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

1 1 substance abuse and rehabilitation 20189 submit

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Substance Abuse and Rehabilitation 2018:9 submit your manuscript | Dove press Dove press 15 TMS in cocaine addiction active 10 Hz stimulation or sham stimulation. A total of 12 sessions of rTMS were administered three times/week (every other day) for 4 weeks at 100% MT over the bilateral PfCx. Each session comprised 20 trains of 50 pulses with 15 sec- onds of interstimulus interval between trains, for a total of 1,000 pulses per session. 88,89 The activation of the sham protocol by a magnetic card reader mimicked the acoustic sounds of the active one without inducing magnetic fields. We considered as outcome the cocaine intake assessed by hair analysis before treatment and at 1, 3, and 6 months later. We decided to use the hair test as a measure of drug intake, because it provides long-term information on drug consump- tion with higher sensitivity and specificity than urine analy- sis. 90,91 We also monitored the subjects who abandoned the study before the end of treatment (dropouts) and relapses among those patients who completed the protocol. Three subjects from the sham group (37%) and one from the active group (10%) abandoned the study before ending the 12 ses- sions of stimulation. Two subjects of four (50%) from the sham group relapsed three times after the treatment, while two subjects of six (33%) from the active group reported one relapse after 6 months from onset of treatment. At the end of the study we analyzed the effect of deep rTMS on cocaine intake on ten cocaine addicts over a 6-month period. Between- group analysis indicated no difference on cocaine intake along time; however, the exploratory within-group analysis showed a significant reduction in the amount of cocaine detected from baseline to 3 and 6 months later in the active group and not in the sham one. Notably a lower rate of drop- out was observed in the active group compared to the sham. In contrast to previous studies, we tested the effect of TMS in both active and sham groups, finding a profound reduction in cocaine intake in both but no difference in cocaine intake between the two experimental condition, thereby highlighting a strong placebo effect. 79,81,85,86 However, the paucity of the sample may have played a role in these results. Moreover, we used as outcome an objective measure of cocaine intake (hair analysis) over 6 months. Cocaine craving was not mea- sured. In 2015, Hanlon et al, starting from a new theoretical model to choose the target area to be stimulated, applied continuous θ -burst stimulation (cTBS) over the medial pre- frontal cortex (MPfCx). 92 Unlike classic rTMS, which deliv- ers several trains of consecutive stimuli, cTBS delivers bursts of three pulses at 50 Hz applied at 5 Hz at an amplitude determined by subjective MT. cTBS is expected to induce LTD (whereas intermittent TBS should produce LTP) in a given brain area, and similar effects have been observed in humans by using continuous or intermittent TBS, respec- tively.
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