Abnormal ventromedial-to-dorsolateral hierarchical topography of striatal circuits in cocaine use disorder and its modulations by brain stimulation.

Cocaine use disorder (CUD) has been linked to cortico-striatal dysfunctions, particularly within the prefrontal-striatal circuitry. However, previous studies have typically focused on discrete parcellations of the striatum, overlooking its continuous variations of neural organization. Moreover, while repetitive transcranial magnetic stimulation (rTMS) has shown benefits in CUD treatment, the neural effects of rTMS on striatal dysfunction in CUD remain poorly understood. Using connectome gradient-mapping techniques on three resting-state functional magnetic resonance imaging datasets, we derived the ventromedial-to-dorsolateral striatal functional topography. We identified specific alterations in this topography in the discovery cohort (41 CUD patients and 44 controls), validated findings in an independent cohort (53 CUD patients and 45 controls), and examined whether rTMS targeting the left dorsolateral prefrontal cortex (dlPFC) could normalize abnormalities in the rTMS-treatment cohort (44 patients). Across all datasets, we found a positive correlation between gradient variation and drug dependence severity in CUD. Compared to controls, CUD in both the discovery and replication cohorts exhibited elevated gradient values in the ventral striatum, while decreased values in the dorsal striatum were observed only in the discovery cohort. Furthermore, in the rTMS-treatment cohort, 5-Hz rTMS targeting the left dlPFC significantly normalized the aberrant gradient values in the ventral striatum, and these changes also related to cocaine craving changes. Overall, our study provides novel evidence of specific alterations in the ventromedial-to-dorsolateral functional topography of the striatum in CUD patients and highlights the impact of rTMS on striatal circuits through prefrontal modulation.