Role of maintenance treatment on long-term efficacy of bilateral iTBS of the prefrontal cortex in treatment-seeking cocaine addicts: A retrospective analysis

Abstract

CUD, like other addictions, is a chronic disease characterized by a high rate of relapse and drop-out (DO) from medical and behavioral treatment programs, which is positively correlated with relapse. Repetitive transcranial Magnetic Stimulation (rTMS) protocols have shown therapeutic potential in addiction in the short term, but only a few studies have explored their long-term efficacy, so far. This study explores the long-term outcome of bilateral intermittent theta-burst stimulation (iTBS) of the prefrontal cortex (PFC) in cocaine use disorder (CUD) and the possible influence of maintenance treatment in improving abstinence and decreasing DO rates. Eighty-nine treatment-seeking CUD patients were exposed to 20 sessions of iTBS. At the end of the treatment 61 (81%) abstinent patients underwent a 12 months follow-up. Among these, 27 patients chose to follow a maintenance treatment (M), whereas 34 patients chose not to adhere to a maintenance treatment (NM). Overall, among patients reaching the 12 months follow-up endpoint, 69.7% were still abstinent and 30.3% relapsed. In NM-patients the DO rate was significantly higher than in M-ones (58.82 vs. 29.63%). The present observations show the long-term therapeutic effect of bilateral PFC iTBS to decrease cocaine consumption. Moreover, they underline the importance to perform a maintenance protocol to consolidate abstinence and decrease DO rates over time.

Neuromodulation (Brain Stimulation) Technologies for Treatment of Substance Use Disorders

“…The initial follow-up study [90], demonstrated that rTMS treatment had a lasting effect in reducing cocaine consumption. Similarly, Sanna et al [115], found comparable results and highlighted the importance of a maintenance protocol to maintain abstinence and decrease the rate of patient withdrawal over time. Furthermore, a single-participant study using active DBS targeting the nucleus accumbens showed a significant reduction in cocaine cravings and consumption [116].…”

Transcranial Magnetic Stimulation as a Tool to Promote Smoking Cessation and Decrease Drug and Alcohol Use

“…Finally, there appears to be a brief period of increased plasticity post-stimulation that can be exploited to reinforce learning by way of personalized motivational statements. One of the most recent studies in the cocaine use field highlighted the importance of a maintenance protocol for the sake of evaluating long-term outcomes in this population [76]. The durability of effects is most important for successful addiction treatment, and future studies should ideally conduct follow-up measurements after the completion of the acute TMS intervention.…”

“…Both treatments had low dropout rates and similar safety and tolerability profiles. The same group explored the long-term outcome of iTBS with the H4 coil in CUD and the possible influence of maintenance treatments on abstinence and drop-out rates [76]. In a retrospective analysis of 89 patients who were exposed to 20 sessions of iTBS, 61 (81%) patients were abstinent at the end of treatment and were followed up for 12 months.…”