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

39 however none of these studies has been replicated

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39 However, none of these studies has been replicated so far and the variability of the stimulation protocol imple- mented does not allow firm conclusions. Another important factor concerns the measurements of outcome and the follow- up assessment along the timeline. Half the studies used a self-report scale (VAS) as a measurement for craving. This is a construct developed to define and evaluate the desire/drive to take the substance of abuse reported by the addicts, and thereby it is a subjective measure that correlates with clini- cal effects and relapse rates. 31,33 Only two studies of six were objective markers of intake consisting in urine drug tests and hair analysis used. Finally, the timeline of the experimental procedure must be considered. 85,87 Most of the studies revised evaluated the TMS effects after treatment, and only one study performed 3- and 6-month follow-up. 87 This aspect must be evaluated carefully for short- and long-term effects so as to modulate the protocol and maximize the stimulation effects. Conclusion We observed encouraging but preliminary evidence of efficacy of rTMS in treating behavioral and psychological symptoms of cocaine addiction. However, the very small samples and lack of methodological control do not permit identification of a specific protocol of stimulation as supe- rior vs others, although the PfCx appears to be the brain area targeted and with solid neurobiological rationale promises to yield more favorable outcomes in terms of reduction of cocaine intake in future. 22,44,92 Further studies are needed, and should employ standard methodological procedures to find the exact location of targeted areas to improve effectiveness of stimulation, consider subjective (craving) and objective (intake) measurements in relation to neurophysiologic substrates to have a comprehensive understanding of the neuropathology, and consider timeline follow-up to evaluate the lasting nature of neural changes induced by rTMS carefully. Overall, rTMS appears ready to be scrutinized with scientific rigor in a condition (ie, CUD) presently bereft of specific pharmacological and efficacious treatment. Acknowledgment This work was supported in part through a fundraising cam- paign organized and conducted by Gieffe Supermercati SRL. Disclosure The authors report no conflicts of interest in this work. Substance Abuse and Rehabilitation downloaded from by 71.219.80.117 on 18-Aug-2018 For personal use only. 1 / 1
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Substance Abuse and Rehabilitation 2018:9 submit your manuscript | Dove press Dove press 17 TMS in cocaine addiction References 1. European Monitoring Centre for Drugs and Drug Addiction. European Drug Report: Trends and Developments . Lisbon: EMCDDA; 2017. 2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders . 5th ed. Washington: APA; 2013.
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