A Randomized Placebo-Controlled Trial of Targeted Prefrontal Cortex Modulation with Bilateral tDCS in Patients with Crack-Cocaine Dependence
A Randomized Placebo-Controlled Trial of Targeted Prefrontal Cortex Modulation with Bilateral tDCS in Patients with Crack-Cocaine Dependence
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DOI：
10.1093/ijnp/pyv066
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发表时间：
2015-11-01
影响因子：
4.8
通讯作者：
Nakamura-Palacios, Ester Miyuki
中科院分区：
文献类型：
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作者：
Batista, Edson Kruger;Klauss, Jaisa;Nakamura-Palacios, Ester Miyuki
背景资料：经颅直流电刺激的背外侧前额叶皮层已被证明是临床上有用的治疗药物addiction.Methods：我们进行了一项双盲随机临床试验，旨在评估双边背外侧前额叶皮层经颅直流电刺激（左阴极/右阳极）对快克可卡因成瘾的影响。我们将渴望定义为主要结果，其他临床测量，包括抑郁和焦虑症状，以及生活质量，作为次要结果。17名男性可卡因吸食者（平均年龄30.4 ± 9.8 SD）随机接受5次主动经颅直流电刺激（2 mA，35 cm（2），持续20分钟），每隔一天，19只雄性（平均年龄30.3 ± 8.4 SD）接受假经颅直流电刺激（安慰剂）作为对照组。与假经颅直流电刺激相比，经颅直流电刺激组治疗后的渴求评分显著降低（P = 0.028）和基线值（P = 0.003），仅经颅直流电刺激组在4周内（治疗前、治疗期间和治疗后）呈线性下降（P = 0.047）。经颅直流电刺激组焦虑评分降低，假经颅直流电刺激组焦虑评分升高（P =.03），以及对生活质量的整体感知（P = 0.031）健康（P = 0.048）在假手术中减少，经颅直流电刺激组与增高经颅直流电刺激组之间差异显著。重复双侧经颅直流电刺激背外侧前额叶皮层减少了对快克可卡因的渴望，减少了焦虑，提高了生活质量。我们推测，经颅直流电刺激的效果可能与增加前额叶处理和调节的渴望行为。
Background: Transcranial direct current stimulation over the dorsolateral prefrontal cortex has been shown to be clinically useful in the treatment of drug addiction.Methods: We conducted a double-blind randomized clinical trial aiming to assess the effects of bilateral dorsolateral prefrontal cortex transcranial direct current stimulation (left cathodal/right anodal) on crack-cocaine addiction. We defined craving as the primary outcome, and other clinical measurements, including depressive and anxiety symtoms, and quality of life, as secondary outcomes. Seventeen male crack-cocaine users (mean age 30.4 +/- 9.8 SD) were randomized to receive 5 sessions of active transcranial direct current stimulation (2 mA, 35 cm(2), for 20 minutes), every other day, and 19 males (mean age 30.3 +/- 8.4 SD) to receive sham-transcranial direct current stimulation (placebo) as control group.Results: Craving scores were significantly reduced in the transcranial direct current stimulation group after treatment when compared with sham-transcranial direct current stimulation (P =.028) and baseline values (P =.003), and decreased linearly over 4 weeks (before, during, and after treatment) in the transcranial direct current stimulation group only (P =.047). Changes of anxiety scores towards increase in the sham-transcranial direct current stimulation and decrease in the transcranial direct current stimulation group (P =.03), and of the overall perception of quality of life (P =.031) and of health (P =.048) towards decrease in the sham-transcranial direct current stimulation group and increase in the transcranial direct current stimulation group differed significantly between groups.Conclusions: Repetitive bilateral transcranial direct current stimulation over the dorsolateral prefrontal cortex reduced craving for crack-cocaine use, decreased anxiety, and improved quality of life. We hypothesize that transcranial direct current stimulation effects may be associated with increased prefrontal processing and regulation of craving behavior.