Target Interpretability and Functional Mapping of rTMS and Theta-Burst Stimulation of the Cerebellar Vermis and Midline Cerebellum: A Scoping Review.

The cerebellar vermis and midline cerebellum contribute to motor, oculomotor, vestibular, cognitive, affective, autonomic, and network-level functions. Human rTMS/TBS studies targeting these regions are methodologically heterogeneous, and reported effects may be over-attributed when anatomical labels, localization methods, or target separability are unclear. We conducted a PRISMA-ScR-guided scoping review of human repetitive transcranial magnetic stimulation and theta-burst stimulation studies targeting the cerebellar vermis or midline cerebellum. PubMed/MEDLINE, Scopus, Web of Science Core Collection, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) were searched from inception to 6 August 2026, with no publication-date restriction. Evidence was synthesized by functional domain, methodological characteristics, and a pragmatic target-interpretability framework based on anatomical labeling, localization, condition separability, and reporting adequacy. Forty-eight studies met the eligibility criteria. Evidence spanned ten functional domains or application-oriented areas and was heterogeneous in populations, protocols, localization, comparator or sham procedures, outcome timing, and adverse-event reporting. Twenty-six studies used direct vermis/midline targets, 12 provided separately interpretable vermis/midline conditions, and 10 used lower-specificity medial/paravermal or midline-related targets. Trial-registry searching yielded 243 unique registrations, identifying ongoing and unpublished studies that contextualize the evidence map; however, no additional study entered the primary synthesis from registry alone. The review contributes a functional evidence map, a pragmatic framework for anatomical attribution, and an author-proposed minimum reporting checklist derived from mapped methodological gaps. The literature supports broad functional investigation of vermal and midline stimulation, but not established therapeutic efficacy. Future studies require more precise targeting, reproducible reporting, rigorous controls, and domain-specific replication.