The goal of this clinical trial is to learn if repetitive Transcranial Magnetic Stimulation (rTMS), a non-invasive brain stimulation technique, works to treat Metabolic dysfunction-associated and alcohol-associated liver disease (MetALD). The main questions it aims to answer are:
* Can rTMS effectively treat MetALD?
* Is an individualized, precision-targeted rTMS approach more effective than the standard rTMS method?
* What changes in brain activity are associated with the treatment?
Researchers will compare three different types of stimulation:
* Group A: Individualized rTMS targeting a deep brain reward area (the Nucleus Accumbens) based on each participant's brain scan (fMRI).
* Group B: Standard rTMS applied using the traditional "5 cm" rule for positioning.
* Group C: Sham (placebo) rTMS, which mimics the procedure but delivers no significant magnetic stimulation.
Participants will:
* Be randomly assigned to one of the three groups (A, B, or C).
* Undergo an MRI brain scan before starting treatment.
* Receive a total of 20 rTMS sessions, completing at least 4 sessions per week.
* Have additional MRI scans and clinical assessments halfway through and immediately after the treatment course.
* Attend follow-up visits at 1, 3, and 6 months after treatment completion to assess long-term effects.