NeuroImage Clinical · Published 2026-01-01 · DOI 10.1016/j.nicl.2026.104012
Background: Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment for obsessive–compulsive disorder (OCD), but response rates are variable. Pre-treatment characteristics of the stimulated region can influence rTMS outcome. Objective/hypothesis: We investigated the relationship between network features of the rTMS stimulation location and treatment outcome in a randomised trial of rTMS combined with exposure and response prevention psychotherapy (ERP) for OCD, using graph analysis of single-layer functional and structural brain networks, and of structural–functional multilayer networks. Methods: We analysed data from 58 treatment-refractory adult OCD patients. Participants received either: high frequency (HF) rTMS to the left dorsolateral prefrontal cortex (DLPFC) (n = 19); HF rTMS to the left pre-supplementary motor area (preSMA) (n = 21); or control rTMS to the vertex (n = 18), all combined with ERP. We used pre-treatment resting state functional MRI (rs-fMRI) and diffusion MRI (dMRI) scans to construct single-layer and structural–functional multilayer networks for each participant. We computed various centrality measures of the stimulated location and subnetwork, and examined their relationship with treatment outcome. Results: We found no associations between functional/structural single-layer network characteristics and treatment outcome. However, higher average multilayer betweenness centrality of the stimulated subnetwork in the DLPFC rTMS group (but not in the preSMA/vertex groups) was associated with symptom reduction (p = 0.013). Conclusions: Participants with greater integration of the stimulated subnetwork with the rest of the structural–functional network showed greater improvement following DLPFC rTMS-ERP. Our exploratory results give a preliminary indication of the importance of the interplay between structural and functional networks for rTMS outcome.
Abstract from DOAJ. Public domain (CC0 1.0).
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