SAR-161206-transcranial-magnetic-stimulation-for-the-treatment-of-cocai_051818.pdf

224477 if the coil geometry is among the key factors

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22,44,77 If the coil geometry is among the key factors in the efficacy of stimulation to activate the targeted brain areas, anatomical pathways also play an important role in the final effect of stimulation. 53,72 For this reason, the TMS naviga- tor device integrated with a magnetic resonance imaging guide was developed, which is able to identify the targeted area to stimulate and to estimate the orientation, intensity, and gradients of the E-fields based on the subject’s brain anatomy. 78 This innovative integrated approach of TMS plus neuronavigation will be useful in future to optimize the TMS effect and by that to ameliorate clinical benefits. TMS for treatment of cocaine addiction: evidence to date The six studies that investigated the effect of TMS in cocaine addiction are discussed herein and summarized in Table 1. In 2007, Camprodon et al investigated the effect of rTMS on cocaine craving. Secondary end points were changes in anxiety, happiness, sadness, and discomfort. 79 In this ran- domized crossover study, six patients fulfilling Diagnostic and Statistical Manual of Mental Disorders , 4th edition (DSM)-IV criteria for cocaine dependence underwent two session of rTMS – one to the left and one to the right DlP- fCx – with a week’s break between sessions. Patients were asked to complete a visual analog scale (VAS) ranging from “not at all” to “more than ever” before, immediately after, and 4 hours after TMS. Notably, during the whole study, patients remained hospitalized. The protocol of stimulation Table 1 Studies that have implemented TMS in the treatment of cocaine addicts n TMS device and parameters Target area Control group Assessment Results Terraneo et al 85 32 rTMS (8-coil), 8 sessions, 40 trains, 15 Hz, 100% MT, 2,400 pulses DlPfCx, left Pharm Urine, craving More cocaine-free urine samples in rTMS group, reduction in craving in rTMS group Rapinesi et al 86 7 rTMS (H coil), 12 sessions, 20 trains, 20 Hz, 100% MT, 720 pulses DlPfCx, bilateral No Craving (VAS) Reduction in craving Bolloni et al 87 10 rTMS (H1 coil), 12 sessions, 20 trains, 10 Hz, 100% MT, 1,000 pulses DlPfCx, bilateral Sham TMS Hair analysis Reduction in Intake in 10 Hz rTMS group, no difference among subjects Politi et al 81 36 rTMS (8-coil), 10 sessions, 20 trains, 15 Hz, 100% MT, 600 pulses DlPfCx, left No Craving (VAS) Reduction in craving Camprodon et al 79 6 rTMS, 2 sessions, 20 trains, 10 Hz, 90% MT, 2,000 pulses DlPfCx, right/left No Craving (VAS) Reduction in craving with right rTMS Hanlon et al 92 11 cTBS + fMRI, 1 session, 110% MT, 1,800 pulses MPfCx, left Sham TMS Craving Reduction in craving Abbreviations: rTMS, repetitive transcranial magnetic stimulation; MT, motor threshold; cTBS, continuous θ -burst stimulation; fMRI, functional magnetic resonance imaging; DlPfCx, dorsolateral prefrontal cortex; MPfCx, medial prefrontal cortex; VAS, visual analogue scale.
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