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Lolli F, Salimova M, Scarpino M, Lanzo G, Cossu C, Bastianelli M, Occupati B, Gori F, Del Vecchio A, Ercolini A, Pascolo S, Cimino V, Meneghin N, Fierini F, D’Anna G, Innocenti M, Ballerini A, Pallanti S, Grippo A, Mannaioni G. A randomised, double-blind, sham-controlled study of left prefrontal cortex 15 Hz repetitive transcranial magnetic stimulation in cocaine consumption and craving. PLoS One 2021; 16:e0259860. [PMID: 34784373 PMCID: PMC8594832 DOI: 10.1371/journal.pone.0259860] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background Cocaine use disorder (CUD) is a global health issue with no effective treatment. Repetitive Transcranial Magnetic Stimulation (rTMS) is a recently proposed therapy for CUD. Methods We conducted a single-center, randomised, sham-controlled, blinded, parallel-group research with patients randomly allocated to rTMS (15 Hz) or Sham group (1:1) using a computerised block randomisation process. We enrolled 62 of 81 CUD patients in two years. Patients were followed for eight weeks after receiving 15 15 Hz rTMS/sham sessions over the left dorsolateral prefrontal cortex (DLPFC) during the first three weeks of the study. We targeted the DLFPC following the 5 cm method. Cocaine lapses in twice a week urine tests were the primary outcome. The secondary outcomes were craving severity, cocaine use pattern, and psychometric assessments. Findings We randomly allocated patients to either an active rTMS group (32 subjects) or a sham treatment group (30 subjects). Thirteen (42%) and twelve (43.3%) of the subjects in rTMS and sham groups, respectively, completed the full trial regimen, displaying a high dropout rate. Ten/30 (33%) of rTMS-treated patients tested negative for cocaine in urine, in contrast to 4/27 of placebo controls (p = 0.18, odd ratio 2.88, CI 0.9–10). The Kaplan-Meier survival curve did not state a significant change between the treated and sham groups in the time of cocaine urine negativisation (p = 0.20). However, the severity of cocaine-related cues mediated craving (VAS peak) was substantially decreased in the rTMS treated group (p<0.03) after treatment at T1, corresponding to the end of rTMS treatment. Furthermore, in the rTMS and sham groups, self-reported days of cocaine use decreased significantly (p<0.03). Finally, psychometric impulsivity parameters improved in rTMS-treated patients, while depression scales improved in both groups. Conclusions In CUD, rTMS could be a useful tool for lowering cocaine craving and consumption. Trial registration The study number on clinicalTrials.gov is NCT03607591.
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Affiliation(s)
- Francesco Lolli
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
- Azienda Ospedaliera Universitaria di Careggi, Neurophysiology Unit, Firenze, Italy
- * E-mail:
| | - Maya Salimova
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Maenia Scarpino
- Azienda Ospedaliera Universitaria di Careggi, Neurophysiology Unit, Firenze, Italy
| | - Giovanni Lanzo
- Azienda Ospedaliera Universitaria di Careggi, Neurophysiology Unit, Firenze, Italy
| | - Cesarina Cossu
- Azienda Ospedaliera Universitaria di Careggi, Neurophysiology Unit, Firenze, Italy
| | - Maria Bastianelli
- Azienda Ospedaliera Universitaria di Careggi, Neurophysiology Unit, Firenze, Italy
| | - Brunella Occupati
- Azienda Ospedaliera Universitaria di Careggi, Clinical Toxicology and Poison Control Centre, Firenze, Italy
| | - Filippo Gori
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Amedeo Del Vecchio
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Anita Ercolini
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Silvia Pascolo
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Virginia Cimino
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Nicolò Meneghin
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Fabio Fierini
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Giulio D’Anna
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Matteo Innocenti
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Andrea Ballerini
- Azienda Ospedaliera Universitaria di Careggi, Clinical Psychiatry, Firenze, Italy
| | - Stefano Pallanti
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Antonello Grippo
- Azienda Ospedaliera Universitaria di Careggi, Neurophysiology Unit, Firenze, Italy
| | - Guido Mannaioni
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
- Azienda Ospedaliera Universitaria di Careggi, Clinical Toxicology and Poison Control Centre, Firenze, Italy
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