Repetitive Transcranial Magnetic Stimulation in Alcohol Dependence: A Randomized, Double-Blind, Sham-Controlled Proof-of-Concept Trial Targeting the Medial Prefrontal and Anterior Cingulate Cortices

• DOI: 10.1016/j.biopsych.2021.11.020
• Publication Date: 2021-12-06T06:41:22Z
• Authors: Maayan Harel; Irene Perini; Robin Kämpe; Uri Alyagon; Hadar Shalev; Itay Besser; Wolfgang H. Sommer; Markus Heilig; Abraham Zangen
• Keywords: Neurologi; Prefrontal Cortex; Gyrus Cinguli; Transcranial Magnetic Stimulation; 3. Good health; Alcoholism; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Neurology; Double-Blind Method; Humans; Craving

BackgroundAlcohol addiction is associated with a high disease burden, and treatment options are limited. In proof-of-concept study, we used deep repetitive transcranial magnetic stimulation (dTMS) to target circuitry the pathophysiology of alcohol addiction. We evaluated clinical outcomes explored neural signatures using functional resonance imaging.MethodsThis was double-blind, randomized, sham-controlled trial. A total 51 recently abstinent treatment-seeking patients use disorder (moderate severe) were randomized sham or active dTMS, an H7 coil targeting midline frontocortical areas, including medial prefrontal anterior cingulate cortices. Treatment included 15 sessions over 3 weeks, followed by five months follow-up. Each session delivered 100 trains 30 pulses at 10 Hz. The primary predefined outcome reduction in percentage heavy drinking days, obtained timeline follow-back interviews. Secondary analyses self-reports craving, ethyl glucuronide urine, brain imaging measures.ResultsBoth craving after days during follow-up significantly lower versus control group (percentage = 2.9 ± 0.8% vs. 10.6 1.9%, p .037). Active dTMS decreased resting-state connectivity dorsal cortex caudate nucleus subgenual cortex.ConclusionsWe provide initial for structures as These data strongly support rationale full-scale confirmatory multicenter Therapeutic benefits appear be persistent changes network activity.