Effects of 10 add‐on HF‐rTMS treatment sessions on alcohol use and craving among detoxified inpatients with alcohol use disorder: a randomized sham‐controlled clinical trial

Abstract

Background and aims Alcohol use disorder (AUD) is a chronic disorder with high relapse rates. There are currently few clinical trials of high frequency repetitive transcranial magnetic stimulation (HF‐rTMS) to reduce alcohol use among AUD patients, and results are mixed. The current study tested the effect of 10 add‐on sessions of HF‐rTMS over the right dorsolateral pre‐frontal cortex (DLPFC) on alcohol use and craving. Design Single‐center, single blind sham‐controlled parallel‐group RCT (n = 80), with 3 and 6 months follow‐up. Setting Clinical treatment center in Amsterdam, the Netherlands. Participants Eighty detoxified and abstinent AUD inpatients in clinical treatment (20 females, average age = 44.35 years). Intervention Ten sessions of active or sham HF‐rTMS (60 10 Hz trains of 5 sec at 110% motor threshold) over the right DLPFC on 10 consecutive work‐days. Measurements The primary outcome measure is the number of abstinent days over 6‐month follow‐up (FU). Secondary outcome measures are craving over 6‐month FU (alcohol urge questionnaire and obsessive‐compulsive drinking scale), time to first relapse over 6‐month FU and grams of alcohol consumed over 6‐month FU. Additional outcome measures: full abstinence over 6‐month FU and treatment success over 12‐month FU. Findings HF‐rTMS did not affect the number of abstinent days over 6 months FU [sham = 124 ± 65.9 days, active = 115 ± 69.8 days, difference: 9 days, 95% confidence interval (CI) = Poisson model: 0.578–3.547]. Moreover, HF‐rTMS did not affect craving (AUQ/OCDS) (sham = 15.38/5.28, active = 17.48/4.75, differences = 2.1/−0.53, 95% CI mixed‐effects model = −9.14 to 2.07/−1.44 to 2.40). Conclusions There was no clear evidence that high‐frequency repetitive transcranial magnetic stimulation over the right dorsolateral pre‐frontal cortex treatment has a long‐term positive effect on alcohol use or craving as add‐on treatment for alcohol use disorder. High treatment response at 6‐month follow‐up could have limited the possibility to find an effect.

A systematic review and meta-analysis of neuromodulation therapies for substance use disorders

“… 10 Active OR 10 Sham Sessions Left DLPFC 110% 20 Hz Figure-8 Coil Craving Active vs. Sham: −2.22 [−2.99 – −1.45] Consumption Active vs. Sham: −1.84 [−2.57 – −1.12] NA Active rTMS significantly ↓ days of heavy drinking and alcohol craving compared to sham. Hoven et al [ 70 ] N = 80 A randomized, dingle-blind, sham-controlled study with recently abstinent, alcohol-dependent participants. 10 Active OR 10 Sham Sessions Right DLPFC 110% 10 Hz Figure-8 Coil Craving Active vs. Sham: −0.16 [−0.59–0.28] NA Abstinent Days Over 6-months Active vs. Sham: −0.13 [−0.56–0.30] No significant difference in number of abstinent days over 6-months or alcohol craving was observed following active rTMS compared to sham stimulation.…”

Efficacy of transcranial magnetic stimulation in the treatment of alcohol dependence - a review article

“…A few years later, in 2015, Mishra et al [18] showed that stimulation on the left side (using the same protocol) had comparable efficacy to that on the right side. In 2022 Hoven et al [19] used a very similar protocol, also stimulating the right dorsolateral prefrontal cortex. The study included a slightly larger group of subjects.…”

“…W 2022 roku Hoven i wsp. [19] zastosowali bardzo podobny protokół, również stymulując prawą grzbietowo boczną korę przedczołową. Badaniem objęto nieco większą grupę osób.…”