A Preliminary Investigation of Pre-Frontal repetitive Transcranial Magnetic Stimulation (rTMS) for the Treatment of Cannabis Use Disorder

项目摘要/摘要： 大麻使用障碍(CUD)是一种常见的疾病，几乎没有有效的治疗方法，到目前为止，还没有FDA- 批准的药物。因此，提供者几乎没有选择为寻求治疗的人提供服务。 一项不断扩大的文献基础表明，兴奋性重复经颅磁力的单一治疗 刺激(RTMS)背外侧前额叶皮质(DLPFC)可暂时减少药物线索 在物质使用障碍中诱发渴求。最近的两项临床试验表明，提供一个疗程的 多种rTMS疗法有望成为烟草和可卡因使用障碍的潜在治疗方法。 与成瘾的研究结果一致，在重度抑郁障碍中，rTMS的单一治疗几乎没有 任何情绪影响；然而，重复治疗导致临床上有意义的改善和缓解 抑郁症患者中有相当一部分是抑郁症患者。 候选人和指导团队最近完成了一项基于实验室的试验，证明了一种单一的 对于寻求大麻使用障碍的非治疗患者，rTMS的治疗是安全、耐受和可行的。 参与者。此外，rTMS减少了大麻线索诱导的渴望。鉴于这些有希望的初步结果 研究发现，一个完整疗程的rTMS可能会对渴望有更大的影响，并对 吸食大麻。 在这份职业发展奖的申请中，应聘者建议确定一门rtms课程是否 应用于DLPFC的治疗可以减少大麻线索诱导的渴望(Aim1)和线索反应性 在寻找大麻的治疗中，在fMRI范式(AIM2)期间的奖励结构中，使用紊乱的个体。 此外，他将确定一个疗程的rTMS是否减少大麻的使用(探索性目标)。开发一种 新的有效的治疗方法将有可能帮助大约100万吸食大麻的人 每年寻求治疗的美国人。值得注意的是，rTMS是一种副作用很小的治疗方法，它可能集中在 目标是CUD的病理生理学。

Project Summary / Abstract: Cannabis use disorder (CUD) is a common condition with few validated treatments and, to date, no FDA- approved medications. Subsequently, providers have few options to offer treatment seekers. An expanding literature base suggests that a single treatment of excitatory repetitive Transcranial Magnetic stimulation (rTMS) applied to the dorsolateral pre-frontal cortex (DLPFC) may temporarily reduce drug cue induced craving across substance use disorders. Two recent clinical trials suggest that delivering a course of multiple rTMS treatments holds promise as a potential treatment for tobacco and cocaine use disorders. Consistent with the findings in addictions, in Major Depressive Disorder a single treatment of rTMS has little if any mood effect; however repeated treatments result in clinically meaningful improvement and remission from depression in a substantial number of depressed patients. The candidate and mentorship team recently completed a laboratory-based trial demonstrating that a single treatment of rTMS is safe, tolerable, and feasible in non-treatment seeking cannabis use disordered participants. Additionally, rTMS reduced cannabis cue-induced craving. Given these promising preliminary findings, it is possible that a full course of rTMS would have a larger effect on craving and an effect on cannabis use. In this application for a career development award, the candidate proposes to determine if a course of rTMS treatments applied to the DLPFC can result in reduced cannabis cue-induced craving (Aim1) and cue reactivity in reward structures during an fMRI paradigm (Aim2) in treatment seeking cannabis use disordered individuals. Additionally, he will determine if a course of rTMS reduces cannabis use (Exploratory Aim). Development of a novel, effective treatment for CUD would have the potential of helping the estimated one million cannabis using Americans that seek treatment each year. Of note, rTMS is a treatment with few side effects, and it may focally target CUD's pathophysiology.