Abstract
BackgroundDeep transcranial magnetic stimulation (DTMS) is a non-invasive method of stimulating widespread cortical areas and, presumably, deeper neural networks. The current study assessed the effects of DTMS in the treatment of substance use disorders (SUD) using a systematic review.MethodsElectronic literature search (PsycInfo, Medline until April 2017) identified k = 9 studies (k = 4 randomized-controlled trials, RCTs, with inactive sham and k = 5 open-label studies). DTMS was most commonly applied using high frequency/intensity (10–20 Hz/100–120% of the resting motor threshold, MT) protocols for 10–20 daily sessions in cases with alcohol, nicotine or cocaine use disorders. The outcome measures were craving and dependence (according to standardized scales) or consumption (frequency, abstinence or results of biological assays) at the end of the daily treatment phases and at the last follow-up.ResultsAcute and longer-term (6–12 months) reductions in alcohol craving were observed after 20 sessions (20 Hz, 120% MT) relative to baseline in k = 4 open-label studies with comorbid SUD and major depressive disorder (MDD). In k = 2 RCTs without MDD, alcohol consumption acutely decreased after 10–12 sessions (10–20 Hz, 100–120% MT) relative to baseline or to sham. Alcohol craving was reduced only after higher frequency/intensity DTMS (20 Hz, 120% MT) relative to sham in k = 1 RCT. Nicotine consumption was reduced and abstinence was increased after 13 sessions (10 Hz, 120% MT) and at the 6-month follow-up relative to sham in k = 1 RCT. Cocaine craving was reduced after 12 sessions (15 Hz, 100% MT) and at the 2-month follow-up relative to baseline in k = 1 open-label study while consumption was reduced after 12 sessions (10 Hz, 100% MT) relative to baseline but not to sham in k = 1 RCT.ConclusionsHigh-frequency DTMS may be effective at treating some SUD both acutely and in the longer-term. Large RCTs with inactive sham are required to determine the efficacy and the optimal stimulation parameters of DTMS for the treatment of SUD.
Highlights
Deep transcranial magnetic stimulation (DTMS) is a non-invasive method of stimulating widespread cortical areas and, presumably, deeper neural networks
Our review summarizes the preliminary evidence suggesting that high-frequency DTMS might be a promising treatment for cases with substance use disorders (SUD) who failed to respond to other available treatments
According to data from nine studies, craving, dependence, and consumption of alcohol, nicotine, and cocaine were reduced after daily treatment with DTMS and some of these effects lasted for up to 12 months without maintenance treatment
Summary
Deep transcranial magnetic stimulation (DTMS) is a non-invasive method of stimulating widespread cortical areas and, presumably, deeper neural networks. The current focus in the field is to test other therapeutic applications of DTMS beyond MDD [7, 8] One such application involves the use of DTMS for treatment of substance use disorders (SUD). The unique structure of the H-coils is of particular interest because it allows to repetitively stimulate the entire cortex in contrast to other systems offering a more focal stimulation (for example, the figure of eight, F8-coil, used for repetitive transcranial magnetic stimulation, rTMS). Such a broad stimulation with H-coils could increase the electrical field in deeper, subcortical brain regions [12, 13]. DTMS with H-coils is a promising candidate for treatment of various SUD that affect similar neural circuitry (deeper corticostriatal pathways) [14] and share numerous molecular targets [15]
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