositioned single-channel TMS. For superficial targets, single-channel TMS showed slightly better focality, but for deeper cortical targets (>25mm skin-cortex distance), mTMS performed similarly. More stimulation channels improved focality but required stronger current-rate constraints. The planar design performed better for deeper targets, while spherical designs improved with additional channels. Conclusion: mTMS systems demonstrate remarkable performance comparable to standard TMS, enabling efficient multi-target stimulation without repositioning. Our open-source framework provides practical tools for designing and evaluating mTMS systems, supporting goal-directed mTMS development and effective application.
Numssen et al. (Fri,) studied this question.