loading . . . The methodological foundations of lesion network mapping remain sound Lesion network mapping (LNM) and related techniques have been used in over 200 studies, primarily to test whether anatomically distributed lesions that cause the same symptom fall within a common brain network. A recent article challenges the specificity and validity of this technique, suggesting that lesion network maps primarily reflect intrinsic properties of the normative connectome rather than lesion-symptom relationships. However, the data and procedures in van den Heuvel et al. do not reflect those used in most LNM studies. Further, the main conclusions were based on similarity between maps, but similarity does not imply the absence of meaningful differences. In contrast, LNM provides evidence for meaningful differences using specificity testing. Exemplary analyses of 1090 lesion locations from 34 prior LNM studies do not support van den Heuvel's concerns and confirm the lesion-deficit specificity of LNM. While we encourage further methodological investigation, the analyses of van den Heuvel et al. do not invalidate prior LNM findings or future applications. ### Competing Interest Statement SHS has intellectual property on use of brain connectivity to guide brain stimulation, is a former scientific consultant for Magnus Medical, has received investigator-initiated research funding from Neuronetics and BrainsWay, received speaking fees from BrainsWay and Otsuka (for PsychU.org), former shareholder in BrainsWay (publicly traded), current shareholder in Magnus Medical (not publicly traded). SHS also provides clinical consultations for individualized brain stimulation targeting in both private practice and academic settings. A.H. reports lecture fees for Boston Scientific, is a consultant for and holds stock options of Modulight.bio, was a consultant for FxNeuromodulation in recent years and serves as a co-inventor on a patent granted to Charite University Medicine Berlin that covers multisymptom DBS fiberfiltering and an automated DBS parameter suggestion algorithm unrelated to this work (patent #LU103178). J.J. reports lecturer honoraria from Insightec, Addiktum, Nordic Inducare, Lundbeck and Novartis; conference travel support from Insightec, Abbvie and Abbott; consulting for Adamant Health, Summaryx and TEVA Finland; advisory board for TEVA Finland; stock ownership of Neurologic Finland and Suomen Neurolaboratorio. M.D.F. is a scientific consultant for Magnus Medical. M.D.F. has intellectual property on the use of brain connectivity imaging to analyze lesions and guide brain stimulation, has consulted for Magnus Medical, Soterix, Abbott, Boston Scientific, Tal Medical, MDC Venture Capital, and is on the Scientific Advisory Board of Salma Health. He has received research support from Neuronetics and Boston Scientific. F.L.W.V.J.S reports no conflicts of interest. S.B.S reports no conflicts of interest. A.L.C. reports no conflicts of interest. A.D.B. has intellectual property on an automated neuroimaging platform for lesion-informed outcome prediction and is a co-founder of NeuroPred, Inc. National Institute of Mental Health, https://ror.org/04xeg9z08, R01MH136248, K23MH121657, R01MH140916, R01MH113929, R21MH126271, UM1NS132358 https://www.biorxiv.org/content/10.64898/2026.02.24.707529v1
