Journal: Brain Stimulation 10:346-540 (2017)
Authors: K.K Kedzior, I Gerkensmeier, M Schuchinsky
Deep transcranial magnetic stimulation (DTMS) is a non-invasive method of stimulating widespread cortical areas and presumably deeper neural networks.
The current study assessed the efficacy of DTMS in the treatment of substance use disorders (SUD) using a systematic review and meta-analysis.
Following a systematic literature search of PsycInfo and Medline (any date till August 2016), k=5 open-label studies and k=3 double-blind, randomised sham-controlled trials were included in the review. Short-term (acute) and longer-term (at the last follow-up) efficacy was measured as craving (Obsessive Compulsive Drinking Scale, OCDS; Visual Analogue Scale for Craving, VAS), dependence (Fagerstrom Test for Nicotine Dependence, FTND), or consumption (use frequency, abstinence rate, biological test outcomes).
A random-effects meta-analysis revealed a large pooled reduction in craving (for alcohol and cocaine) and dependence (for nicotine) after an acute treatment with DTMS relative to baseline (Hedges’g=2.65, 95% confidence interval, 95% CI: 1.28-4.02, p<.001, k=5 studies, n=53 participants, I2=85%). A qualitative synthesis showed that high-frequency (18-20 Hz) and high-intensity (120% of the resting motor threshold, MT) DTMS reduced alcohol craving particularly in patients with comorbid alcohol use disorder (AUD) and a major depressive disorder in the short-term (after 20 sessions) and at 6-12 months follow-up. Cocaine craving was reduced after 12 sessions of DTMS (15 Hz, 100% MT) and both craving and consumption were reduced at 2-6 months follow-up respectively. Nicotine consumption (but not craving) was reduced after 13 sessions of DTMS (10 Hz, 120% MT) and at 6-months follow-up.
Acute improvements in various symptoms of SUD after high-frequency DTMS could be due to changes in activity of the cortico-mesolimbic pathways and neural regions involved in control of reward-mediated behavior. Repetitive stimulation might induce changes in neuroplasticity which could contribute to the longer-term effects of DTMS on SUD without maintenance treatment.
התוויות טיפוליות נוספותDeep Transcranial Magnetic Stimulation Over the Medial Prefrontal and Anterior Cingulate Cortex Alte...Can deep transcranial magnetic stimulation (dTMS) be used to treat substance use disorders (SUD)? A ...
