RTMS of the left dorsolateral prefrontal cortex in individuals with cocaine use disorder: preliminary findings

Abstract

Recently, repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) has emerged as a potentially promising treatment for CUD. rTMS appears to have unique therapeutic applications to directly target and remodel dysfunctions in brain circuits altered by chronic exposure to cocaine, including circuits implicated in reward processing, craving, inhibitory and cognitive control, mood, and learning. Furthermore, rTMS of the DLPFC has been found to increase dopamine release in the caudate/dorsal striatum. Thus, we hypothesized that DLPFC neuromodulation via rTMS would improve symptoms of anhedonia in individuals with CUD. We tested this hypothesis in a double-blind, sham controlled multicenter trial (30 M; 10 F; mean age 36.67±7.04 years) with longstanding history of CUD (disease duration 15.60 ± 5.62 years) and seeking treatment for their cocaine use. The stimulation protocol included 10 sessions (twice a day, 5 days/week, 15 Hz frequency, pulse intensity 100% of the resting motor threshold, 60 pulses per train, inter train pause of 15 s, 40 stimulation trains, 2400 pulses/session) and targeted the left DLPFC, located with the BeamF3 method. Following this, the participants received the maintenance intervention of 2 sessions per week for 3 months. Results show efficacy in the reduction of cocaine consumption and craving scores, associated with an improvement of anhedonia and other clinical symptoms.