Treatment-resistant obsessive-compulsive disorder (OCD) generally improves with deep-brain stimulation (DBS), thought to modulate neural activity at both the implantation site and in connected brain regions. However, its invasive nature, side-effects, and lack of customization, make non-invasive treatments preferable. Harnessing the established remote effects of cortical transcranial magnetic stimulation (TMS), connectivity-based approaches have emerged for depression that aim at influencing distant regions connected to the stimulation site. We here investigated whether effective OCD DBS targets (here subthalamic nucleus [STN] and nucleus accumbens [NAc]) could be modulated non-invasively with TMS. In a proof-of-concept study with nine healthy individuals, we used 7T magnetic resonance imaging (MRI) and probabilistic tractography to reconstruct the fiber tracts traversing manually segmented STN/NAc. Two TMS targets were individually selected based on the strength of their structural connectivity to either the STN, or both the STN and NAc. In a sham-controlled, within-subject cross-over design, TMS was administered over the personalized targets, located around the precentral and middle frontal gyrus. Resting-state functional 3T MRI was acquired before, and at 5 and 25 min after stimulation to investigate TMS-induced changes in the functional connectivity of the STN and NAc with other regions of the brain. Static and dynamic seed-to-voxel correlation analyses were conducted. TMS over both targets was able to modulate the functional connectivity of the STN and NAc, engaging both overlapping and distinct regions, and unfolding following different temporal dynamics. Given the relevance of the engaged connected regions to OCD pathology, we argue that a personalized, connectivity-based procedure is worth investigating as potential treatment for refractory OCD.

难治性强迫症 (OCD) 通常可以通过深部脑刺激 (DBS) 得到改善，深部脑刺激 (DBS) 被认为可以调节植入部位和相连大脑区域的神经活动。然而，其侵入性、副作用和缺乏定制性使得非侵入性治疗更受欢迎。利用皮质经颅磁刺激 (TMS) 的既定远程效应，出现了基于连接的抑郁症治疗方法，旨在影响与刺激部位连接的远程区域。我们在此研究是否可以使用 TMS 非侵入性地调节有效的 OCD DBS 目标（此处为丘脑底核 [STN] 和伏隔核 [NAc]）。在一项针对 9 名健康个体的概念验证研究中，我们使用 7T 磁共振成像 (MRI) 和概率纤维束成像来重建穿过手动分段 STN/NAc 的纤维束。根据两个 TMS 目标与 STN 或 STN 和 NAc 的结构连接强度单独选择。在假手术控制的受试者内交叉设计中，TMS 是针对位于中央前回和额中回周围的个性化目标进行的。在刺激前、刺激后 5 分钟和 25 分钟采集静息态功能 3T MRI，以研究 TMS 引起的 STN 和 NAc 与大脑其他区域功能连接的变化。进行了静态和动态种子与体素相关性分析。对两个目标的 TMS 能够调节 STN 和 NAc 的功能连接，参与重叠和不同的区域，并按照不同的时间动态展开。考虑到参与的连接区域与强迫症病理学的相关性，我们认为基于连接的个性化程序值得研究作为难治性强迫症的潜在治疗方法。