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

85 a total of 32 cocaine addicts were randomly

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85 A total of 32 cocaine addicts were randomly assigned to the experimental group (rTMS over left DlPfCx) or the control group during 29 days. The rTMS treatment was applied with daily sessions for the first 5 days, and once a week for the following 3 weeks. At the end of stage 1, a 63-day follow-up took place, during which the participants could choose to continue in the same group or switch to the other. During stage 2, participants belonging to control group in stage 1 received the same protocol of stimulation applied in the rTMS experimental group. At the end of stage 1, 16 patients (100%) concluded the treatment in the rTMS group, while 13 patients (81%) concluded the pharmacological treatment in the control group. The authors analyzed the urine drug tests in the two groups at the end of stage 1, finding a higher number of cocaine-free urine samples in the rTMS group. Similar observations were found in the craving VAS, which resulted in significantly lower scores in the experimental group. The ten subjects that switched to the rTMS group in stage 2 displayed significant improvement with favorable outcomes comparable to those of the rTMS group. No differences were found in secondary outcomes. In spite of the open-label design and the use of a variety of pharmacological treatments as a control group, this study provided significant progress in methodological control, since an objective marker of cocaine consumption was used. Another important aspect of the Terraneo et al study is the direct comparison between rTMS-treated patients and pharmacological treatment (as usual) patients. 85 Rapinesi et al administered 12 sessions of rTMS through the H-coil to seven cocaine addicts. 86 The 12 sessions were applied three times a week alternately during 4 weeks. Bilateral rTMS was delivered at high frequency (15 Hz) and 100% MT in 20 trains with 2 seconds of interstimulus interval for a total of 8,640 pulses (720 pulses/session). They used cocaine craving measured with VAS as an outcome assessed the week before, each week during the treatment and 1 month after rTMS. At the end of the study, the authors found a significant craving reduction from baseline to 2 weeks and 4 weeks and from baseline to 1 month later. Despite there being a significant increase of craving from week 4 to 8, this study provided the first evidence of medium-term effect (baseline to 1 month after treatment) of bilateral rTMS of the PfCx as a whole in cocaine craving. However, the small sample, absence of a control group, and subjective outcome did not allow the authors to make any definitive conclusion. In 2016, we designed a double-blind randomized pilot study to test the efficacy of bilateral deep rTMS in cocaine intake. 87 A total of 18 treatment-seeking patients with current CUD according to DSM-IV criteria were recruited and randomly assigned to Substance Abuse and Rehabilitation downloaded from by 71.219.80.117 on 18-Aug-2018 For personal use only.
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