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Repetitive transcranial magnetic stimulation (rTMS) has gained attention as a potential treatment for CUD symptoms. Here, we sought to elucidate whether rTMS induces changes in white matter (WM) microstructure in frontostriatal circuits after 2\u2009weeks of therapy in patients with CUD and to test whether baseline WM microstructure of the same circuits affects clinical improvement. This study consisted of a 2\u2010week, parallel\u2010group, double\u2010blind, randomized controlled clinical trial (acute phase) (sham [<jats:italic>n<\/jats:italic>\u2009=\u200923] and active [<jats:italic>n<\/jats:italic>\u2009=\u200927]), in which patients received two daily sessions of rTMS on the left dorsolateral prefrontal cortex (lDLPFC) as an add\u2010on treatment. T1\u2010weighted and high angular resolution diffusion\u2010weighted imaging (DWI\u2010HARDI) at baseline and 2\u2009weeks after served to evaluate WM microstructure. After active rTMS, results showed a significant increase in neurite density compared with sham rTMS in WM tracts connecting lDLPFC with left and right ventromedial prefrontal cortex (vmPFC). Similarly, rTMS showed a reduction in orientation dispersion in WM tracts connecting lDLPFC with the left caudate nucleus, left thalamus, and left vmPFC. Results also showed a greater reduction in craving Visual Analogue Scale (VAS) after rTMS when baseline intra\u2010cellular volume fraction (ICVF) was low in WM tracts connecting left caudate nucleus with substantia nigra and left pallidum, as well as left thalamus with substantia nigra and left pallidum. Our results evidence rTMS\u2010induced WM microstructural changes in fronto\u2010striato\u2010thalamic circuits and support its efficacy as a therapeutic tool in treating CUD. Further, individual clinical improvement may rely on the patient's individual structural connectivity integrity.<\/jats:p>","DOI":"10.1111\/adb.13381","type":"journal-article","created":{"date-parts":[[2024,2,15]],"date-time":"2024-02-15T09:41:37Z","timestamp":1707990097000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Cortical and subcortical microstructure integrity changes after repetitive transcranial magnetic stimulation therapy in cocaine use disorder and relates to clinical outcomes"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5216-7177","authenticated-orcid":false,"given":"Jalil","family":"Rasgado\u2010Toledo","sequence":"first","affiliation":[{"name":"Instituto de Neurobiolog\u00eda Universidad Nacional Aut\u00f3noma de M\u00e9xico campus Juriquilla  Quer\u00e9taro 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