Transcranial magnetic stimulation of dorsolateral prefrontal cortex reduces cocaine use: A pilot study.
Transcranial magnetic stimulation of dorsolateral prefrontal cortex reduces cocaine use: A pilot study.
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DOI：
10.1016/j.euroneuro.2015.11.011
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发表时间：
2016-01
影响因子：
5.6
通讯作者：
Gallimberti, Luigi
中科院分区：
文献类型：
--
作者：
Terraneo, Alberto;Leggio, Lorenzo;Saladini, Marina;Ermani, Mario;Bonci, Antonello;Gallimberti, Luigi
关键词：
最近的动物研究表明，强迫性可卡因寻求强烈降低前边缘额叶皮层的活动，而该脑区的光遗传学刺激显着抑制强迫性可卡因寻求，为应用脑刺激减少可卡因消耗提供了强有力的理由。因此，我们采用重复经颅磁刺激（rTMS）来测试背外侧前额叶皮层（DLPFC）刺激是否可以防止人类使用可卡因。在为期29天的研究（第1阶段）中，32名可卡因成瘾患者被随机分配到左侧DLPFC的实验组（rTMS）或对照组（药物）。随后是63天的随访（第2阶段），在此期间，所有参与者都接受了rTMS治疗。在完成第1阶段的患者中，rTMS组16例（100%），对照组13例（81%）。未观察到显著不良事件。在第1阶段，与对照组相比，rTMS组中无可卡因尿液药物检测的数量显著较高（p=0.004）。与对照组相比，rTMS组对可卡因的渴望也显著降低（p=0.038）。在对照组完成第1阶段的13例患者中，10例患者在第2阶段接受了rTMS治疗，并显示出显著改善，良好的结局与rTMS组相当。目前的初步研究结果支持rTMS在可卡因成瘾患者中的安全性，并表明其对rTMS驱动的PFC刺激在减少可卡因使用方面的潜在治疗作用，为开展更大规模的安慰剂对照研究提供了强有力的依据。
Recent animal studies demonstrate that compulsive cocaine seeking strongly reduces prelimbic frontal cortex activity, while optogenetic stimulation of this brain area significantly inhibits compulsive cocaine seeking, providing a strong rationale for applying brain stimulation to reduce cocaine consumption. Thus, we employed repetitive transcranial magnetic stimulation (rTMS), to test if dorsolateral prefrontal cortex (DLPFC) stimulation might prevent cocaine use in humans. Thirty-two cocaine-addicted patients were randomly assigned to either the experimental group (rTMS) on the left DLPFC, or to a control group (pharmacological agents) during a 29-day study (Stage 1). This was followed by a 63-day follow-up (Stage 2), during which all participants were offered rTMS treatment. Amongst the patients who completed Stage 1, 16 were in the rTMS group (100%) and 13 in the control group (81%). No significant adverse events were noted. During Stage 1, there were a significantly higher number of cocaine-free urine drug tests in the rTMS group compared to control (p=0.004). Craving for cocaine was also significantly lower in the rTMS group compared to the controls (p=0.038). Out of 13 patients who completed Stage 1 in the control group, 10 patients received rTMS treatment during Stage 2 and showed significant improvement with favorable outcomes becoming comparable to those of the rTMS group. The present preliminary findings support the safety of rTMS in cocaine addicted patients, and suggest its potential therapeutic role for rTMS-driven PFC stimulation in reducing cocaine use, providing a strong rationale for developing larger placebo-controlled studies.
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