Effects of Transcranial Magnetic Stimulation on Cognitive-Affective Task-Based Functional Connectivity

<b><i>Objective:</i></b> Repetitive transcranial magnetic stimulation (rTMS) uses electromagnetic fields to induce electrical currents in the superficial cortex, and this electric signal is believed to propagate to functionally connected distal brain regions. We previously reported that rTMS targeting the postcentral gyrus affected resting-state functional connectivity with the posterior insula. The current study investigated whether rTMS targeting the postcentral gyrus would affect task-based functional connectivity (TBFC) with the posterior insula during a cognitive-affective distress task. <b><i>Methods:</i></b> Twenty-five healthy participants were assigned to 10 Hertz (Hz) (<i>n</i> = 13) or 1 Hz (<i>n</i> = 12) rTMS groups. Participants received five consecutive days of once-daily rTMS and underwent pre- and post-rTMS magnetic resonance imaging (MRI) scans while completing a cognitive-affective distress task with negative auditory feedback. rTMS coil placement over the right postcentral gyrus was guided with neuronavigation, and TBFC analysis of the MRI data was performed using the bilateral auditory cortex as a seed region-of-interest. <b><i>Results:</i></b> There was an false discovery rate (FDR)-corrected significant group-by-session-by-condition interaction in a right putamen/posterior insula cluster: in the distress condition, the 1 Hz rTMS group had significantly weaker (i.e., smaller absolute value) negative TBFC following rTMS (<i>p</i> = 0.005), while the 10 Hz group had no significant effect. <b><i>Conclusion:</i></b> This preliminary, proof-of-concept study suggests that rTMS can modulate TBFC in distal brain regions implicated in the neural response to cognitive-affective negative feedback. Future research should investigate whether rTMS can both modulate insula-associated TBFC and improve cognitive-affective task performance or mood outcomes, potentially by increasing the number of rTMS sessions or using different rTMS pulse sequences. Impact Statement Clinical application of repetitive transcranial magnetic stimulation (rTMS) may exert a therapeutic effect by modulating the strength of functional connectivity between superficial cortical areas and deeper brain regions. These effects on functional connectivity are typically measured while participants are at rest. This proof-of-concept study suggests that rTMS can have a measurable effect on task-based functional connectivity as well. In the future, this could be an important means of understanding how rTMS exerts effects on cognitive-affective task performance and mood.