Non-invasive brain stimulation of cerebellar and cortical targets: A systematic review and ALE meta-analysis of cognitive and connectivity outcomes in adults

M Manzo; G Schilirò; R Guiomar; B Catoira; A Ganho-Ávila; P Caponnetto; P Castilho; E Santarnecchi; G D'Urso; C Baeken

doi:10.1016/j.neubiorev.2026.106688

Non-invasive brain stimulation of cerebellar and cortical targets: A systematic review and ALE meta-analysis of cognitive and connectivity outcomes in adults

Neurosci Biobehav Rev. 2026 Jul:186:106688. doi: 10.1016/j.neubiorev.2026.106688. Epub 2026 Apr 13.

Authors

M Manzo¹, G Schilirò², R Guiomar³, B Catoira⁴, A Ganho-Ávila⁵, P Caponnetto⁶, P Castilho⁵, E Santarnecchi⁷, G D'Urso⁸, C Baeken⁹

Affiliations

¹ Precision Neuroscience & Neuromodulation Program, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy; Ghent Experimental Psychiatry Laboratory, Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. Electronic address: marco.manzo@unicampania.it.
² Ghent Experimental Psychiatry Laboratory, Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Educational Sciences, Section of Psychology, University of Catania, Catania, Italy.
³ Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra 3000-315, Portugal; Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra 3000-315, Portugal. Electronic address: raquel.guiomar@fpce.uc.pt.
⁴ Ghent Experimental Psychiatry Laboratory, Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Psychiatry, NEUR Research Group, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Brussels 1090, Belgium.
⁵ Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra 3000-315, Portugal; Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra 3000-315, Portugal.
⁶ Department of Educational Sciences, Section of Psychology, University of Catania, Catania, Italy; Center of Excellence For The Acceleration of Harm Reduction (COEHAR), University of Catania, Catania, Italy; Psychiatric Unit, University Hospital "AOU Policlinico G. Rodolico-San Marco", Catania, Italy.
⁷ Precision Neuroscience & Neuromodulation Program, Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy.
⁹ Ghent Experimental Psychiatry Laboratory, Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Psychiatry, NEUR Research Group, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Brussels 1090, Belgium; Center for Care and Cure, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.

PMID: 41980666
DOI: 10.1016/j.neubiorev.2026.106688

Abstract

Background: Beyond motor control, the cerebellum contributes to cognition, emotion, and social functioning through distributed cerebro-cerebellar loops. Neuroimaging and lesion studies implicate these networks in executive control, affect regulation, and social cognition, with relevance for psychiatric and neurodevelopmental conditions.

Objectives: We conducted a systematic review and ALE meta-analysis to determine whether non-invasive brain stimulation (NIBS) applied to cortical or cerebellar targets modulates task-related brain activity and cerebro-cerebellar connectivity, and whether such effects relate to cognitive performance.

Methods: A two-step search (December 2023; updated January 2025) across PubMed, PsycINFO, Scopus, and Web of Science identified 1130 records. Twenty sham-controlled studies met inclusion criteria. Coordinate-based ALE employed random-effects inference (cluster-forming p < 0.001; cluster-level p < 0.05; 1000 permutations).

Results: Cerebellar stimulation of posterior lobules (Crus I/II; lobules VI-VIII) modulated language prediction, working memory, and social sequencing, with facilitation or interference depending on task demands and timing. Cortical stimulation of prefrontal and temporoparietal regions induced downstream changes in cerebellar coupling during executive and emotion-regulation tasks, particularly in clinical cohorts. ALE analysis (11 experiments; 67 foci; N = 480) identified convergent clusters in left occipito-parietal cortex and right TPJ; the latter did not survive sensitivity analyses excluding clinical samples.

Conclusions: NIBS modulates networks functionally linked to the cerebellum during cognitive tasks, with heterogeneous, protocol-dependent effects. Notably, cortical stimulation causally shifts cerebro-cerebellar connectivity, with convergent clusters in left occipito-parietal cortex and right TPJ. Greater standardization and identification of response predictors are required to advance mechanistic understanding and clinical translation.

Keywords: ALE meta-analysis; Cerebello-cortical networks; Functional connectivity; Neuroimaging; Social cognition; Transcranial direct current stimulation (tDCS); Transcranial magnetic stimulation (TMS).

Publication types

Systematic Review
Meta-Analysis
Review

MeSH terms

Adult
Cerebellum* / physiology
Cerebral Cortex* / physiology
Cognition* / physiology
Connectome*
Emotional Regulation* / physiology
Executive Function* / physiology
Humans
Nerve Net* / physiology
Transcranial Direct Current Stimulation*
Transcranial Magnetic Stimulation*