Transcranial magnetic stimulation for the treatment of cocaine addiction: evidence to date

Bolloni, Corinna; Badas, Paola; Corona, Giorgio; Diana, Marco

doi:10.2147/sar.s161206

Cited by 32 publications

(19 citation statements)

References 113 publications

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“…At present, only a limited number of studies have been conducted to explore the potential therapeutic effect of TMS in treating cocaine addiction (for recent comprehensive reviews see Bolloni et al, 2018; Rachid, 2018). Previous studies aimed at treating cocaine-dependent patients used high frequency protocols ranging from 10 to 20 Hz, from 90 to 100% resting motor threshold (rMT), and from 600 to 2400 pulses during 1 up to 10 sessions lasting about half an hour (Camprodon et al, 2007; Politi et al, 2008; Terraneo et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Intermittent Theta Burst Stimulation of the Prefrontal Cortex in Cocaine Use Disorder: A Pilot Study

et al. 2019

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Transcranial Magnetic Stimulation (TMS) is earning a role in the therapeutic arsenal of cocaine use disorder (CUD). A widespread and still growing number of studies have reported beneficial use of repeated TMS (rTMS) in reduction of craving, intake and cue-induced craving in cocaine addicts. In spite of these encouraging findings, many issues are still unresolved such as brain area to be stimulated, laterality of the effects, coil geometry and stimulation protocols/parameters. Intermittent theta burst stimulation (iTBS) is a more tolerable protocol administered at lower intensities and shorter intervals than conventional rTMS protocols. Yet, its effects on cocaine craving and length of abstinence in comparison with standard high frequency (10–15 Hz) protocols have never been evaluated so far. In the present paper, we describe the effect of the bilateral iTBS of the prefrontal cortex (PFC) in a population ( n = 25) of treatment-seeking cocaine addicts, in an outpatient setting, and compare them with 15 Hz stimulation of the same brain area ( n = 22). The results indicate that iTBS produces effects on cocaine consumption and cocaine craving virtually superimposable to the 15 Hz rTMS group. Both treatments had low numbers of dropouts and similar side-effects, safety and tolerability profiles. While larger studies are warranted to confirm these observations, iTBS appears to be a valid approach to be considered in treatment-seeking cocaine addicts, especially in light of its brief duration (3 min) vs. 15 Hz stimulation (15 min). The use of iTBS would allow increasing the number of patients treated per day with current rTMS devices, thus reducing patient discomfort and hopefully reducing drop-out rates without compromising clinical effectiveness.

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Section: Discussionmentioning

confidence: 99%

Intermittent Theta Burst Stimulation of the Prefrontal Cortex in Cocaine Use Disorder: A Pilot Study

et al. 2019

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“…independently read and identified all titles and excluded any irrelevant papers. In addition, reference lists of previously published reviews were manually screened for relevant articles .…”

Section: Methodsmentioning

confidence: 99%

Effects of repetitive transcranial magnetic stimulation (rTMS) on craving and substance consumption in patients with substance dependence: a systematic review and meta‐analysis

et al. 2019

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Background and Aims Repetitive transcranial magnetic stimulation (rTMS) is increasingly used as an intervention for treating substance dependence. We aimed to assess evidence of the anti‐craving and consumption‐reducing effects of rTMS in patients with alcohol, nicotine and illicit drug dependence. Methods A systematic review and meta‐analysis of 26 randomized controlled trials (RCTs) published from January 2000 to October 2018 that investigated the effects of rTMS on craving and substance consumption in patients with nicotine, alcohol and illicit drug dependence (n = 748). Craving, measured using self‐reported questionnaires or visual analog scale, and substance consumption, measured using self‐report substance intake or number of addiction relapse cases, were considered as primary and secondary outcomes, respectively. Substance type, study design and rTMS parameters were used as the independent factors in the meta‐regression. Results Results showed that excitatory rTMS of the left dorsolateral pre‐frontal cortex (DLPFC) significantly reduced craving [Hedges' g = −0.62; 95% confidence interval (CI) = −0.89 to −0.35; P < 0.0001], compared with sham stimulation. Moreover, meta‐regression revealed a significant positive association between the total number of stimulation pulses and effect size among studies using excitatory left DLPFC stimulation (P = 0.01). Effects of other rTMS protocols on craving were not significant. However, when examining substance consumption, excitatory rTMS of the left DLPFC and excitatory deep TMS (dTMS) of the bilateral DLPFC and insula revealed significant consumption‐reducing effects, compared with sham stimulation. Conclusion Excitatory repetitive transcranial magnetic stimulation of the dorsolateral pre‐frontal cortex appears to have an acute effect on reducing craving and substance consumption in patients with substance dependence. The anti‐craving effect may be associated with stimulation dose.

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“…As an effective pharmacotherapy for cocaine use disorder is still needed [6], nonconventional alternatives gain space in the research scenario. For instance, auricular acupuncture [7], and transcranial magnetic stimulation [8] have been tested, so far with ineffective results.…”

Section: Introductionmentioning

confidence: 99%

Homeopathy for Cocaine-Related Disorders: Implementing a Study Protocol in Primary Care (Cocacrack-3 Study Protocol)

Adler¹,

Bernardo²,

Denez³

et al. 2020

J Addict Sci

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Introduction: Previous results showed a significant decrease in cocaine-using days among cocaine users treated homeopathic fifty-millesimal (LM) potencies of Opium and Erythroxylum coca, as compared to placebo. Those results might have been biased by low adhesion of crack-cocaine users to treatment, trend that has been observed in clinical trials and practice, usually performed in specialized services. Objectives: to investigate 1) the effectiveness and tolerability of LMpotencies of Opium and Erythroxylum coca for cocaine-related disorders and 2) the effectiveness of a qualified primary care setting in increasing treatment attendance and retention. Methods: A randomized, placebo-controlled, double-blind, crossover clinical trial with twelve-week study duration per patient will be performed. 120 participants aged between 18 and 60 years, with Assist score for cocaine between 4 and 26 will be included. Exclusion criterion: urinary benzoylecgonine < 150 ng/mL. Participants will receive verum for 6 weeks followed by placebo for 6 weeks, or vice-versa. Primary endpoint: percentage of reported number of cocaine using days at week 6. Secondary endpoints: percentage of reported number of cocaine using days during participation in the study; percentage of positive benzoylecgonine samples; cocaine craving score, daily craving episodes number, craving episodes mean duration, patient perception of medication action favoring craving reduction (assessed by Minnesota Cocaine Craving Scale); Assist score for cocaine; treatment attendance; retention in treatment; Adverse Events. Discussion: For the first time, this study utilizes a primary care setting as a platform to increase treatment adhesion of cocaine users and assess the effectiveness of homeopathy for cocaine-related disorders.

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Transcranial magnetic stimulation for the treatment of cocaine addiction: evidence to date

Cited by 32 publications

References 113 publications

Intermittent Theta Burst Stimulation of the Prefrontal Cortex in Cocaine Use Disorder: A Pilot Study

Intermittent Theta Burst Stimulation of the Prefrontal Cortex in Cocaine Use Disorder: A Pilot Study

Effects of repetitive transcranial magnetic stimulation (rTMS) on craving and substance consumption in patients with substance dependence: a systematic review and meta‐analysis

Homeopathy for Cocaine-Related Disorders: Implementing a Study Protocol in Primary Care (Cocacrack-3 Study Protocol)

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