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

项目概要/摘要： 大麻使用障碍（CUD）是一种常见的疾病，很少有经过验证的治疗方法，迄今为止，FDA还没有 批准的药物。因此，提供者几乎没有办法为寻求治疗者提供选择。 一个不断扩大的文献基础表明，一个单一的治疗兴奋性重复经颅磁 应用于背外侧前额叶皮层（DLPFC）的rTMS可能会暂时减少药物提示 在物质使用障碍中诱发渴望。最近的两项临床试验表明， 多种rTMS治疗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，在重度抑郁症中，单一的rTMS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。 候选人和导师团队最近完成了一项基于实验室的试验，证明了一个单一的 rTMS治疗在非寻求治疗的大麻使用障碍中是安全、可耐受和可行的 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 研究结果表明，一个完整的rTMS过程可能会对渴望产生更大的影响， 使用大麻 在职业发展奖的申请中，候选人建议确定rTMS课程是否 应用于DLPFC的治疗可以导致大麻线索诱导的渴望（Aim 1）和线索反应性降低 在寻求大麻使用障碍个体的治疗中，在fMRI范例（Aim 2）期间的奖励结构。 此外，他还将确定rTMS疗程是否会减少大麻的使用（探索性目的）。发展 一种新的，有效的治疗CUD的方法将有可能帮助估计100万大麻使用者。 每年都有美国人寻求治疗。值得注意的是，rTMS是一种副作用少的治疗方法， 针对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.