Structural and Functional Connectivity Predict the Effects of Direct Brain Stimulation on Memory

Intracranial stimulation can enhance episodic memory in humans; however, the behavioral effects vary substantially across individuals and stimulation sites. Here, we investigated whether the network embedding of a stimulation target, defined by MRI-based normative structural and functional connectivity, accounts for variability in stimulation-linked memory enhancement. We analyzed data from 50 adults with medically refractory epilepsy who underwent intracranial EEG monitoring and completed a verbal delayed free-recall task during stimulation of left temporal cortex sites across 61 sessions (39 closed-loop; 22 random). On average, closed-loop stimulation delivered during classifier-detected low-encoding states increased recall rates, whereas random stimulation produced no reliable benefit. Diffusion tractography from a normative database showed that sites yielding greater memory enhancement were characterized by stronger structural coupling to a distributed fronto-temporo-parietal network. Greater structure-function congruence with a normative verbal-encoding activation network predicted larger closed-loop memory benefit (Spearman ρ = 0.58, P < 0.0001). Functional connectivity exhibited overlapping trends but did not yield robust regional associations after permutation correction. Multivariate Partial Least Squares Structural Equation Modeling further identified stimulation mode, baseline memory, and a structural profile factor as independent predictors of memory enhancement, with no independent contribution of functional connectivity. These findings indicate that reliable stimulation-driven memory improvement depends not only on the timing of stimulation, but also on whether the stimulated target is structurally embedded within an encoding-relevant network scaffold.