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A Clinical Trial to Assess the Role of Repetitive Transcranial Magnetic Stimulation in Smoking Cessation in an Egyptian Sample. ADDICTIVE DISORDERS & THEIR TREATMENT 2021. [DOI: 10.1097/adt.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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102
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Efficacy and acceptability of noninvasive brain stimulation interventions for weight reduction in obesity: a pilot network meta-analysis. Int J Obes (Lond) 2021; 45:1705-1716. [PMID: 33972697 DOI: 10.1038/s41366-021-00833-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/17/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Obesity has recently been recognized as a neurocognitive disorder involving circuits associated with the reward system and the dorsolateral prefrontal cortex (DLPFC). Noninvasive brain stimulation (NIBS) has been proposed as a strategy for the management of obesity. However, the results have been inconclusive. The aim of the current network meta-analysis (NMA) was to evaluate the efficacy and acceptability of different NIBS modalities for weight reduction in participants with obesity. METHODS Randomized controlled trials (RCTs) examining NIBS interventions in patients with obesity were analyzed using the frequentist model of NMA. The coprimary outcome was change in body mass index (BMI) and acceptability, which was calculated using the dropout rate. RESULTS Overall, the current NMA, consisting of eight RCTs, revealed that the high-frequency repetitive transcranial magnetic stimulation (TMS) over the left DLPFC was ranked to be associated with the second-largest decrease in BMI and the largest decrease in total energy intake and craving severity, whereas the high-frequency deep TMS over bilateral DLPFC and the insula was ranked to be associated with the largest decrease in BMI. CONCLUSION This pilot study provided a "signal" for the design of more methodologically robust and larger RCTs based on the findings of the potentially beneficial effect on weight reduction in participants with obesity by different NIBS interventions.
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Devoto F, Ferrulli A, Zapparoli L, Massarini S, Banfi G, Paulesu E, Luzi L. Repetitive deep TMS for the reduction of body weight: Bimodal effect on the functional brain connectivity in "diabesity". Nutr Metab Cardiovasc Dis 2021; 31:1860-1870. [PMID: 33853721 DOI: 10.1016/j.numecd.2021.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Deep repetitive Transcranial Magnetic Stimulation (deep rTMS) over the bilateral insula and prefrontal cortex (PFC) can promote weight-loss in obesity, preventing cardiometabolic complications as Type 2 Diabetes (T2D). To investigate the changes in the functional brain integration after dTMS, we conducted a resting-state functional connectivity (rsFC) study in obesity. METHODS AND RESULTS This preliminary study was designed as a randomized, double-blind, sham-controlled study: 9 participants were treated with high-frequency stimulation (realTMS group), 8 were sham-treated (shamTMS group). Out of the 17 enrolled patients, 6 were affected by T2D. Resting-state fMRI scans were acquired at baseline (T0) and after the 5-week intervention (T1). Body weight was measured at three time points [T0, T1, 1-month follow-up visit (FU1)]. A mixed-model analysis showed a significant group-by-time interaction for body weight (p = .04), with a significant decrease (p < .001) in the realTMS group. The rsFC data revealed a significant increase of degree centrality for the realTMS group in the medial orbitofrontal cortex (mOFC) and a significant decrease in the occipital pole. CONCLUSION An increase of whole-brain functional connections of the mOFC, together with the decrease of whole-brain functional connections with the occipital pole, may reflect a brain mechanism behind weight-loss through a diminished reactivity to bottom-up visual-sensory processes in favor of increased reliance on top-down decision-making processes. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT03009695.
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Affiliation(s)
- Francantonio Devoto
- Department of Psychology and PhD Program in Neuroscience of the School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anna Ferrulli
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, MI, Italy
| | - Laura Zapparoli
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Stefano Massarini
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, MI, Italy
| | | | - Eraldo Paulesu
- Department of Psychology, University of Milano-Bicocca, Milan, Italy; IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, MI, Italy.
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Deep Transcranial Magnetic Stimulation Affects Gut Microbiota Composition in Obesity: Results of Randomized Clinical Trial. Int J Mol Sci 2021; 22:ijms22094692. [PMID: 33946648 PMCID: PMC8125086 DOI: 10.3390/ijms22094692] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023] Open
Abstract
Growing evidence highlights the crucial role of gut microbiota in affecting different aspects of obesity. Considering the ability of deep transcranial magnetic stimulation (dTMS) to modulate the cortical excitability, the reward system, and, indirectly, the autonomic nervous system (ANS), we hypothesized a potential role of dTMS in affecting the brain-gut communication pathways, and the gut microbiota composition in obesity. In a hospital setting, 22 subjects with obesity (5 M, 17 F; 44.9 ± 2.2 years; BMI 37.5 ± 1.0 kg/m2) were randomized into three groups receiving 15 sessions (3 per week for 5 weeks) of high frequency (HF), low frequency (LF) dTMS, or sham stimulation. Fecal samples were collected at baseline and after 5 weeks of treatment. Total bacterial DNA was extracted from fecal samples using the QIAamp DNA Stool Mini Kit (Qiagen, Italy) and analyzed by a metagenomics approach (Ion Torrent Personal Genome Machine). After 5 weeks, a significant weight loss was found in HF (HF: −4.1 ± 0.8%, LF: −1.9 ± 0.8%, sham: −1.3 ± 0.6%, p = 0.042) compared to LF and sham groups, associated with a decrease in norepinephrine compared to baseline (HF: −61.5 ± 15.2%, p < 0.01; LF: −31.8 ± 17.1%, p < 0.05; sham: −35.8 ± 21.0%, p > 0.05). Furthermore, an increase in Faecalibacterium (+154.3% vs. baseline, p < 0.05) and Alistipes (+153.4% vs. baseline, p < 0.05) genera, and a significant decrease in Lactobacillus (−77.1% vs. baseline, p < 0.05) were found in HF. Faecalibacterium variations were not significant compared to baseline in the other two groups (LF: +106.6%, sham: +27.6%; p > 0.05) as well as Alistipes (LF: −54.9%, sham: −15.1%; p > 0.05) and Lactobacillus (LF: −26.0%, sham: +228.3%; p > 0.05) variations. Norepinephrine change significantly correlated with Bacteroides (r2 = 0.734; p < 0.05), Eubacterium (r2 = 0.734; p < 0.05), and Parasutterella (r2 = 0.618; p < 0.05) abundance variations in HF. In conclusion, HF dTMS treatment revealed to be effective in modulating gut microbiota composition in subjects with obesity, reversing obesity-associated microbiota variations, and promoting bacterial species representative of healthy subjects with anti-inflammatory properties.
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105
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Oberman LM, Hynd M, Nielson DM, Towbin KE, Lisanby SH, Stringaris A. Repetitive Transcranial Magnetic Stimulation for Adolescent Major Depressive Disorder: A Focus on Neurodevelopment. Front Psychiatry 2021; 12:642847. [PMID: 33927653 PMCID: PMC8076574 DOI: 10.3389/fpsyt.2021.642847] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/18/2021] [Indexed: 12/31/2022] Open
Abstract
Adolescent depression is a potentially lethal condition and a leading cause of disability for this age group. There is an urgent need for novel efficacious treatments since half of adolescents with depression fail to respond to current therapies and up to 70% of those who respond will relapse within 5 years. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising treatment for major depressive disorder (MDD) in adults who do not respond to pharmacological or behavioral interventions. In contrast, rTMS has not demonstrated the same degree of efficacy in adolescent MDD. We argue that this is due, in part, to conceptual and methodological shortcomings in the existing literature. In our review, we first provide a neurodevelopmentally focused overview of adolescent depression. We then summarize the rTMS literature in adult and adolescent MDD focusing on both the putative mechanisms of action and neurodevelopmental factors that may influence efficacy in adolescents. We then identify limitations in the existing adolescent MDD rTMS literature and propose specific parameters and approaches that may be used to optimize efficacy in this uniquely vulnerable age group. Specifically, we suggest ways in which future studies reduce clinical and neural heterogeneity, optimize neuronavigation by drawing from functional brain imaging, apply current knowledge of rTMS parameters and neurodevelopment, and employ an experimental therapeutics platform to identify neural targets and biomarkers for response. We conclude that rTMS is worthy of further investigation. Furthermore, we suggest that following these recommendations in future studies will offer a more rigorous test of rTMS as an effective treatment for adolescent depression.
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Storch EA, Tendler A, Schneider SC, Guzick AG, La Buissonniere-Ariza V, Goodman WK. Moderators and predictors of response to deep transcranial magnetic stimulation for obsessive-compulsive disorder. J Psychiatr Res 2021; 136:508-514. [PMID: 33218749 DOI: 10.1016/j.jpsychires.2020.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/25/2020] [Accepted: 10/16/2020] [Indexed: 02/08/2023]
Abstract
Deep transcranial magnetic stimulation (dTMS) has emerged as a treatment option for adults with obsessive-compulsive disorder (OCD) who continue to exhibit impairing symptoms following an adequate response to first line interventions. Currently, little is known about the predictors or moderators of dTMS outcome for OCD. This paper examined if several theoretically relevant variables may predict and moderate treatment effects including OCD symptom severity, functional impairment, co-occurring depressive symptoms, age, gender, age of OCD onset, and family history of OCD. As part of a previously reported study, 100 patients received 29 dTMS or sham stimulation treatments over 6 weeks. dTMS was administered using a Magstim Rapid2 TMS (The Magstim Co. Ltd., Whitland, Carmarthenshire, United Kingdom) stimulator equipped with a H shaped coil design, which was specifically designed to stimulate the dorsal mPFC-ACC bilaterally. Findings suggest older participants and those with lower OCD severity and disability respond faster to both dTMS and sham stimulation. dTMS of the dorsal mPFC/ACC appeared to have larger benefits for individuals with greater OCD severity, whereas the difference between treatment arms was minimal in those with lower severity. Implications of these findings for treatment of OCD are discussed.
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Affiliation(s)
- Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA.
| | | | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA; BrainsWay Inc, USA
| | - Andrew G Guzick
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA; BrainsWay Inc, USA
| | | | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA; BrainsWay Inc, USA
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107
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Franklin TR, Jagannathan K, Spilka NH, Keyser H, Rao H, Ely AV, Janes AC, Wetherill RR. Smoking-induced craving relief relates to increased DLPFC-striatal coupling in nicotine-dependent women. Drug Alcohol Depend 2021; 221:108593. [PMID: 33611027 PMCID: PMC8026729 DOI: 10.1016/j.drugalcdep.2021.108593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Craving is a major contributor to drug-seeking and relapse. Although the ventral striatum (VS) is a primary neural correlate of craving, strategies aimed at manipulating VS function have not resulted in efficacious treatments. This incongruity may be because the VS does not influence craving in isolation. Instead, craving is likely mediated by communication between the VS and other neural substrates. Thus, we examined how striatal functional connectivity (FC) with key nodes of networks involved in addiction affects relief of craving, which is an important step in identifying viable treatment targets. METHODS Twenty-four nicotine-dependent non-abstinent women completed two resting-state (rs) fMRI scans, one before and one following smoking a cigarette in the scanner, and provided craving ratings before and after smoking the cigarette. A seed-based approach was used to examine rsFC between the VS, putamen and germane craving-related brain regions; the dorsolateral prefrontal cortex (dlPFC), the posterior cingulate cortex, and the anterior ventral insula. RESULTS Smoking a cigarette was associated with a decrease in craving. Relief of craving correlated with increases in right dlPFC- bilateral VS (r = 0.57, p = 0.003, corrected) as did increased right dlPFC-left putamen coupling (r = 0.62, p = 0.001, corrected). CONCLUSIONS Smoking-induced relief of craving is associated with enhanced rsFC between the dlPFC, a region that plays a pivotal role in decision making, and the striatum, the neural structure underlying motivated behavior. These findings are highly consistent with a burgeoning literature implicating dlPFC-striatal interactions as a neurobiological substrate of craving.
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Affiliation(s)
- Teresa R Franklin
- Center for Studies of Addiction, Department of Psychiatry, The University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA.
| | - Kanchana Jagannathan
- Center for Studies of Addiction, Department of Psychiatry, The University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
| | - Nathaniel H Spilka
- Center for Studies of Addiction, Department of Psychiatry, The University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
| | - Heather Keyser
- Center for Studies of Addiction, Department of Psychiatry, The University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
| | - Hengy Rao
- Center for Functional Neuroimaging, Department of Neurology, The University of Pennsylvania Perelman School of Medicine, 3700 Hamilton Walk, Philadelphia, PA, USA
| | - Alice V Ely
- Center for Studies of Addiction, Department of Psychiatry, The University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
| | - Amy C Janes
- Functional Integration of Addiction Research Lab, Department of Psychiatry, Harvard Medical School/McLean Hospital, 115 Mill St. Belmont, MA, 02478, USA
| | - Reagan R Wetherill
- Center for Studies of Addiction, Department of Psychiatry, The University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 500, Philadelphia, PA, 19104, USA
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108
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Peyton L, Oliveros A, Choi DS, Jang MH. Hippocampal regenerative medicine: neurogenic implications for addiction and mental disorders. Exp Mol Med 2021; 53:358-368. [PMID: 33785869 PMCID: PMC8080570 DOI: 10.1038/s12276-021-00587-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/28/2021] [Accepted: 02/16/2021] [Indexed: 12/13/2022] Open
Abstract
Psychiatric illness is a prevalent and highly debilitating disorder, and more than 50% of the general population in both middle- and high-income countries experience at least one psychiatric disorder at some point in their lives. As we continue to learn how pervasive psychiatric episodes are in society, we must acknowledge that psychiatric disorders are not solely relegated to a small group of predisposed individuals but rather occur in significant portions of all societal groups. Several distinct brain regions have been implicated in neuropsychiatric disease. These brain regions include corticolimbic structures, which regulate executive function and decision making (e.g., the prefrontal cortex), as well as striatal subregions known to control motivated behavior under normal and stressful conditions. Importantly, the corticolimbic neural circuitry includes the hippocampus, a critical brain structure that sends projections to both the cortex and striatum to coordinate learning, memory, and mood. In this review, we will discuss past and recent discoveries of how neurobiological processes in the hippocampus and corticolimbic structures work in concert to control executive function, memory, and mood in the context of mental disorders. A region of the brain called the hippocampus and its connections to other parts of the brain via what are called cortico-limbic structures are implicated in a variety of mental health disorders. These disorders can be accompanied by reduced hippocampal volume. Mi-Hyeon Jang, Doo-Sup Choi and colleagues at the Mayo Clinic College of Medicine and Science, Rochester, USA, review the role of hippocampal and cortico-limbic neurobiology in memory and mood in mental disorders. They focus particular attention on the role of neurogenesis, the production and growth of new nerve cells and connections. Disrupted neurogenesis in the adult hippocampus is implicated in conditions including addiction, depression, schizophrenia and related psychotic disorders. Learning more about neural regeneration in the hippocampus could yield insights into mental health conditions and open new avenues toward developing drug-based treatments.
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Affiliation(s)
- Lee Peyton
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Alfredo Oliveros
- Department of Neurologic Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Doo-Sup Choi
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. .,Department of Psychiatry & Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Mi-Hyeon Jang
- Department of Neurologic Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. .,Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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109
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Turel O, He Q, Wei L, Bechara A. The role of the insula in internet gaming disorder. Addict Biol 2021; 26:e12894. [PMID: 32147952 DOI: 10.1111/adb.12894] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/22/2020] [Accepted: 02/27/2020] [Indexed: 11/29/2022]
Abstract
Internet gaming disorder (IGD) is a concerning issue that requires further research. Here, we seek to examine its neural etiology with an emphasis on the role of the insula. To do so, we relied on the tripartite neurocognitive model of addictive behaviors as applied to IGD. We hypothesized that (a) video game cues will elicit stronger reward system activation and weaker prefrontal activation in gamers vs controls, (b) the IGD scores of gamers will be positively associated with activation of the reward system and negatively with activation of prefrontal regions, (c) deprivation from video gaming will result in increased activation of the insula, when gamers are exposed to video game cues vs to neutral cues, and (d) in deprivation conditions, there will be positive and negative coupling, respectively, between activation of the insula and the reward and prefrontal regions in gamers. We tested these hypotheses with a design with one between-subjects factor (gamers vs controls) and two within-subjects factors: stimuli (gaming vs neutral; for all participants) and session (deprivation vs satiety; only for gamers). Findings based on functional magnetic resonance imaging (fMRI; applied to all 52 subjects, 26 gamers, and 26 controls) and psychophysiological interaction (PPI; applied to the 26 gamers) engaged in a video reactivity task supported our assertions. The IGD score positively correlated with activity in the right ventral striatum and negatively with activity in the right dorsolateral prefrontal cortex (DLPFC). Left insular cortex activity was the highest when observing video gaming cues under deprivation. Lastly, there was an increased coupling between the left insula and left ventral striatum and a decreased coupling with left DLPFC when observing video gaming cues compared with when watching control videos in the deprivation condition.
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Affiliation(s)
- Ofir Turel
- Information Systems and Decision Sciences California State University Fullerton California USA
- Brain and Creativity Institute University of Southern California Los Angeles California USA
| | - Qinghua He
- Faculty of Psychology Southwest University Chongqing China
- Key Laboratory of Cognition and Personality, Ministry of Education Southwest University Chongqing China
- Chongqing Collaborative Innovation Center for Brain Science Chongqing China
- Southwest University Branch Collaborative Innovation Center of Assessment Toward Basic Education Quality at Beijing Normal University Chongqing China
- Institute of Psychology, Key Laboratory of Mental Health Chinese Academy of Sciences Beijing China
| | - Lei Wei
- Faculty of Psychology Southwest University Chongqing China
| | - Antoine Bechara
- Brain and Creativity Institute University of Southern California Los Angeles California USA
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Antonelli M, Fattore L, Sestito L, Di Giuda D, Diana M, Addolorato G. Transcranial Magnetic Stimulation: A review about its efficacy in the treatment of alcohol, tobacco and cocaine addiction. Addict Behav 2021; 114:106760. [PMID: 33316590 DOI: 10.1016/j.addbeh.2020.106760] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/30/2022]
Abstract
Substance Use Disorder (SUD) is a chronic and relapsing disease characterized by craving, loss of control, tolerance and physical dependence. At present, the combination of pharmacotherapy and psychosocial intervention is the most effective management strategy in preventing relapse to reduce dropout rates and promote abstinence in SUD patients. However, only few effective medications are available. Transcranial Magnetic Stimulation (TMS) is a non-invasive brain stimulation technique that modulates the cellular activity of the cerebral cortex through a magnetic pulse applied on selected brain areas. Recently, the efficacy of TMS has been investigated in various categories of SUD patients. The present review analyzes the application of repetitive TMS in patients with alcohol, tobacco, and cocaine use disorder. Although the number of clinical studies is still limited, repetitive TMS yields encouraging results in these patients, suggesting a possible role of TMS in the treatment of SUD.
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Affiliation(s)
- Mariangela Antonelli
- Alcohol Use Disorder and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | - Liana Fattore
- CNR Institute of Neuroscience-Cagliari, National Research Council, Italy
| | - Luisa Sestito
- Alcohol Use Disorder and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | - Daniela Di Giuda
- Institute of Nuclear Medicine, Catholic University of Rome, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Marco Diana
- G. Minardi' Laboratory of Cognitive Neuroscience, Department of Chemistry and Pharmacy, University of Sassari, Italy
| | - Giovanni Addolorato
- Alcohol Use Disorder and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy; Internal Medicine Unit, Columbus-Gemelli Hospital, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy.
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111
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Wang C, Huang P, Shen Z, Qian W, Wang S, Jiaerken Y, Luo X, Li K, Zeng Q, Zhou C, Yang Y, Zhang M. Increased striatal functional connectivity is associated with improved smoking cessation outcomes: A preliminary study. Addict Biol 2021; 26:e12919. [PMID: 32436626 DOI: 10.1111/adb.12919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/26/2022]
Abstract
The striatum is the critical area of reward processing and has been repeatedly linked to nicotine addiction. However, it remains unclear whether different smoking cessation outcomes (relapse or not) are associated with different functional connectivity changes of the striatum during smoking cessation treatment. A total of 30 treatment-seeking smokers were recruited in the study and underwent magnetic resonance imaging (MRI) scans immediately before and after a 12-week treatment with varenicline. After the 12-week treatment with varenicline, 14 subjects relapsed to smoking (relapsers), whereas 16 not relapsed (nonrelapsers). Changes in resting-state functional connectivity (rsFC) across groups and visits were assessed using repeated measures analysis of covariance (ANCOVA). Significant interaction effects were detected: (1) between left nucleus accumbens (NAc) and left orbitofrontal cortex (OFC), insula, inferior frontal gyrus (IFG), and bilateral precuneus; (2) between right NAc and left insula, IFG, and bilateral dorsolateral prefrontal cortex (DLPFC); and (3) between bilateral putamen and left precuneus. Post hoc region-of-interest analyses in brain areas showing interaction effects indicated significantly decreased rsFC after treatment compared with before treatment in relapsers but opposite longitudinal changes in nonrelapers. These novel findings suggest that increased striatal rsFC is associated with improved smoking cessation outcomes. These striatal functional circuits may serve as potential therapeutic targets for more efficacious treatment of nicotine addiction.
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Affiliation(s)
- Chao Wang
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Peiyu Huang
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Zhujing Shen
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Wei Qian
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Shuyue Wang
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Yeerfan Jiaerken
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Xiao Luo
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Kaicheng Li
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Qingze Zeng
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Cheng Zhou
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
| | - Yihong Yang
- Neuroimaging Research Branch National Institute on Drug Abuse, National Institutes of Health Baltimore MD USA
| | - Minming Zhang
- Department of Radiology, the Second Affiliated Hospital Zhejiang University School of Medicine Hangzhou China
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de Miquel C, Pross B, Papazova I, Güler D, Hasan A. The two-way relationship between nicotine and cortical activity: a systematic review of neurobiological and treatment aspects. Eur Arch Psychiatry Clin Neurosci 2021; 271:157-180. [PMID: 32594235 DOI: 10.1007/s00406-020-01155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/16/2020] [Indexed: 11/29/2022]
Abstract
Nicotine intake and cortical activity are closely related, as they can influence each other. Nicotine is implicated in the induction and modification of cortical plasticity and excitability, whereas a change on cortical plasticity and excitability can also lead to a modification of the smoking behaviour of an individual. The aim of this systematic review was, on the one hand, to evaluate the effects of nicotinergic modulation on cortical excitability and plasticity, and, on the other hand, to assess if modifying the brain's excitability and plasticity could influence one's smoking behaviour. Two systematic literature searches in the PubMed/MEDLINE and PsycINFO databases were conducted. Studies focusing either on the impact of nicotinergic modulation on cortical activity or the treatment effect of non-invasive brain stimulation techniques (NIBS) on smoking behaviour were included. A total of 22 studies for the first systematic search and 35 studies for the second one were included after full-text screening. Nicotine's effect on cortical activity appeared to depend on smoking status of the individual. While deprived smokers seem to generally profit from nicotine consumption in terms of cortical excitability and plasticity, the contrary was true for non-smokers. Regarding the questions of how changes in cortical excitability can influence smoking behaviour, a trend points towards NIBS being a potential intervention technique for smoking cessation.
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Affiliation(s)
- Carlota de Miquel
- Department of Psychiatry and Psychotherapy, University Medical Hospital, LMU, Nußbaumstr. 7, 80336, Munich, Germany. .,Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| | - Benjamin Pross
- Department of Psychiatry and Psychotherapy, University Medical Hospital, LMU, Nußbaumstr. 7, 80336, Munich, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Irina Papazova
- Department of Psychiatry and Psychotherapy, University Medical Hospital, LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Duygu Güler
- Department of Psychiatry and Psychotherapy, University Medical Hospital, LMU, Nußbaumstr. 7, 80336, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Medical Hospital, LMU, Nußbaumstr. 7, 80336, Munich, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, Bezirkskrankenhaus Augsburg, Augsburg, Germany
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Clinical and Functional Connectivity Outcomes of 5-Hz Repetitive Transcranial Magnetic Stimulation as an Add-on Treatment in Cocaine Use Disorder: A Double-Blind Randomized Controlled Trial. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:745-757. [PMID: 33508499 DOI: 10.1016/j.bpsc.2021.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/04/2020] [Accepted: 01/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cocaine use disorder (CUD) is a global condition lacking effective treatment. Repetitive transcranial magnetic stimulation (rTMS) may reduce craving and frequency of cocaine use, but little is known about its efficacy and neural effects. We sought to elucidate short- and long-term clinical benefits of 5-Hz rTMS as an add-on to standard treatment in patients with CUD and discern underlying functional connectivity effects using magnetic resonance imaging. METHODS A total of 44 patients with CUD were randomly assigned to complete the 2-week double-blind randomized controlled trial (acute phase) (sham [n = 20, 2 female] and active [n = 24, 4 female]), in which they received two daily sessions of rTMS on the left dorsolateral prefrontal cortex (PFC). Subsequently, 20 patients with CUD continued to an open-label maintenance phase for 6 months (two weekly sessions for up to 6 mo). RESULTS rTMS plus standard treatment for 2 weeks significantly reduced craving (baseline: 3.9 ± 3.6; 2 weeks: 1.5 ± 2.4, p = .013, d = 0.77) and impulsivity (baseline: 64.8 ± 16.8; 2 weeks: 53.1 ± 17.4, p = .011, d = 0.79) in the active group. We also found increased functional connectivity between the left dorsolateral PFC and ventromedial PFC and between the ventromedial PFC and right angular gyrus. Clinical and functional connectivity effects were maintained for 3 months, but they dissipated by 6 months. We did not observe reduction in positive results for cocaine in urine; however, self-reported frequency and grams consumed for 6 months were reduced. CONCLUSIONS With this randomized controlled trial, we show that 5-Hz rTMS has potential promise as an adjunctive treatment for CUD and merits further research.
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114
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Maldonado R, Calvé P, García-Blanco A, Domingo-Rodriguez L, Senabre E, Martín-García E. Vulnerability to addiction. Neuropharmacology 2021; 186:108466. [PMID: 33482225 DOI: 10.1016/j.neuropharm.2021.108466] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/03/2020] [Accepted: 01/14/2021] [Indexed: 12/22/2022]
Abstract
Addiction is a chronic brain disease that has dramatic health and socioeconomic consequences worldwide. Multiple approaches have been used for decades to clarify the neurobiological basis of this disease and to identify novel potential treatments. This review summarizes the main brain networks involved in the vulnerability to addiction and specific innovative technological approaches to investigate these neural circuits. First, the evolution of the definition of addiction across the Diagnostic and Statistical Manual of Mental Disorders (DSM) is revised. We next discuss several innovative experimental techniques that, combined with behavioral approaches, have allowed recent critical advances in understanding the neural circuits involved in addiction, including DREADDs, calcium imaging, and electrophysiology. All these techniques have been used to investigate specific neural circuits involved in vulnerability to addiction and have been extremely useful to clarify the neurobiological basis of each specific component of the addictive process. These novel tools targeting specific brain regions are of great interest to further understand the different aspects of this complex disease. This article is part of the special issue on 'Vulnerabilities to Substance Abuse.'.
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Affiliation(s)
- R Maldonado
- Laboratory of Neuropharmacology-Neurophar, Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; Hospital Del Mar Medical Research Institute (IMIM), Barcelona, Spain.
| | - P Calvé
- Laboratory of Neuropharmacology-Neurophar, Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - A García-Blanco
- Laboratory of Neuropharmacology-Neurophar, Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - L Domingo-Rodriguez
- Laboratory of Neuropharmacology-Neurophar, Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - E Senabre
- Laboratory of Neuropharmacology-Neurophar, Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - E Martín-García
- Laboratory of Neuropharmacology-Neurophar, Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.
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115
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A double-blind randomized clinical trial of high frequency rTMS over the DLPFC on nicotine dependence, anxiety and depression. Sci Rep 2021; 11:1640. [PMID: 33452340 PMCID: PMC7810712 DOI: 10.1038/s41598-020-80927-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022] Open
Abstract
High frequency repetitive transcranial magnetic stimulation (HF-rTMS) over the left dorsolateral prefrontal cortex (L-DLPFC) is a widely applied treatment protocol for chronic smoking and major depressive disorder. However, no previous study has measured the effects of rTMS on both nicotine consumption and anxiety/depression in the same volunteers despite the relationship between them. The aim of this work was to evaluate the efficacy of 10 daily sessions of HF-rTMS over the L-DLPFC in chronic cigarette smokers' addiction and investigate the possible beneficial effects of this treatment procedure on symptoms of depression and anxiety in the same subjects. The study included 40 treatment-seeking nicotine-dependent cigarette smokers. Onset/duration of smoking, number of cigarettes/day, Fagerstrom Test of Nicotine Dependence (FTND), Tobacco Craving Questionnaire-Short Form (TCQ-SF), Hamilton depression and anxiety scales (HAM-D and HAM-A) were recorded. Participants were randomly assigned to the active or the sham treatment group. Those in the active group received 10 trains of 20 Hz stimulation, at 80% of the resting motor threshold (rMT) for 10 consecutive working days over L-DLPFC. Participants were reassessed immediately after treatment, and then 3 months later using all rating scales. There were no differences between active and sham groups at baseline. The cigarette consumption/day, and scores on FTND, and TCQ decreased significantly in both groups (p = 0.0001 for each) immediately after treatment. However, improvement persisted to 3 months in the active group but not in the sham group. Moreover, there was a significant reduction in HAM-D and HAM-A scores immediately after treatment in the active but not the sham group. Subjects with a longer history of smoking had a lower percent improvement in FTND (p = 0.005). Our findings revealed that HF-rTMS over L-DLPCF for 10 days reduced cigarette consumption, craving, dependence, and improved associated symptoms of anxiety and depression.ClinicalTrials.gov Identifier: NCT03264755 registered at 29/08/2017.
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Rossi S, Antal A, Bestmann S, Bikson M, Brewer C, Brockmöller J, Carpenter LL, Cincotta M, Chen R, Daskalakis JD, Di Lazzaro V, Fox MD, George MS, Gilbert D, Kimiskidis VK, Koch G, Ilmoniemi RJ, Lefaucheur JP, Leocani L, Lisanby SH, Miniussi C, Padberg F, Pascual-Leone A, Paulus W, Peterchev AV, Quartarone A, Rotenberg A, Rothwell J, Rossini PM, Santarnecchi E, Shafi MM, Siebner HR, Ugawa Y, Wassermann EM, Zangen A, Ziemann U, Hallett M. Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clin Neurophysiol 2021; 132:269-306. [PMID: 33243615 PMCID: PMC9094636 DOI: 10.1016/j.clinph.2020.10.003] [Citation(s) in RCA: 558] [Impact Index Per Article: 186.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022]
Abstract
This article is based on a consensus conference, promoted and supported by the International Federation of Clinical Neurophysiology (IFCN), which took place in Siena (Italy) in October 2018. The meeting intended to update the ten-year-old safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings (Rossi et al., 2009). Therefore, only emerging and new issues are covered in detail, leaving still valid the 2009 recommendations regarding the description of conventional or patterned TMS protocols, the screening of subjects/patients, the need of neurophysiological monitoring for new protocols, the utilization of reference thresholds of stimulation, the managing of seizures and the list of minor side effects. New issues discussed in detail from the meeting up to April 2020 are safety issues of recently developed stimulation devices and pulse configurations; duties and responsibility of device makers; novel scenarios of TMS applications such as in the neuroimaging context or imaging-guided and robot-guided TMS; TMS interleaved with transcranial electrical stimulation; safety during paired associative stimulation interventions; and risks of using TMS to induce therapeutic seizures (magnetic seizure therapy). An update on the possible induction of seizures, theoretically the most serious risk of TMS, is provided. It has become apparent that such a risk is low, even in patients taking drugs acting on the central nervous system, at least with the use of traditional stimulation parameters and focal coils for which large data sets are available. Finally, new operational guidelines are provided for safety in planning future trials based on traditional and patterned TMS protocols, as well as a summary of the minimal training requirements for operators, and a note on ethics of neuroenhancement.
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Affiliation(s)
- Simone Rossi
- Department of Scienze Mediche, Chirurgiche e Neuroscienze, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab (SI-BIN Lab), University of Siena, Italy.
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center, Georg-August University of Goettingen, Germany; Institue of Medical Psychology, Otto-Guericke University Magdeburg, Germany
| | - Sven Bestmann
- Department of Movement and Clinical Neurosciences, UCL Queen Square Institute of Neurology, London, UK and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Carmen Brewer
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jürgen Brockmöller
- Department of Clinical Pharmacology, University Medical Center, Georg-August University of Goettingen, Germany
| | - Linda L Carpenter
- Butler Hospital, Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Massimo Cincotta
- Unit of Neurology of Florence - Central Tuscany Local Health Authority, Florence, Italy
| | - Robert Chen
- Krembil Research Institute and Division of Neurology, Department of Medicine, University of Toronto, Canada
| | - Jeff D Daskalakis
- Center for Addiction and Mental Health (CAMH), University of Toronto, Canada
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico, Roma, Italy
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Mark S George
- Medical University of South Carolina, Charleston, SC, USA
| | - Donald Gilbert
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | | | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering (NBE), Aalto University School of Science, Aalto, Finland
| | - Jean Pascal Lefaucheur
- EA 4391, ENT Team, Faculty of Medicine, Paris Est Creteil University (UPEC), Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, (APHP), Créteil, France
| | - Letizia Leocani
- Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS-San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Sarah H Lisanby
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Carlo Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institut, Institut Guttmann, Universitat Autonoma Barcelona, Spain
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg-August University of Goettingen, Germany
| | - Angel V Peterchev
- Departments of Psychiatry & Behavioral Sciences, Biomedical Engineering, Electrical & Computer Engineering, and Neurosurgery, Duke University, Durham, NC, USA
| | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Alexander Rotenberg
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - John Rothwell
- Department of Movement and Clinical Neurosciences, UCL Queen Square Institute of Neurology, London, UK and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Paolo M Rossini
- Department of Neuroscience and Rehabilitation, IRCCS San Raffaele-Pisana, Roma, Italy
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mouhsin M Shafi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Yoshikatzu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Eric M Wassermann
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Abraham Zangen
- Zlotowski Center of Neuroscience, Ben Gurion University, Beer Sheva, Israel
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA.
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Burnette EM, Grodin EN, Ghahremani DG, Galván A, Kohno M, Ray LA, London ED. Diminished cortical response to risk and loss during risky decision making in alcohol use disorder. Drug Alcohol Depend 2021; 218:108391. [PMID: 33153830 PMCID: PMC7750289 DOI: 10.1016/j.drugalcdep.2020.108391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Risky decision-making is an important facet of addiction. Individuals with alcohol dependence show abnormalities in gambling and other risk-taking tasks. In one such measure, the Balloon Analogue Risk Task (BART), participants sequentially choose to pump a virtual balloon to increase potential reward while the risk of explosion increases, or to cash-out and take earnings. In a prior study, alcohol-dependent participants differed from controls in brain activation during decision-making on the BART, but the relationship between risk/reward magnitude and brain activation was not studied, nor were participants compared to controls. Here we compared the degree to which risk and magnitude of reward influenced brain activation in alcohol-dependent participants vs. controls during decision-making on the BART. METHODS Thirty-two participants (16 alcohol-dependent, 16 control; 5 females/group) performed the BART during fMRI. A parametric analysis tested for a relationship between risk/reward magnitude and activation in rDLPFC and bilateral striatum regions of interest when participants chose to take risk or to cash out. An exploratory whole-brain voxel-wise analysis of mean activation during pumping, cash-out, and explosion events was also conducted. RESULTS Compared with controls, alcohol-dependent participants displayed less modulation of activation in the rDLPFC when taking risk. Exploratory analyses found that alcohol-dependent participants showed less activation than controls during explosions in a cluster including the insula. No differences were seen in striatal activation. CONCLUSIONS Insensitivity of the rDLPFC to risk and of the insula to loss may contribute to decision-making deficits in alcohol dependence.
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Affiliation(s)
- Elizabeth M. Burnette
- Department of Psychology, University of California, Los Angeles, CA,Neuroscience Interdepartmental Program, University of California, Los Angeles, CA
| | - Erica N. Grodin
- Department of Psychology, University of California, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA
| | - Dara G. Ghahremani
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA
| | - Adriana Galván
- Department of Psychology, University of California, Los Angeles, CA,Neuroscience Interdepartmental Program, University of California, Los Angeles, CA,Brain Research Institute, University of California, Los Angeles, CA
| | - Milky Kohno
- Department of Psychiatry, Oregon Health and Sciences University, Portland, OR
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, CA,Neuroscience Interdepartmental Program, University of California, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA,Brain Research Institute, University of California, Los Angeles, CA
| | - Edythe D. London
- Neuroscience Interdepartmental Program, University of California, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA,Brain Research Institute, University of California, Los Angeles, CA,Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA
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118
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Noël X. Les addictions sous l’angle neurocognitif. PSYCHO-ONCOLOGIE 2020. [DOI: 10.3166/pson-2020-0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les principaux modèles neurocognitifs conçoivent l’addiction comme le résultat d’un déséquilibre de trois systèmes cérébraux en constante interaction : un circuit striatoamygdalien qui favorise les comportements automatiques, habituels et saillants, le cortex préfrontal impliqué dans la prise de décision et dans le contrôle inhibiteur. Enfin, la région insulaire permet un traitement proprioceptif à l’origine d’états émotionnels conscients, ce qui exerce une influence sur la prise de décision. L’influence du stress ainsi que les perspectives cliniques sont discutées.
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119
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Sanna A, Fattore L, Badas P, Corona G, Diana M. The hypodopaminergic state ten years after: transcranial magnetic stimulation as a tool to test the dopamine hypothesis of drug addiction. Curr Opin Pharmacol 2020; 56:61-67. [PMID: 33310457 DOI: 10.1016/j.coph.2020.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 01/29/2023]
Abstract
An altered dopamine transmission has been described for different types of addiction for a long time. Preclinical and clinical evidence support the hypodopaminergic hypothesis and underpin the need to increase dopamine transmission to obtain therapeutic benefit. Repetitive transcranial magnetic stimulation (rTMS) of prefrontal cortex shows efficacy in treating some forms of addiction. Recent imaging studies confirmed that the therapeutic effect of rTMS is correlated with an enhancement of dopamine transmission. Novel targets for rTMS are under evaluation to increase its effectiveness in treating addiction, and research is ongoing to find the optimal protocol to boost dopaminergic transmission in the addicted brain. TMS can thus be considered a useful tool to test the dopamine hypothesis of drug addiction and instrumental in the search for addiction therapeutics.
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Affiliation(s)
- Angela Sanna
- Department of Medical Science and Public Health, Section of Neurology, University of Cagliari
| | - Liana Fattore
- CNR Institute of Neuroscience-Cagliari, National Research Council, Cittadella Universitaria, Monserrato, 09042, CA, Italy
| | - Paola Badas
- rTMS Italia, via Tonale 15, Cagliari, 09122, Italy
| | | | - Marco Diana
- 'G.Minardi' Laboratory of Cognitive Neuroscience, Department of Chemistry and Pharmacy, University of Sassari, via Muroni 23v, 07100, Italy.
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120
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Mahoney JJ, Hanlon CA, Marshalek PJ, Rezai AR, Krinke L. Transcranial magnetic stimulation, deep brain stimulation, and other forms of neuromodulation for substance use disorders: Review of modalities and implications for treatment. J Neurol Sci 2020; 418:117149. [PMID: 33002757 PMCID: PMC7702181 DOI: 10.1016/j.jns.2020.117149] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/07/2020] [Accepted: 09/18/2020] [Indexed: 12/13/2022]
Abstract
Given the high prevalence of individuals diagnosed with substance use disorder, along with the elevated rate of relapse following treatment initiation, investigating novel approaches and new modalities for substance use disorder treatment is of vital importance. One such approach involves neuromodulation which has been used therapeutically for neurological and psychiatric disorders and has demonstrated positive preliminary findings for the treatment of substance use disorder. The following article provides a review of several forms of neuromodulation which warrant consideration as potential treatments for substance use disorder. PubMed, PsycINFO, Ovid MEDLINE, and Web of Science were used to identify published articles and clinicaltrials.gov was used to identify currently ongoing or planned studies. Search criteria for Brain Stimulation included the following terminology: transcranial direct current stimulation, transcranial magnetic stimulation, theta burst stimulation, deep brain stimulation, vagus nerve stimulation, trigeminal nerve stimulation, percutaneous nerve field stimulation, auricular nerve stimulation, and low intensity focused ultrasound. Search criteria for Addiction included the following terminology: addiction, substance use disorder, substance-related disorder, cocaine, methamphetamine, amphetamine, alcohol, nicotine, tobacco, smoking, marijuana, cannabis, heroin, opiates, opioids, and hallucinogens. Results revealed that there are currently several forms of neuromodulation, both invasive and non-invasive, which are being investigated for the treatment of substance use disorder. Preliminary findings have demonstrated the potential of these various neuromodulation techniques in improving substance treatment outcomes by reducing those risk factors (e.g. substance craving) associated with relapse. Specifically, transcranial magnetic stimulation has shown the most promise with several well-designed studies supporting the potential for reducing substance craving. Deep brain stimulation has also shown promise, though lacks well-controlled clinical trials to support its efficacy. Transcranial direct current stimulation has also demonstrated promising results though consistently designed, randomized trials are also needed. There are several other forms of neuromodulation which have not yet been investigated clinically but warrant further investigation given their mechanisms and potential efficacy based on findings from other studied indications. In summary, given promising findings in reducing substance use and craving, neuromodulation may provide a non-pharmacological option as a potential treatment and/or treatment augmentation for substance use disorder. Further research investigating neuromodulation, both alone and in combination with already established substance use disorder treatment (e.g. medication treatment), warrants consideration.
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Affiliation(s)
- James J Mahoney
- West Virginia University School of Medicine, Rockefeller Neuroscience Institute, 33 Medical Center Drive, Morgantown, WV 26505, United States of America; WVU Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV 26505, United States of America; WVU Department of Neuroscience, 64 Medical Center Drive, Morgantown, WV 26505, United States of America.
| | - Colleen A Hanlon
- Wake Forest School of Medicine, Cancer Biology and Center for Substance Use and Addiction, 475 Vine Street, Winston-Salem, NC 27101, United States of America
| | - Patrick J Marshalek
- West Virginia University School of Medicine, Rockefeller Neuroscience Institute, 33 Medical Center Drive, Morgantown, WV 26505, United States of America; WVU Department of Behavioral Medicine and Psychiatry, 930 Chestnut Ridge Road, Morgantown, WV 26505, United States of America; WVU Department of Neuroscience, 64 Medical Center Drive, Morgantown, WV 26505, United States of America
| | - Ali R Rezai
- West Virginia University School of Medicine, Rockefeller Neuroscience Institute, 33 Medical Center Drive, Morgantown, WV 26505, United States of America; WVU Department of Neuroscience, 64 Medical Center Drive, Morgantown, WV 26505, United States of America; WVU Department of Neurosurgery, 64 Medical Center Drive, Morgantown, WV 26505, United States of America
| | - Lothar Krinke
- West Virginia University School of Medicine, Rockefeller Neuroscience Institute, 33 Medical Center Drive, Morgantown, WV 26505, United States of America; WVU Department of Neuroscience, 64 Medical Center Drive, Morgantown, WV 26505, United States of America; Magstim Inc., 9855 West 78 Street, Suite 12, Eden Prairie, MN 55344, United States of America
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121
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Blini E, Tilikete C, Chelazzi L, Farnè A, Hadj-Bouziane F. The role of the vestibular system in value attribution to positive and negative reinforcers. Cortex 2020; 133:215-235. [PMID: 33130427 DOI: 10.1016/j.cortex.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 01/06/2023]
Abstract
Somatic inputs originating from bioregulatory processes can guide cognition and behavior. One such bodily signal, mostly overlooked so far, is represented by visuo-vestibular coupling and its alteration, which in extreme cases may result in motion sickness. We argued that the inherently perturbed interoceptive state that follows can be a powerful determinant of human motivated behavior, resulting in a blunted response to appetitive stimuli and an exaggerated response to noxious ones. We sought to assess such differential impact of visuo-vestibular mismatches on value through a task involving conflict monitoring. We therefore administered to 42 healthy participants a modified version of the Flankers task, in which distractors (arrows, pointing in either a congruent or incongruent direction) signaled the availability of monetary incentives (gains, losses, or neutral trials). While performing the task, participants received either galvanic vestibular stimulation (GVS), or sham stimulation. We have found impaired behavioral performances when value, which was attached to task-irrelevant information, was at stake. Gains and losses, interestingly, dissociated, and only the latter caused enhanced interference costs in the task, suggesting that negative incentives may be more effective in capturing human attention than positive ones. Finally, we have found some weak evidence for GVS to further increase the processing of losses, as suggested by even larger interference costs in this condition. Results were, however, overall ambiguous, and suggest that much more research is needed to better understand the link between the vestibular system and motivation.
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Affiliation(s)
- Elvio Blini
- Integrative Multisensory Perception Action & Cognition Team (ImpAct), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center (CRNL), Lyon, France; University of Lyon, Lyon, France; Department of General Psychology, University of Padova, Padova, Italy.
| | - Caroline Tilikete
- Integrative Multisensory Perception Action & Cognition Team (ImpAct), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center (CRNL), Lyon, France; University of Lyon, Lyon, France; Hospices Civils de Lyon, Neuro-Ophthalmology and Neurocognition, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Leonardo Chelazzi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; National Institute of Neuroscience - Verona Unit, Verona, Italy
| | - Alessandro Farnè
- Integrative Multisensory Perception Action & Cognition Team (ImpAct), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center (CRNL), Lyon, France; University of Lyon, Lyon, France; Hospices Civils de Lyon, Neuro-Immersion Platform, Lyon, France
| | - Fadila Hadj-Bouziane
- Integrative Multisensory Perception Action & Cognition Team (ImpAct), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center (CRNL), Lyon, France; University of Lyon, Lyon, France.
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Zhao Y, Sallie SN, Cui H, Zeng N, Du J, Yuan T, Li D, De Ridder D, Zhang C. Anterior Cingulate Cortex in Addiction: New Insights for Neuromodulation. Neuromodulation 2020; 24:S1094-7159(21)00082-9. [PMID: 33090660 DOI: 10.1111/ner.13291] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Substance use disorder (SUD) is characterized by compulsive use of addictive substances with considerable impact on both the medical system and society as a whole. The craving of substances leads to relapse in the majority of patients within one year of traditional treatments. In recent decades, neuromodulation approaches have emerged as potential novel treatments of SUD, but the ideal neural target remains contentious. MATERIALS AND METHODS In this review, we discuss new insights on the anterior cingulate cortex (ACC) as a neuromodulation target for SUD. RESULTS AND CONCLUSION First, we illustrate that the ACC serves as a central "hub" in addiction-related neural networks of cognitive functions, including, but not limited to, decision-making, cognitive inhibition, emotion, and motivation. Then, we summarize the literature targeting the ACC to treat SUDs via available neuromodulation approaches. Finally, we propose potential directions to improve the effect of stimulating the ACC in SUD treatment. We emphasize that the ACC can be divided into at least four sub-regions, which have distinctive functions and connections. Studies focusing on these sub-regions may help to develop more precise and effective ACC stimulation according to patients' symptom profiles and cognitive deficits.
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Affiliation(s)
- Yijie Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Samantha N Sallie
- Department of Psychiatry, University of Cambridge, Level E4, Addenbrooke's Hospital, Cambridge, UK
| | - Hailun Cui
- Department of Psychiatry, University of Cambridge, Level E4, Addenbrooke's Hospital, Cambridge, UK
| | - Ningning Zeng
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Du
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tifei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Li X, Hartwell KJ, Henderson S, Badran BW, Brady KT, George MS. Two weeks of image-guided left dorsolateral prefrontal cortex repetitive transcranial magnetic stimulation improves smoking cessation: A double-blind, sham-controlled, randomized clinical trial. Brain Stimul 2020; 13:1271-1279. [PMID: 32534252 PMCID: PMC7494651 DOI: 10.1016/j.brs.2020.06.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 05/01/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous studies have found that repetitive transcranial magnetic stimulation (rTMS) to the left dorsal lateral prefrontal cortex (LDLPFC) transiently reduces smoking craving, decreases cigarette consumption, and increases abstinence rates. OBJECTIVE We investigated whether 10 daily MRI-guided rTMS sessions over two weeks to the LDLPFC paired with craving cues could reduce cigarette consumption and induce smoking cessation. METHODS We enrolled 42 treatment-seeking nicotine-dependent smokers (≥10 cigarettes per day) in a randomized, double-blind, sham-controlled trial. Participants received 10 daily sessions over 2 weeks of either active or sham MRI-guided rTMS (10Hz, 3000 pulses each session) to the LDLPFC concurrently with video smoking cues. The primary outcome was a reduction in biochemically confirmed cigarette consumption with a secondary outcome of abstinence on the target quit date. We also recorded cue-induced craving and withdrawal symptoms. RESULTS Compared to sham (n = 17), participants receiving active rTMS (n = 21) smoked significantly fewer cigarettes per day during the 2-week treatment (mean [SD], 13.73[9.18] vs. 11.06[9.29], P < .005) and at 1-month follow-up (12.78[9.53] vs. 7.93[7.24], P < .001). Active rTMS participants were also more likely to quit by their target quit rate (23.81%vs. 0%, OR 11.67, 90% CL, 0.96-141.32, x2 = 4.66, P = .031). Furthermore, rTMS significantly reduced mean craving throughout the treatments and at follow-up (29.93[13.12] vs. 25.01[14.45], P < .001). Interestingly across the active treatment sample, more lateral coil location was associated with more success in quitting (-43.43[0.40] vs. -41.79[2.24], P < .013). CONCLUSIONS Daily MRI-guided rTMS to the LDLPFC for 10 days reduces cigarette consumption and cued craving for up to one month and also increases the likelihood of smoking cessation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02401672.
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Affiliation(s)
- Xingbao Li
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Karen J Hartwell
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, 29401, USA
| | - Scott Henderson
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Bashar W Badran
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, 29401, USA
| | - Mark S George
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, 29401, USA
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McCathern AG, Mathai DS, Cho RY, Goodman WK, Storch EA. Deep transcranial magnetic stimulation for obsessive compulsive disorder. Expert Rev Neurother 2020; 20:1029-1036. [PMID: 32684005 DOI: 10.1080/14737175.2020.1798232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a common psychiatric disorder that can be chronic and debilitating if not properly treated. Current first-line treatments for OCD include cognitive-behavioral therapy with exposure and response prevention and serotonin uptake inhibitor medications; however, these therapies are not effective for all individuals. AREAS COVERED Deep transcranial magnetic stimulation (dTMS) has been hypothesized to be an effective alternative for individuals with treatment-resistant OCD. dTMS has thought to be favorable due to its low side effect profile and its minimally invasive nature. EXPERT OPINION This review evaluates the current research on effectiveness of dTMS therapy for individuals with treatment-resistant OCD. This review also investigates shortcomings in current dTMS research and the hypothesized future of dTMS therapy.
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Affiliation(s)
- Alexis G McCathern
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - David S Mathai
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - Raymond Y Cho
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
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Duriez P, Bou Khalil R, Chamoun Y, Maatoug R, Strumila R, Seneque M, Gorwood P, Courtet P, Guillaume S. Brain Stimulation in Eating Disorders: State of the Art and Future Perspectives. J Clin Med 2020; 9:E2358. [PMID: 32717984 PMCID: PMC7465000 DOI: 10.3390/jcm9082358] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
The management of eating disorders (EDs) is still difficult and few treatments are effective. Recently, several studies have described the important contribution of non-invasive brain stimulation (repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and electroconvulsive therapy) and invasive brain stimulation (deep brain stimulation and vagal nerve stimulation) for ED management. This review summarizes the available evidence supporting the use of brain stimulation in ED. All published studies on brain stimulation in ED as well as ongoing trials registered at clinicaltrials.gov were examined. Articles on neuromodulation research and perspective articles were also included. This analysis indicates that brain stimulation in EDs is still in its infancy. Literature data consist mainly of case reports, cases series, open studies, and only a few randomized controlled trials. Consequently, the evidence supporting the use of brain stimulation in EDs remains weak. Finally, this review discusses future directions in this research domain (e.g., sites of modulation, how to enhance neuromodulation efficacy, personalized protocols).
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Affiliation(s)
- Philibert Duriez
- GHU Paris Psychiatry and Neuroscience, Clinique des Maladies Mentales et de l’Encéphale (CMME), Sainte-Anne Hospital, 75014 Paris, France; (P.D.); (P.G.)
- Institute of Psychiatry and Neurosciences of Paris (IPNP), UMR_S1266, INSERM, Université de Paris, 102-108 rue de la Santé, 75014 Paris, France
| | - Rami Bou Khalil
- Department of Psychiatry, Hotel Dieu de France- Saint Joseph University, 166830 Beirut, Lebanon; (R.B.K.); (Y.C.)
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
| | - Yara Chamoun
- Department of Psychiatry, Hotel Dieu de France- Saint Joseph University, 166830 Beirut, Lebanon; (R.B.K.); (Y.C.)
| | - Redwan Maatoug
- Sorbonne Université, AP-HP, Service de Psychiatrie Adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, 75013 Paris, France;
| | - Robertas Strumila
- Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, 03101 Vilnius, Lithuania;
| | - Maude Seneque
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 34295 Montpellier, France
| | - Philip Gorwood
- GHU Paris Psychiatry and Neuroscience, Clinique des Maladies Mentales et de l’Encéphale (CMME), Sainte-Anne Hospital, 75014 Paris, France; (P.D.); (P.G.)
- Institute of Psychiatry and Neurosciences of Paris (IPNP), UMR_S1266, INSERM, Université de Paris, 102-108 rue de la Santé, 75014 Paris, France
| | - Philippe Courtet
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 34295 Montpellier, France
| | - Sébastien Guillaume
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 34295 Montpellier, France
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Anterior insula stimulation suppresses appetitive behavior while inducing forebrain activation in alcohol-preferring rats. Transl Psychiatry 2020; 10:150. [PMID: 32424183 PMCID: PMC7235223 DOI: 10.1038/s41398-020-0833-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 02/08/2023] Open
Abstract
The anterior insular cortex plays a key role in the representation of interoceptive effects of drug and natural rewards and their integration with attention, executive function, and emotions, making it a potential target region for intervention to control appetitive behaviors. Here, we investigated the effects of chemogenetic stimulation or inhibition of the anterior insula on alcohol and sucrose consumption. Excitatory or inhibitory designer receptors (DREADDs) were expressed in the anterior insula of alcohol-preferring rats by means of adenovirus-mediated gene transfer. Rats had access to either alcohol or sucrose solution during intermittent sessions. To characterize the brain network recruited by chemogenetic insula stimulation we measured brain-wide activation patterns using pharmacological magnetic resonance imaging (phMRI) and c-Fos immunohistochemistry. Anterior insula stimulation by the excitatory Gq-DREADDs significantly attenuated both alcohol and sucrose consumption, whereas the inhibitory Gi-DREADDs had no effects. In contrast, anterior insula stimulation failed to alter locomotor activity or deprivation-induced water drinking. phMRI and c-Fos immunohistochemistry revealed downstream activation of the posterior insula and medial prefrontal cortex, as well as of the mediodorsal thalamus and amygdala. Our results show the critical role of the anterior insula in regulating reward-directed behavior and delineate an insula-centered functional network associated with the effects of insula stimulation. From a translational perspective, our data demonstrate the therapeutic potential of circuit-based interventions and suggest that potentiation of insula excitability with neuromodulatory methods, such as repetitive transcranial magnetic stimulation (rTMS), could be useful in the treatment of alcohol use disorders.
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Repetitive transcranial magnetic stimulation targeting the insular cortex for reduction of heavy drinking in treatment-seeking alcohol-dependent subjects: a randomized controlled trial. Neuropsychopharmacology 2020; 45:842-850. [PMID: 31711065 PMCID: PMC7075882 DOI: 10.1038/s41386-019-0565-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/08/2019] [Accepted: 11/01/2019] [Indexed: 11/08/2022]
Abstract
Insula responses to drug cues are correlated with cravings, and lesions in this area reduce nicotine seeking. Here, we investigated the potential efficacy of repetitive transcranial magnetic stimulation (rTMS) targeting the insula in alcohol addiction. Treatment-seeking alcohol-dependent patients (Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition; N = 56) participated in this double-blind, sham-controlled, randomized trial. Participants received 10 Hz rTMS or sham using an H8 coil, 5 days a week for 3 weeks. Stimulation targeted insular cortex and overlaying regions bilaterally, while excluding anterior prefrontal areas. Craving and self-reported as well as biomarker-based drinking measures were collected at baseline, during treatment, and through 12 weeks. Resting-state magnetic resonance imaging (rsMRI) data were collected before and after treatment. Task-based MRI was used to probe brain correlates of reward processing, affective responses, and alcohol following completion of treatment. A marked overall decrease in craving and drinking measures was observed during treatment, but did not differ between rTMS or sham stimulation. Both groups equally increased their alcohol use following completion of treatment and through the 12-week follow-up. Analysis using seeds in the insula identified differences in resting-state connectivity between active and sham groups at completion of treatment, potentially indicating an ability of treatment to modify insula function. However, while each task robustly replicated brain responses established in the literature, no effects of rTMS were found. Collectively, this study does not support efficacy of rTMS targeting the insula in alcohol addiction.
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128
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Zhao D, Li Y, Liu T, Voon V, Yuan TF. Twice-Daily Theta Burst Stimulation of the Dorsolateral Prefrontal Cortex Reduces Methamphetamine Craving: A Pilot Study. Front Neurosci 2020; 14:208. [PMID: 32273837 PMCID: PMC7113524 DOI: 10.3389/fnins.2020.00208] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/25/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Transcranial magnetic stimulation (TMS) holds potential promise as a therapeutic modality for disorders of addiction. Our previous findings indicate that high-frequency repetitive transcranial magnetic stimulation (rTMS) over the left dorsal-lateral prefrontal cortex (DLPFC) and low-frequency rTMS over the right DLPFC can reduce drug craving for methamphetamine. One major issue with rTMS is the duration of treatment and hence potential dropout rate. Theta burst stimulation (TBS) has been recently shown to be non-inferior relative to repetitive transcranial magnetic stimulation for major depression. Here, we aim to compare the clinical efficacy and tolerability of intermittent and continuous theta burst stimulation protocols targeting left or right dorsolateral prefrontal cortex on methamphetamine craving in abstinent-dependent subjects. METHODS In this randomized single-blind pilot study, 83 abstinent methamphetamine-dependent subjects from a long-term residential treatment program were randomly allocated into three groups: intermittent theta burst stimulation (iTBS) over the left DLPFC (active group), continuous theta burst stimulation (cTBS) over the left DLPFC (active control group), or cTBS over the right DLPFC (active group) was administered twice daily over 5 days for a total of 10 sessions. We measured the primary outcome of cue-induced craving and secondarily sleep quality, depression, anxiety, impulsivity scores, and adverse effects. RESULTS We show a pre- vs. postintervention effect on craving, which, on paired t tests, showed that the effect was driven by iTBS of the left DLPFC and cTBS of the right DLPFC, reducing cue-induced craving but not cTBS of the left DLPFC. We did not show the critical group-by-time interaction. The secondary outcomes of depression, anxiety, and sleep were unrelated to the improvement in craving in the left iTBS and right cTBS group. In the first two sessions, self-reported adverse effects were higher with left iTBS when compared to right cTBS. The distribution of craving change suggested greater clinical response (50% improvement) with right cTBS and a bimodal pattern of effect with left iTBS, suggesting high interindividual variable response in the latter. CONCLUSION Accelerated twice-daily TBS appears feasible and tolerable at modulating craving and mood changes in abstinent methamphetamine dependence critically while reducing session length. We emphasize the need for a larger randomized controlled trial study with a sham control to confirm these findings and longer duration of clinically relevant follow-up. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry number, 17013610.
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Affiliation(s)
- Di Zhao
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongqiang Li
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ting Liu
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
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Ward HB, Mosquera MJ, Suzuki J, Mariano TY. A Systematic Review of Noninvasive Brain Stimulation for Opioid Use Disorder. Neuromodulation 2020; 23:301-311. [DOI: 10.1111/ner.13108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/20/2019] [Accepted: 01/02/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Heather B. Ward
- Department of Psychiatry Brigham & Women's Hospital Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
| | - Matthew J. Mosquera
- Department of Psychiatry Brigham & Women's Hospital Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
| | - Joji Suzuki
- Department of Psychiatry Brigham & Women's Hospital Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
| | - Timothy Y. Mariano
- Department of Psychiatry Brigham & Women's Hospital Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
- Butler Hospital Providence RI USA
- Center for Neurorestoration and Neurotechnology Providence Veterans Affairs Medical Center Providence RI USA
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Alyagon U, Shahar H, Hadar A, Barnea-Ygael N, Lazarovits A, Shalev H, Zangen A. Alleviation of ADHD symptoms by non-invasive right prefrontal stimulation is correlated with EEG activity. NEUROIMAGE-CLINICAL 2020; 26:102206. [PMID: 32062566 PMCID: PMC7021642 DOI: 10.1016/j.nicl.2020.102206] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/21/2020] [Accepted: 02/03/2020] [Indexed: 12/13/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a prevalent disorder with effective pharmacological treatment that benefits most patients. However, about one-third fail to benefit while others search non-pharmacological alternatives, and for those options are scarce. One alternative treatment option is to alter abnormal right prefrontal cortex (rPFC) activity, given that rPFC abnormality has been repeatedly implicated in ADHD neurophathology. Here, we evaluated whether targeting the rPFC with multiple sessions of repetitive transcranial magnetic stimulation (rTMS), which can modulate neuronal excitability, activity, and plasticity in a non-invasive manner, will affect clinical symptoms in adults suffering from ADHD. Concomitantly, we used EEG to characterize electrophysiological alterations induced by treatment and to search for correlation between baseline neuronal activity and clinical response. Forty-three drug free adults with ADHD were randomized to receive either Real, Active Control, or Sham treatment (13 females, age ranging 21-46; n = 15, 14, 14, respectively), and underwent three weeks of daily high-frequency (18 Hz) stimulation sessions. We found that Real treatment was safe and resulted in significant improvement of symptoms (η2p = 0.34; Cohen's d(against Sham) = 0.96; Cohen's d(against AC) = 0.68; p = 0.00085). Furthermore, based on EEG recorded within the first treatment session we established a novel biomarker, composed of the Alpha and Low-gamma power, which highly correlated the magnitude of the clinical outcome (r = 0.92, p = 0.0001). Taken together, the results of this pilot study indicate safety and effectiveness of rTMS directed to the rPFC for treatment of adult ADHD patients. The biomarker is suggested to reflect the responsiveness of the cortex to this rTMS intervention. Following validation of the results in larger samples, this study may represent a step towards a non-pharmacological treatment for adults with ADHD using EEG-based selection of optimal candidates for treatment.
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Affiliation(s)
- Uri Alyagon
- Department of Life Sciences and the Zlotowski Centre for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hamutal Shahar
- Department of Life Sciences and the Zlotowski Centre for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviad Hadar
- Department of Life Sciences and the Zlotowski Centre for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noam Barnea-Ygael
- Department of Life Sciences and the Zlotowski Centre for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Avi Lazarovits
- Department of Life Sciences and the Zlotowski Centre for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hadar Shalev
- Psychiatry Department, Soroka Medical Center, Beer-Sheva, Israel
| | - Abraham Zangen
- Department of Life Sciences and the Zlotowski Centre for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Spagnolo PA, Montemitro C, Pettorruso M, Martinotti G, Di Giannantonio M. Better Together? Coupling Pharmacotherapies and Cognitive Interventions With Non-invasive Brain Stimulation for the Treatment of Addictive Disorders. Front Neurosci 2020; 13:1385. [PMID: 31998061 PMCID: PMC6967837 DOI: 10.3389/fnins.2019.01385] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/09/2019] [Indexed: 01/11/2023] Open
Affiliation(s)
- Primavera A Spagnolo
- Human Motor Control Section, Medical Neurology Branch, National Institute on Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Chiara Montemitro
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy.,Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
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Lefaucheur JP, Aleman A, Baeken C, Benninger DH, Brunelin J, Di Lazzaro V, Filipović SR, Grefkes C, Hasan A, Hummel FC, Jääskeläinen SK, Langguth B, Leocani L, Londero A, Nardone R, Nguyen JP, Nyffeler T, Oliveira-Maia AJ, Oliviero A, Padberg F, Palm U, Paulus W, Poulet E, Quartarone A, Rachid F, Rektorová I, Rossi S, Sahlsten H, Schecklmann M, Szekely D, Ziemann U. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018). Clin Neurophysiol 2020; 131:474-528. [PMID: 31901449 DOI: 10.1016/j.clinph.2019.11.002] [Citation(s) in RCA: 985] [Impact Index Per Article: 246.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/21/2019] [Accepted: 11/02/2019] [Indexed: 02/08/2023]
Abstract
A group of European experts reappraised the guidelines on the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) previously published in 2014 [Lefaucheur et al., Clin Neurophysiol 2014;125:2150-206]. These updated recommendations take into account all rTMS publications, including data prior to 2014, as well as currently reviewed literature until the end of 2018. Level A evidence (definite efficacy) was reached for: high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the painful side for neuropathic pain; HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) using a figure-of-8 or a H1-coil for depression; low-frequency (LF) rTMS of contralesional M1 for hand motor recovery in the post-acute stage of stroke. Level B evidence (probable efficacy) was reached for: HF-rTMS of the left M1 or DLPFC for improving quality of life or pain, respectively, in fibromyalgia; HF-rTMS of bilateral M1 regions or the left DLPFC for improving motor impairment or depression, respectively, in Parkinson's disease; HF-rTMS of ipsilesional M1 for promoting motor recovery at the post-acute stage of stroke; intermittent theta burst stimulation targeted to the leg motor cortex for lower limb spasticity in multiple sclerosis; HF-rTMS of the right DLPFC in posttraumatic stress disorder; LF-rTMS of the right inferior frontal gyrus in chronic post-stroke non-fluent aphasia; LF-rTMS of the right DLPFC in depression; and bihemispheric stimulation of the DLPFC combining right-sided LF-rTMS (or continuous theta burst stimulation) and left-sided HF-rTMS (or intermittent theta burst stimulation) in depression. Level A/B evidence is not reached concerning efficacy of rTMS in any other condition. The current recommendations are based on the differences reached in therapeutic efficacy of real vs. sham rTMS protocols, replicated in a sufficient number of independent studies. This does not mean that the benefit produced by rTMS inevitably reaches a level of clinical relevance.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- ENT Team, EA4391, Faculty of Medicine, Paris Est Créteil University, Créteil, France; Clinical Neurophysiology Unit, Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France.
| | - André Aleman
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - David H Benninger
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jérôme Brunelin
- PsyR2 Team, U1028, INSERM and UMR5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), Centre Hospitalier Le Vinatier, Lyon-1 University, Bron, France
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Saša R Filipović
- Department of Human Neuroscience, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Christian Grefkes
- Department of Neurology, Cologne University Hospital, Cologne, Germany; Institute of Neurosciences and Medicine (INM3), Jülich Research Centre, Jülich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Friedhelm C Hummel
- Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Defitech Chair in Clinical Neuroengineering, Swiss Federal Institute of Technology (EPFL) Valais and Clinique Romande de Réadaptation, Sion, Switzerland; Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
| | - Satu K Jääskeläinen
- Department of Clinical Neurophysiology, Turku University Hospital and University of Turku, Turku, Finland
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Letizia Leocani
- Department of Neurorehabilitation and Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Alain Londero
- Department of Otorhinolaryngology - Head and Neck Surgery, Université Paris Descartes Sorbonne Paris Cité, Hôpital Européen Georges Pompidou, Paris, France
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Jean-Paul Nguyen
- Multidisciplinary Pain Center, Clinique Bretéché, ELSAN, Nantes, France; Multidisciplinary Pain, Palliative and Supportive Care Center, UIC22-CAT2-EA3826, University Hospital, CHU Nord-Laënnec, Nantes, France
| | - Thomas Nyffeler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland; Perception and Eye Movement Laboratory, Department of Neurology, University of Bern, Bern, Switzerland; Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Albino J Oliveira-Maia
- Champalimaud Research & Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Medical Park Chiemseeblick, Bernau, Germany
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
| | - Emmanuel Poulet
- PsyR2 Team, U1028, INSERM and UMR5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), Centre Hospitalier Le Vinatier, Lyon-1 University, Bron, France; Department of Emergency Psychiatry, Edouard Herriot Hospital, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | - Irena Rektorová
- Applied Neuroscience Research Group, Central European Institute of Technology, CEITEC MU, Masaryk University, Brno, Czech Republic; First Department of Neurology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Simone Rossi
- Department of Medicine, Surgery and Neuroscience, Si-BIN Lab Human Physiology Section, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy
| | - Hanna Sahlsten
- ENT Clinic, Mehiläinen and University of Turku, Turku, Finland
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - David Szekely
- Department of Psychiatry, Princess Grace Hospital, Monaco
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
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Zhang JJQ, Fong KNK, Ouyang RG, Siu AMH, Kranz GS. Effects of repetitive transcranial magnetic stimulation (rTMS) on craving and substance consumption in patients with substance dependence: a systematic review and meta-analysis. Addiction 2019; 114:2137-2149. [PMID: 31328353 DOI: 10.1111/add.14753] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/10/2019] [Accepted: 07/16/2019] [Indexed: 01/07/2023]
Abstract
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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Affiliation(s)
- Jack J Q Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Rang-Ge Ouyang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Andrew M H Siu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR.,Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
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The Effects of Repetitive Transcranial Magnetic Stimulation in Reducing Cocaine Craving and Use. ADDICTIVE DISORDERS & THEIR TREATMENT 2019. [DOI: 10.1097/adt.0000000000000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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135
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Tendler A, Sisko E, Barnea-Ygael N, Zangen A, Storch EA. A Method to Provoke Obsessive Compulsive Symptoms for Basic Research and Clinical Interventions. Front Psychiatry 2019; 10:814. [PMID: 31824345 PMCID: PMC6882501 DOI: 10.3389/fpsyt.2019.00814] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/15/2019] [Indexed: 12/25/2022] Open
Abstract
The efficacy of deep repetitive transcranial magnetic stimulation (dTMS) for obsessive compulsive disorder (OCD) was recently confirmed in a Food and Drug Administration-regulated, multicenter, sham-controlled study. In this study, patients who failed pharmacotherapy underwent individually tailored provocations just prior to each stimulation session, in the attempt to activate the relevant circuitry and making it labile to change. The procedure that was developed reliably evoked moderate intensity symptoms, making it effective on the one hand and mild enough to allow the patient to continue with the dTMS session on the other. This methodology article describes in a detailed step wise fashion how to evaluate the patient's specific symptoms and design the individualized provocations. Additionally, the article explains how to instruct relevant personnel to administer the provocations, gauge their efficacy, and overcome possible obstacles. This method, apart from its ongoing role in the clinical treatment of OCD by dTMS, may be used for provocation of symptoms in basic studies [e.g., imaging with Electroencephalogram (EEG) or Functional magnetic resonance imaging fMRI] as well as other treatments.
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Affiliation(s)
- Aron Tendler
- Brainsway Ltd., Jerusalem, Israel
- Advanced Mental Health Care, Inc., Palm Beach, FL, United States
- Department of Life Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Elyssa Sisko
- Advanced Mental Health Care, Inc., Palm Beach, FL, United States
| | - Noam Barnea-Ygael
- Department of Life Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Abraham Zangen
- Brainsway Ltd., Jerusalem, Israel
- Department of Life Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Eric A. Storch
- Psychiatry and Behavioral Sciences Electroencephalogram, Functional Magnetic Resonance Imaging, Baylor College of Medicine, Houston, TX, United States
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Hauer L, Scarano GI, Brigo F, Golaszewski S, Lochner P, Trinka E, Sellner J, Nardone R. Effects of repetitive transcranial magnetic stimulation on nicotine consumption and craving: A systematic review. Psychiatry Res 2019; 281:112562. [PMID: 31521838 DOI: 10.1016/j.psychres.2019.112562] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 12/15/2022]
Abstract
We performed a systematic review of the studies employing repetitive transcranial magnetic stimulation (rTMS) in subjects with smoking addiction. High-frequency (HF) rTMS over the prefrontal cortex (PFC), in particular the left dorsolateral PFC (DLPFC), might represent a save and innovative treatment tool for tobacco consumption and craving in nicotine-dependent otherwise healthy people. rTMS can be effective for this indication also in patients with schizophrenia, but the results are conflicting and sufficient evidence from large-scale trials is still lacking. Promising results have been obtained using particular techniques for brain stimulation, such as deep rTMS and theta burst stimulation. Multiple-target HF rTMS can also have a potential in smoking cessation. fMRI and EEG recordings have proven to be useful for objectively assessing the treatment effects. TMS is likely to be most effective when paired with an evidence-based self-help intervention, cognitive-behavioral interventions and nicotine replacement therapy. However, the most recent studies employed different protocols and yielded heterogeneous results, which should be replicated in further controlled studies with larger sample sizes and rigorous standards of randomization. To date, no recommendation other than that a possible efficacy of HF-rTMS of the left DLPFC can be made for alternative rTMS procedures in nicotine craving and consumption.
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Affiliation(s)
- Larissa Hauer
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Salzburg, Austria
| | | | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Stefan Golaszewski
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neurosciences Salzburg, Salzburg, Austria; University for Medical Informatics and Health Technology, UMIT, Hall in Tirol, Austria
| | - Johann Sellner
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
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Abstract
Psychiatry has been at the forefront of advancing clinical transcranial magnetic stimulation (TMS) since the mid-1990s, shortly after the invention of modern TMS in 1985 by Barker. Clinical TMS for psychiatric applications is advancing rapidly, with novel methods and innovations for treating depression, as well as a new clinical indication in obsessive-compulsive disorder. This review summarizes the recent findings and peers into the near future of this fertile and rapidly changing field. It is possible that many, perhaps even most, psychiatrists will be incorporating some form of brain stimulation into their practice within the next decade. The author summarizes the reasons for this optimistic view.
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Affiliation(s)
- Mark S George
- Department of Psychiatry and Behavioral Sciences and Institute of Psychiatry, Medical University of South Carolina, Charleston; and Ralph H. Johnson VA Medical Center, Charleston
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Carmi L, Tendler A, Bystritsky A, Hollander E, Blumberger DM, Daskalakis J, Ward H, Lapidus K, Goodman W, Casuto L, Feifel D, Barnea-Ygael N, Roth Y, Zangen A, Zohar J. Efficacy and Safety of Deep Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Prospective Multicenter Randomized Double-Blind Placebo-Controlled Trial. Am J Psychiatry 2019; 176:931-938. [PMID: 31109199 DOI: 10.1176/appi.ajp.2019.18101180] [Citation(s) in RCA: 225] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is a chronic and disabling condition that often responds unsatisfactorily to pharmacological and psychological treatments. Converging evidence suggests a dysfunction of the cortical-striatal-thalamic-cortical circuit in OCD, and a previous feasibility study indicated beneficial effects of deep transcranial magnetic stimulation (dTMS) targeting the medial prefrontal cortex and the anterior cingulate cortex. The authors examined the therapeutic effect of dTMS in a multicenter double-blind sham-controlled study. METHODS At 11 centers, 99 OCD patients were randomly allocated to treatment with either high-frequency (20 Hz) or sham dTMS and received daily treatments following individualized symptom provocation, for 6 weeks. Clinical response to treatment was determined using the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the primary efficacy endpoint was the change in score from baseline to posttreatment assessment. Additional measures were response rates (defined as a reduction of ≥30% in YBOCS score) at the posttreatment assessment and after another month of follow-up. RESULTS Eighty-nine percent of the active treatment group and 96% of the sham treatment group completed the study. The reduction in YBOCS score among patients who received active dTMS treatment was significantly greater than among patients who received sham treatment (reductions of 6.0 points and 3.3 points, respectively), with response rates of 38.1% and 11.1%, respectively. At the 1-month follow-up, the response rates were 45.2% in the active treatment group and 17.8% in the sham treatment group. Significant differences between the groups were maintained at follow-up. CONCLUSIONS High-frequency dTMS over the medial prefrontal cortex and anterior cingulate cortex significantly improved OCD symptoms and may be considered as a potential intervention for patients who do not respond adequately to pharmacological and psychological interventions.
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Affiliation(s)
- Lior Carmi
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
| | - Aron Tendler
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
| | - Alexander Bystritsky
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
| | - Eric Hollander
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
| | - Daniel M Blumberger
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
| | - Jeff Daskalakis
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
| | - Herbert Ward
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
| | - Kyle Lapidus
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
| | - Wayne Goodman
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
| | - Leah Casuto
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
| | - David Feifel
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
| | - Noam Barnea-Ygael
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
| | - Yiftach Roth
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
| | - Abraham Zangen
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
| | - Joseph Zohar
- The School of Psychological Science, Tel Aviv University, Tel Aviv, Israel (Carmi); the Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel (Carmi, Barnea-Ygael, Roth, Zangen); Advanced Mental Health Care, Inc., Palm Beach, Fla. (Tendler); the Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bystritsky); the Spectrum Neuroscience and Treatment Center, New York (Hollander); the Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Research Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Ontario (Blumberger, Daskalakis); the Department of Psychiatry, University of Florida, Gainesville (Ward); the Department of Psychiatry, Northwell Health, New York (Lapidus); the Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York (Goodman); the Lindner Center of HOPE, Mason, Ohio (Casuto); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati (Casuto); the Department of Psychiatry, University of California San Diego, La Jolla (Feifel); the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Zohar)
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Abstract
Drug consumption is driven by a drug's pharmacological effects, which are experienced as rewarding, and is influenced by genetic, developmental, and psychosocial factors that mediate drug accessibility, norms, and social support systems or lack thereof. The reinforcing effects of drugs mostly depend on dopamine signaling in the nucleus accumbens, and chronic drug exposure triggers glutamatergic-mediated neuroadaptations in dopamine striato-thalamo-cortical (predominantly in prefrontal cortical regions including orbitofrontal cortex and anterior cingulate cortex) and limbic pathways (amygdala and hippocampus) that, in vulnerable individuals, can result in addiction. In parallel, changes in the extended amygdala result in negative emotional states that perpetuate drug taking as an attempt to temporarily alleviate them. Counterintuitively, in the addicted person, the actual drug consumption is associated with an attenuated dopamine increase in brain reward regions, which might contribute to drug-taking behavior to compensate for the difference between the magnitude of the expected reward triggered by the conditioning to drug cues and the actual experience of it. Combined, these effects result in an enhanced motivation to "seek the drug" (energized by dopamine increases triggered by drug cues) and an impaired prefrontal top-down self-regulation that favors compulsive drug-taking against the backdrop of negative emotionality and an enhanced interoceptive awareness of "drug hunger." Treatment interventions intended to reverse these neuroadaptations show promise as therapeutic approaches for addiction.
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Affiliation(s)
- Nora D Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Michael Michaelides
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Ruben Baler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
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140
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Wang C, Shen Z, Huang P, Qian W, Zhou C, Li K, Zeng Q, Luo X, Gu Q, Yu H, Yang Y, Zhang M. Increased interregional functional connectivity of anterior insula is associated with improved smoking cessation outcome. Brain Imaging Behav 2019; 14:408-415. [PMID: 31494823 DOI: 10.1007/s11682-019-00197-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Damage to the insular cortex has been shown to disrupt smoking behavior. However, whether smoking cessation outcomes are associated with abnormal functions of insula and its subregions remains unclear. In this study, we investigated the relationship between insular functions (interregional functional connectivity and regional activity) and treatment outcomes of cigarette smoking. Thirty treatment-seeking smokers were recruited into the treatment study and underwent magnetic resonance imaging (MRI) scans immediately before and after the treatment. Sixteen participants remained abstinent from smoking (quitters), while 14 relapsed to smoking (relapers). Changes in resting-state functional connectivity and fractional amplitude of low frequency fluctuation (fALFF) across groups and visits were assessed using repeated measures ANCOVA. Significant interaction effects were detected: 1) between the left anterior insula and left precuneus; and 2) between the right anterior insula and left precuneus and medial frontal gyrus. Post-hoc region-of-interest analyses in brain areas showing interaction effects indicated significantly increased functional connectivity after treatment compared with before treatment in quitters but opposite longitudinal changes in relapsers. However, no significant effects in fALFF were observed. These novel findings suggest that increased interregional functional connectivity of the anterior insula is associated with improved smoking cessation outcome: individuals with increased functional connectivity of the anterior insula during the treatment would more likely quit smoking successfully. These insular circuits may serve as therapeutic targets for more efficacious treatment of nicotine addiction.
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Affiliation(s)
- Chao Wang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Zhujing Shen
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Qian
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kaicheng Li
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qingze Zeng
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Luo
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Quanquan Gu
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hualiang Yu
- Department of Psychiatry, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yihong Yang
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Minming Zhang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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141
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Ekhtiari H, Tavakoli H, Addolorato G, Baeken C, Bonci A, Campanella S, Castelo-Branco L, Challet-Bouju G, Clark VP, Claus E, Dannon PN, Del Felice A, den Uyl T, Diana M, di Giannantonio M, Fedota JR, Fitzgerald P, Gallimberti L, Grall-Bronnec M, Herremans SC, Herrmann MJ, Jamil A, Khedr E, Kouimtsidis C, Kozak K, Krupitsky E, Lamm C, Lechner WV, Madeo G, Malmir N, Martinotti G, McDonald WM, Montemitro C, Nakamura-Palacios EM, Nasehi M, Noël X, Nosratabadi M, Paulus M, Pettorruso M, Pradhan B, Praharaj SK, Rafferty H, Sahlem G, Salmeron BJ, Sauvaget A, Schluter RS, Sergiou C, Shahbabaie A, Sheffer C, Spagnolo PA, Steele VR, Yuan TF, van Dongen JDM, Van Waes V, Venkatasubramanian G, Verdejo-García A, Verveer I, Welsh JW, Wesley MJ, Witkiewitz K, Yavari F, Zarrindast MR, Zawertailo L, Zhang X, Cha YH, George TP, Frohlich F, Goudriaan AE, Fecteau S, Daughters SB, Stein EA, Fregni F, Nitsche MA, Zangen A, Bikson M, Hanlon CA. Transcranial electrical and magnetic stimulation (tES and TMS) for addiction medicine: A consensus paper on the present state of the science and the road ahead. Neurosci Biobehav Rev 2019; 104:118-140. [PMID: 31271802 PMCID: PMC7293143 DOI: 10.1016/j.neubiorev.2019.06.007] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/30/2019] [Accepted: 06/08/2019] [Indexed: 12/21/2022]
Abstract
There is growing interest in non-invasive brain stimulation (NIBS) as a novel treatment option for substance-use disorders (SUDs). Recent momentum stems from a foundation of preclinical neuroscience demonstrating links between neural circuits and drug consuming behavior, as well as recent FDA-approval of NIBS treatments for mental health disorders that share overlapping pathology with SUDs. As with any emerging field, enthusiasm must be tempered by reason; lessons learned from the past should be prudently applied to future therapies. Here, an international ensemble of experts provides an overview of the state of transcranial-electrical (tES) and transcranial-magnetic (TMS) stimulation applied in SUDs. This consensus paper provides a systematic literature review on published data - emphasizing the heterogeneity of methods and outcome measures while suggesting strategies to help bridge knowledge gaps. The goal of this effort is to provide the community with guidelines for best practices in tES/TMS SUD research. We hope this will accelerate the speed at which the community translates basic neuroscience into advanced neuromodulation tools for clinical practice in addiction medicine.
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Affiliation(s)
| | - Hosna Tavakoli
- Institute for Cognitive Science Studies (ICSS), Iran; Iranian National Center for Addiction Studies (INCAS), Iran
| | - Giovanni Addolorato
- Alcohol Use Disorder Unit, Division of Internal Medicine, Gastroenterology and Hepatology Unit, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy; Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, University Hospital Ghent, Ghent, Belgium
| | - Antonello Bonci
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA; Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Vincent P Clark
- University of New Mexico, USA; The Mind Research Network, USA
| | | | | | - Alessandra Del Felice
- University of Padova, Department of Neuroscience, Padova, Italy; Padova Neuroscience Center (PNC), University of Padova, Padova, Italy
| | | | - Marco Diana
- 'G. Minardi' Laboratory of Cognitive Neuroscience, Department of Chemistry and Pharmacy, University of Sassari, Italy
| | | | - John R Fedota
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | | | - Luigi Gallimberti
- Novella Fronda Foundation, Human Science and Brain Research, Padua, Italy
| | | | - Sarah C Herremans
- Department of Psychiatry and Medical Psychology, University Hospital Ghent, Ghent, Belgium
| | - Martin J Herrmann
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - Asif Jamil
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | | | | | - Karolina Kozak
- University of Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | - Evgeny Krupitsky
- V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St.-Petersburg, Russia; St.-Petersburg First Pavlov State Medical University, Russia
| | - Claus Lamm
- Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Austria
| | | | - Graziella Madeo
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | | | | | - William M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Chiara Montemitro
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA; University G.d'Annunzio of Chieti-Pescara, Italy
| | | | - Mohammad Nasehi
- Cognitive and Neuroscience Research Center (CNRC), Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Xavier Noël
- Université Libre de Bruxelles (ULB), Belgium
| | | | | | | | | | - Samir K Praharaj
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Haley Rafferty
- Spaulding Rehabilitation Hospital, Harvard Medical School, USA
| | | | - Betty Jo Salmeron
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Anne Sauvaget
- Laboratory «Movement, Interactions, Performance» (E.A. 4334), University of Nantes, 25 Bis Boulevard Guy Mollet, BP 72206, 44322, Nantes Cedex 3, France; CHU de Nantes Addictology and Liaison Psychiatry Department, University Hospital Nantes, Nantes Cedex 3, France
| | - Renée S Schluter
- Laureate Institute for Brain Research, USA; Institute for Cognitive Science Studies (ICSS), Iran
| | | | - Alireza Shahbabaie
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | | | | | - Vaughn R Steele
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Ti-Fei Yuan
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, China
| | | | - Vincent Van Waes
- Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université Bourgogne Franche-Comté, Besançon, France
| | | | | | | | - Justine W Welsh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Fatemeh Yavari
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Mohammad-Reza Zarrindast
- Department of Pharmacology School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Laurie Zawertailo
- University of Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | - Xiaochu Zhang
- University of Science and Technology of China, China
| | | | - Tony P George
- University of Toronto, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | | | - Anna E Goudriaan
- Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin, Department of Research and Quality of Care, Amsterdam, The Netherlands
| | | | | | - Elliot A Stein
- Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, USA
| | - Michael A Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; University Medical Hospital Bergmannsheil, Dept. Neurology, Bochum, Germany
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142
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Tanabe J, Regner M, Sakai J, Martinez D, Gowin J. Neuroimaging reward, craving, learning, and cognitive control in substance use disorders: review and implications for treatment. Br J Radiol 2019; 92:20180942. [PMID: 30855982 PMCID: PMC6732921 DOI: 10.1259/bjr.20180942] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/13/2019] [Accepted: 02/21/2019] [Indexed: 01/17/2023] Open
Abstract
Substance use disorder is a leading causes of preventable disease and mortality. Drugs of abuse cause molecular and cellular changes in specific brain regions and these neuroplastic changes are thought to play a role in the transition to uncontrolled drug use. Neuroimaging has identified neural substrates associated with problematic substance use and may offer clues to reduce its burden on the patient and society. Here, we provide a narrative review of neuroimaging studies that have examined the structures and circuits associated with reward, cues and craving, learning, and cognitive control in substance use disorders. Most studies use advanced MRI or positron emission tomography (PET). Many studies have focused on the dopamine neurons of the ventral tegmental area, and the regions where these neurons terminate, such as the striatum and prefrontal cortex. Decreases in dopamine receptors and transmission have been found in chronic users of drugs, alcohol, and nicotine. Recent studies also show evidence of differences in structure and function in substance users relative to controls in brain regions involved in salience evaluation, such as the insula and anterior cingulate cortex. Balancing between reward-related bottom-up and cognitive-control-related top-down processes is discussed in the context of neuromodulation as a potential treatment. Finally, some of the challenges for understanding substance use disorder using neuroimaging methods are discussed.
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Affiliation(s)
| | - Michael Regner
- Department of Radiology, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Joseph Sakai
- Department of Psychiatry, University of Colorado Anschutz Medical Center, Aurora, CO
| | - Diana Martinez
- Department of Psychiatry, Columbia University, New York, USA
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143
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Ferrulli A, Macrì C, Terruzzi I, Massarini S, Ambrogi F, Adamo M, Milani V, Luzi L. Weight loss induced by deep transcranial magnetic stimulation in obesity: A randomized, double-blind, sham-controlled study. Diabetes Obes Metab 2019; 21:1849-1860. [PMID: 30957981 DOI: 10.1111/dom.13741] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/26/2019] [Accepted: 04/03/2019] [Indexed: 01/18/2023]
Abstract
AIM To test the hypothesis that deep transcranial magnetic stimulation (dTMS) reduces food craving and causes weight loss via neuromodulation. MATERIALS AND METHODS This pilot study was designed as a randomized, double-blind, sham-controlled study. A total of 33 obese people (nine men, 24 women, mean age 48.1 ± 10.6 years, body mass index [BMI] 36.9 ± 4.7 kg/m2 ) were randomized and completed the study: 13 participants underwent a 5-week treatment with high-frequency (HF) dTMS (18 Hz; HF group), 10 were treated with low-frequency (LF) dTMS (1 Hz; LF group), and 10 were sham-treated (sham group). Food craving, and metabolic and neuro-endocrine variables were evaluated at baseline, after the 5-week treatment, and at follow-up visits (1 month, 6 months, 1 year after the end of treatment). RESULTS The mixed-model analysis for repeated measures showed a significant interaction of time and groups for body weight (P = 0.001) and BMI (P = 0.001), with a significant body weight (-7.83 ± 2.28 kg; P = 0.0009) and BMI (-2.83 ± 0.83, P = 0.0009) decrease in the HF versus the sham group. A decreasing trend in food craving in the HF versus the LF and sham groups (P = 0.073) was observed. A significant improvement of metabolic and physical activity variables was found (P < 0.05) in the HF group. CONCLUSIONS We demonstrated the safety and efficacy of dTMS, in addition to physical exercise and a hypocaloric diet, in reducing body weight for up to 1 year in obese people. We hypothesize that a possible mechanism of HF dTMS treatment is modulation of the dopaminergic pathway and stimulation of physical activity.
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Affiliation(s)
- Anna Ferrulli
- Endocrinology and Metabolism Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Concetta Macrì
- Endocrinology and Metabolism Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Ileana Terruzzi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Stefano Massarini
- Endocrinology and Metabolism Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Michela Adamo
- Endocrinology and Metabolism Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Valentina Milani
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Livio Luzi
- Endocrinology and Metabolism Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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144
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Sanna A, Fattore L, Badas P, Corona G, Cocco V, Diana M. Intermittent Theta Burst Stimulation of the Prefrontal Cortex in Cocaine Use Disorder: A Pilot Study. Front Neurosci 2019; 13:765. [PMID: 31402851 PMCID: PMC6670008 DOI: 10.3389/fnins.2019.00765] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/09/2019] [Indexed: 12/17/2022] Open
Abstract
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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Affiliation(s)
- Angela Sanna
- Department of Medical Science and Public Health, Section of Neurology, University of Cagliari, Cagliari, Italy
| | - Liana Fattore
- CNR Institute of Neuroscience-Cagliari, National Research Council, Cagliari, Italy
| | | | | | - Viola Cocco
- Department of Medical Science and Public Health, Section of Neurology, University of Cagliari, Cagliari, Italy
| | - Marco Diana
- "G. Minardi" Laboratory of Cognitive Neuroscience, Department of Chemistry and Pharmacy, University of Sassari, Sassari, Italy
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145
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Goudriaan AE, Schluter RS. Non-invasive Neuromodulation in Problem Gambling: What Are the Odds? CURRENT ADDICTION REPORTS 2019. [DOI: 10.1007/s40429-019-00266-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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146
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Ibrahim C, Rubin-Kahana DS, Pushparaj A, Musiol M, Blumberger DM, Daskalakis ZJ, Zangen A, Le Foll B. The Insula: A Brain Stimulation Target for the Treatment of Addiction. Front Pharmacol 2019; 10:720. [PMID: 31312138 PMCID: PMC6614510 DOI: 10.3389/fphar.2019.00720] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/05/2019] [Indexed: 12/15/2022] Open
Abstract
Substance use disorders (SUDs) are a growing public health concern with only a limited number of approved treatments. However, even approved treatments are subject to limited efficacy with high long-term relapse rates. Current treatment approaches are typically a combination of pharmacotherapies and behavioral counselling. Growing evidence and technological advances suggest the potential of brain stimulation techniques for the treatment of SUDs. There are three main brain stimulation techniques that are outlined in this review: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS). The insula, a region of the cerebral cortex, is known to be involved in critical aspects underlying SUDs, such as interoception, decision making, anxiety, pain perception, cognition, mood, threat recognition, and conscious urges. This review focuses on both the preclinical and clinical evidence demonstrating the role of the insula in addiction, thereby demonstrating its promise as a target for brain stimulation. Future research should evaluate the optimal parameters for brain stimulation of the insula, through the use of relevant biomarkers and clinical outcomes for SUDs.
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Affiliation(s)
- Christine Ibrahim
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Dafna S. Rubin-Kahana
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abhiram Pushparaj
- Qunuba Sciences, Toronto, ON, Canada
- Ironstone Product Development, Toronto, ON, Canada
| | | | - Daniel M. Blumberger
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J. Daskalakis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Abraham Zangen
- Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Addictions Division, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Alcohol Research and Treatment Clinic, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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147
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Counterconditioning following memory retrieval diminishes the reinstatement of appetitive memories in humans. Sci Rep 2019; 9:9213. [PMID: 31239475 PMCID: PMC6592881 DOI: 10.1038/s41598-019-45492-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/04/2019] [Indexed: 11/08/2022] Open
Abstract
Appetitive memories play a crucial role in learning and behavior, but under certain circumstances, such memories become maladaptive and play a vital role in addiction and other psychopathologies. Recent scientific research has demonstrated that memories can be modified following their reactivation through memory retrieval in a process termed memory reconsolidation. Several nonpharmacological behavioral manipulations yielded mixed results in their capacity to alter maladaptive memories in humans. Here, we aimed to translate the promising findings observed in rodents to humans. We constructed a novel three-day procedure using aversive counterconditioning to alter appetitive memories after short memory retrieval. On the first day, we used appetitive conditioning to form appetitive memories. On the second day, we retrieved these appetitive memories in one group (Retrieval group) but not in a second group. Subsequently, all participants underwent counterconditioning. On the third day, we attempted to reinstate the appetitive memories from day one. We observed a significant reduction in the reinstatement of the original appetitive memory when counterconditioning was induced following memory retrieval. Here, we provide a novel human paradigm that models several memory processes and demonstrate memory attenuation when counterconditioned after its retrieval. This paradigm can be used to study complex appetitive memory dynamics, e.g., memory reconsolidation and its underlying brain mechanisms.
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148
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Tolerability and feasibility of accelerated repetitive transcranial stimulation for reduction of nicotine craving. Brain Stimul 2019; 12:1315-1316. [PMID: 31253502 DOI: 10.1016/j.brs.2019.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/18/2019] [Indexed: 11/17/2022] Open
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149
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Martens KM, Pechacek KM, Modrak CG, Milleson VJ, Zhu B, Vonder Haar C. Cathodal Transcranial Direct-Current Stimulation Selectively Decreases Impulsivity after Traumatic Brain Injury in Rats. J Neurotrauma 2019; 36:2827-2830. [PMID: 31072218 PMCID: PMC6744944 DOI: 10.1089/neu.2019.6470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Traumatic brain injury (TBI) often results in chronic psychiatric-like symptoms. In a condition with few therapeutic options, neuromodulation has emerged as a promising potential treatment avenue for these individuals. The goal of the current study was to determine if transcranial direct-current stimulation (tDCS) could treat deficits of impulsivity and attention in rats. This could then be used as a model to investigate treatment parameters and the mechanism of action underlying therapeutic effects. Rats were trained on a task to measure attention and motor impulsivity (five-choice serial reaction time task), then given a frontal, controlled cortical impact injury. After rats recovered to a new baseline, tDCS (cathodal, 10 min, 800 μA) was delivered daily prior to testing in a counterbalanced, cross-over design. Treatment with tDCS selectively reduced impulsivity in the TBI group, and the greatest recovery occurred in the rats with the largest deficits. With these data, we have established a rat model for studying the effects of tDCS on psychiatric-like dysfunction. More research is needed to determine the mechanism of action by which tDCS-related gains occur.
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Affiliation(s)
- Kris M Martens
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, West Virginia.,Department of Neuroscience, West Virginia University, Morgantown, West Virginia
| | - Kristen M Pechacek
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Cassandra G Modrak
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Virginia J Milleson
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Binxing Zhu
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Cole Vonder Haar
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, West Virginia.,Department of Neuroscience, West Virginia University, Morgantown, West Virginia
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150
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Regner MF, Tregellas J, Kluger B, Wylie K, Gowin JL, Tanabe J. The insula in nicotine use disorder: Functional neuroimaging and implications for neuromodulation. Neurosci Biobehav Rev 2019; 103:414-424. [PMID: 31207255 DOI: 10.1016/j.neubiorev.2019.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/18/2019] [Accepted: 06/03/2019] [Indexed: 12/30/2022]
Abstract
Insula dysfunction contributes to nicotine use disorders. Yet, much remains unknown about how insular functions promote nicotine use. We review current models of brain networks in smoking and propose an extension to those models that emphasizes the role of the insula in craving. During acute withdrawal, the insula provides the sensation of craving to the cerebrum and is thought to negotiate craving sensations with cognitive control to guide behavior - either to smoke or abstain. Recent studies have shown that insula processing is saturable, such that different insular functions compete for limited resources. We propose that this saturability explains how craving during withdrawal can overload insular processing to the exclusion of other functions, such as saliency and network homeostasis. A novel signal flow model illustrates how limited insular capacity leads to breakdown of normal function. Finally, we discuss suitability of insula as a neuromodulation target to promote cessation. Given the limited efficacy of standard-of-care treatments for nicotine use disorder, insular neuromodulation offers an innovative, potentially therapeutic target for improving smoking cessation.
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Affiliation(s)
- Michael F Regner
- Department of Radiology, University of Colorado School of Medicine, United States; Department of Bioengineering, University of Colorado School of Medicine, United States.
| | - Jason Tregellas
- Department of Radiology, University of Colorado School of Medicine, United States; Department of Psychiatry, University of Colorado School of Medicine, United States; Research Service, Rocky Mountain Regional VA Medical Center, United States
| | - Benzi Kluger
- Department of Psychiatry, University of Colorado School of Medicine, United States; Department of Neurology, University of Colorado School of Medicine, United States
| | - Korey Wylie
- Department of Psychiatry, University of Colorado School of Medicine, United States
| | - Joshua L Gowin
- Department of Radiology, University of Colorado School of Medicine, United States
| | - Jody Tanabe
- Department of Radiology, University of Colorado School of Medicine, United States; Department of Psychiatry, University of Colorado School of Medicine, United States; Department of Neurology, University of Colorado School of Medicine, United States
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