Predictive Role of Executive Function in the Efficacy of Intermittent Theta Burst Transcranial Magnetic Stimulation Modalities for Treating Methamphetamine Use Disorder—A Randomized Clinical Trial

Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) has therapeutic effects on craving in methamphetamine (METH) use disorder (MUD). The chronic abuse of METH causes impairments in executive function, and improving executive function reduces relapse and improves treatment outcomes for drug use disorder. The purpose of this study was to determine whether executive function helped predict patients' responses to rTMS treatment.Methods: This study employed intermittent theta burst stimulation (iTBS) rTMS modalities and observed their therapeutic effects on executive function and craving in MUD patients. MUD patients from an isolated Drug Rehabilitation Institute in China were chosen and randomly allocated to the iTBS group and sham-stimulation group. All participants underwent the Behavior Rating Inventory of Executive Function - Adult Version Scale (BRIEF-A) and Visual Analog Scales (VAS) measurements. Sixty-five healthy adults matched to the general condition of MUD patients were also recruited as healthy controls.Findings: Patients with MUD had significantly worse executive function. iTBS groups had better treatment effects on the MUD group than the sham-stimulation group. Further Spearman rank correlation and stepwise multivariate regression analysis revealed that reduction rates of the total score of the BRIEF-A and subscale scores of the inhibition factor and working memory factor in the iTBS group positively correlated with improvements in craving. ROC curve analysis showed that working memory (AUC = 87.4%; 95% CI = 0.220, 0.631) and GEC (AUC = 0.761%; 95% CI = 0.209, 0.659) had predictive power to iTBS therapeutic efficacy. The cutoff values are 13.393 and 59.804, respectively.Conclusions: The iTBS rTMS had a better therapeutic effect on the executive function of patients with MUD, and the improved executive function had the potential to become a predictor for the efficacy of iTBS modality for MUD treatment.Clinical Trial Registration:ClinicalTrials.gov, identifier: ChiCTR2100046954.

Multiple comparison of different noninvasive brain stimulation and pharmacologic interventions in patients with methamphetamine use disorders: A network meta‐analysis of randomized controlled trials

“…17,21,23,24,31, Finally, 22 RCTs were included (Table S4). [13][14][15][16][117][118][119][120][121][122][123][124][125][126][127][128][129][130][131][132][133][134] Figure 2 illustrates the entire geometric distribution of the treatment arms. S4.…”

“… 17,21,23,24,31,44–116 Finally, 22 RCTs were included (Table S4). 13–16,117–134 Figure 2 illustrates the entire geometric distribution of the treatment arms.…”

Drug-induced change in transmitter identity is a shared mechanism generating cognitive deficits

“…This effect may be mediated by increased inhibitory input to PrL pyramidal neurons, as suggested by a larger number of PFC c-fos+ GABAergic cells after acute clozapine treatment (45) and rescue of PCPinduced decrease in GAD67 and PV expression in PV+ neurons after chronic exposure (15). It will be of interest to learn whether the induction or reversal of changes in transmitter identity contributes to the therapeutic effect of transcranial magnetic stimulation (46)(47)(48)(49)(50) and other forms of non-invasive manipulation of neuronal activity (51).…”

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

“…Only one study uses EEG signals together with VAS scores to assess the effects (144). Some studies use images (125,141,143,145), some use videos (135) and still others use VR as the cues (144). One study asks the participants to actively interact with the tools used for METH consumption (142).…”

“…Zhao et al showed that high-frequency rTMS over the DLPFC and low-frequency rTMS over the right DLPFC could reduce cravings for METH(135). Other studies have shown that TMS of the left DLPFC is effective to reduce METH addiction(142,143). Wen et al reported a decrease in theta/beta ratio after participants had received TMS treatment(144).Liu et al…”