Efficacy of Repetitive Transcranial Magnetic Stimulation in Patients With Methamphetamine Use Disorder: A Systematic Review and Meta-Analysis of Double-Blind Randomized Controlled Trials

Abstract

BackgroundRepetitive transcranial magnetic stimulation (rTMS) has demonstrated therapeutic potential for treating patients with methamphetamine use disorder (MUD). However, the most effective target and stimulation frequency of rTMS for treating MUD remains unclear. This meta-analysis explored the effect of rTMS on MUD.MethodsIn this study, PubMed, Cochrane Systematic Reviews, and the Cochrane Collaboration Central Register of Controlled Clinical Trials were searched electronically for double-blind randomized controlled trials that used rTMS for treating MUD. We used published trials to investigate the efficacy of rTMS in MUD up to March 5, 2022, and pooled studies using a random-effect model to compare rTMS treatment effects. Patients who were diagnosed with MUD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders were recruited. Clinical craving scores between baseline and after rTMS were compared using the standardized mean difference (SMD) with 95% confidence intervals (CIs). The heterogeneity of the included trials was evaluated through a visual inspection of funnel plots and the I2 statistic.ResultsWe identified seven trials with 462 participants with MUD that met the inclusion criteria. All the studies evaluated craving scores, with rTMS demonstrating a more significant effect than the sham treatment on reducing craving scores (SMD = 0.983, CI = 0.620–1.345, p ≤ 0.001). A subgroup meta-analysis revealed that intermittent theta-burst stimulation (iTBS) had a greater positive effect than 10-Hz rTMS. A metaregression revealed that the SMDs increased with the increase in baseline craving scores, whereas they decreased with the increase in the proportion of men and duration of abstinence.ConclusionThe meta-analysis suggests that rTMS may be associated with treatment effect on craving symptoms in patients with MUD. iTBS may have a greater positive effect on craving reduction than 10-z rTMS.

Applications of TMS in individuals with methamphetamine use disorder: A review

“…Excitation of the lDLPFC and inhibition of the rDLPFC have been found to reduce cravings with the effects lasting for some time. It must be noted that iTBS may reduce cravings better than 10 Hz rTMS [ 54 ]. However, future research should examine more participants, compare different TMS parameters, seek more effective stimulation targets, and adopt various technical methods, such as virtual reality, physiological indicators, and brain signals, to comprehensively evaluate cravings.…”

Challenges and future trends in wearable closed-loop neuromodulation to efficiently treat methamphetamine addiction

“…Frequencies over 5 Hz have been shown to increase cortical excitability, whereas low frequency rTMS, such as 1 Hz, decreases cortical excitability. Still another type of rTMS is the theta burst stimulation (TBS, a variation of high frequency rTMS) has also been applied to evaluate the effects on withdrawal of METH (134)(135)(136)(137). TBS can be further separated into continuous TBS (cTBS) and intermittent TBS (iTBS), depending on the existence of intertrain intervals.…”

Systematic review and meta‐analysis: Combining transcranial magnetic stimulation or direct current stimulation with pharmacotherapy for treatment of substance use disorders

“…Significant craving reductions after NIBS have also been seen in reviews on cocaine, 3 methamphetamine, 17 and alcohol 18 . A distinction seen in these substances from tobacco is less success regarding cessation.…”