Pubblicazioni

A randomised, double-blind, sham-controlled study of left prefrontal cortex 15 Hz repetitive transcranial magnetic stimulation in cocaine consumption and craving

F, Lolli; M, Salimova; M, Scarpino; G, Lanzo; C, Cossu; M, Bastianelli; B, Occupati; F, Gori; A, Del Vecchio; A, Ercolini; S, Pascolo; V, Cimino; N, Meneghin; F, Fierini; D', ; G, Anna; M, Innocenti; A, Ballerini; S, Pallanti; A, Grippo; G, Mannaioni

Abstract:

Background: Cocaine use disorder (CUD) is a global health issue with no effective treatment. Repetitive Transcranial Magnetic Stimulation (rTMS) is a recently proposed therapy for CUD. Methods: We conducted a single-center, randomised, sham-controlled, blinded, parallel-group research with patients randomly allocated to rTMS (15 Hz) or Sham group (1:1) using a computerised block randomisation process. We enrolled 62 of 81 CUD patients in two years. Patients were followed for eight weeks after receiving 15 15 Hz rTMS/sham sessions over the left dorsolateral prefrontal cortex (DLPFC) during the first three weeks of the study. We targeted the DLFPC following the 5 cm method. Cocaine lapses in twice a week urine tests were the primary outcome. The secondary outcomes were craving severity, cocaine use pattern, and psychometric assessments. Findings: We randomly allocated patients to either an active rTMS group (32 subjects) or a sham treatment group (30 subjects). Thirteen (42%) and twelve (43.3%) of the subjects in rTMS and sham groups, respectively, completed the full trial regimen, displaying a high dropout rate. Ten/30 (33%) of rTMS-treated patients tested negative for cocaine in urine, in contrast to 4/27 of placebo controls (p = 0.18, odd ratio 2.88, CI 0.9-10). The Kaplan-Meier survival curve did not state a significant change between the treated and sham groups in the time of cocaine urine negativisation (p = 0.20). However, the severity of cocaine-related cues mediated craving (VAS peak) was substantially decreased in the rTMS treated group (p<0.03) after treatment at T1, corresponding to the end of rTMS treatment. Furthermore, in the rTMS and sham groups, self-reported days of cocaine use decreased significantly (p<0.03). Finally, psychometric impulsivity parameters improved in rTMS-treated patients, while depression scales improved in both groups. Conclusions: In CUD, rTMS could be a useful tool for lowering cocaine craving and consumption.

Patologie/Applicazioni:

• Dipendenze
• Stimolazione Magnetica Transcranica (TMS)

Anno:

2021

Tipo di pubblicazione:

Articolo

Parola chiave:

rTMS; Dipendenza; cocaina; CUD; neurostimolazione

Testata scientifica:

Plos One

Nota:

In questo studio controllato con sham, in cieco, si indaga l'effetto della stimolazione magnetica transcranica ripetitiva (rTMS) applicata alla corteccia dorsolaterale prefrontale (DLPFC) di sinistra nel trattamento del disturbo da uso di cocaina. Sessantadue pazienti vengono assegnati in maniera casuale a due gruppi: uno sottoposto a rTMS (15 Hz.) e uno a stimolazione sham. I pazienti vengono seguiti per otto settimane dopo essere stati sottoposti a 15 sessioni di rTMS o stimolazione sham nelle prime tre settimane dello studio. Come esiti primari vengono presi in considerazione gli esami delle urine, il craving, il comportamento di consumo della sostanza e le valutazioni psicometriche. I risultati mostrano come il gruppo sottoposto a rTMS abbia mostrato significativi miglioramenti rispetto a quello sottoposto a stimolazione sham. Questo trial dimostra come la rTMS applicata alla DLPFC di sinistra possa essere uno strumento utile per ridurre il desiderio e il consumo di cocaina.

DOI:

10.1371/journal.pone.0259860