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

1 suds can be described as a chronic neuropathology

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1 SUDs can be described as a chronic neuropathology characterized by a reduction in the ability to control compulsive drug-seeking behavior, regardless of negative consequences. 2 Preclinical studies in rodents and human imag- ing evidence have shown the role of repetitive drug use in aberrant forms of neural plasticity consisting, briefly, in a significant reduction in dopaminergic activity linked to the dysfunction of cortical and subcortical pathways. 3–21 These findings complement the fundamental building blocks of the dopamine (DA) hypothesis of drug addiction, which ascribes to the hypofunctioning DA system a key role in the genesis of drug abuse and leads to the theory that functional “boosting” of DA signaling may hold beneficial effects in reducing drug craving/intake. 4,22,23 Drug addiction is now considered a whole-brain pathology, since brain-wide activity patterns are compromised. 18,19,24,25 These changes in brain function lead to the Correspondence: Corinna Bolloni; Marco Diana Laboratory of Cognitive Neuroscience, G Minardi Department of Chemistry and Pharmacy, University of Sassari, 23A Via Muroni, Sassari 07100, Italy Tel + 39 079 228 711 Email [email protected]; [email protected] 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 12 Bolloni et al motivational and cognitive impairment that characterizes addictive disorders. 10,13,26 Indeed, alterations in mesocorti- cal brain networks and related dysfunction in dopaminergic activity are accompanied by increased salience for the abused substance and increased cue reactivity for related stimuli, which in turn support the motivation/drive to use the sub- stance and to relapse. 27–30 This mechanism seems to have a putative role in the development of addiction, amplified and supported by an uncontrollable urge to take the substance of abuse (ie, craving), which leads to searching for the sub- stance and relapse. Indeed, higher craving rates are related to higher relapse rates. 18,19,31,32 Despite the fact that drug craving is considered an important risk factor for relapse, it can be counteracted and restricted by exerting cognitive and behavioral control. 33,34 However, the diminished functioning of the dorsolateral prefrontal cortex (DlPfCx) and anterior cingulate cortex provides a reason for the impaired inhibitory behavioral control and higher tendency to relapse in alcohol and/or drug use. 34–38 However, despite these recent advances in understanding the neurobiology of addiction, expectations of therapeutic treatments have fallen shorter than desired. 39,40 Transcranial magnetic stimulation (TMS) represents a nonpharmaco- logical tool and a testable opportunity in the treatment of SUDs, owing to its capacity to target and modulate specific brain circuits that are involved in the neuropathology of addiction.
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