Abstract
In alcohol-dependent patients craving is a difficult-to-treat phenomenon. It has been suggested that high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) may have beneficial effects. However, exactly how this application exerts its effect on the underlying craving neurocircuit is currently unclear. In an effort to induce alcohol craving and to maximize detection of HF-rTMS effects to cue-induced alcohol craving, patients were exposed to a block and event-related alcohol cue-reactivity paradigm while being scanned with fMRI. Hence, we assessed the effect of right dorsolateral prefrontal cortex (DLPFC) stimulation on cue-induced and general alcohol craving, and the related craving neurocircuit. Twenty-six recently detoxified alcohol-dependent patients were included. First, we evaluated the impact of one sham-controlled stimulation session. Second, we examined the effect of accelerated right DLPFC HF-rTMS treatment: here patients received 15 sessions in an open label accelerated design, spread over 4 consecutive days. General craving significantly decreased after 15 active HF-rTMS sessions. However, cue-induced alcohol craving was not altered. Our brain imaging results did not show that the cue-exposure affected the underlying craving neurocircuit after both one and fifteen active HF-rTMS sessions. Yet, brain activation changes after one and 15 HF-rTMS sessions, respectively, were observed in regions associated with the extended reward system and the default mode network, but only during the presentation of the event-related paradigm. Our findings indicate that accelerated HF-rTMS applied to the right DLPFC does not manifestly affect the craving neurocircuit during an alcohol-related cue-exposure, but instead it may influence the attentional network.
Highlights
Alcohol addiction is a chronic relapsing disorder
These stimulation results are in line with the work of Mishra and colleagues (2010) [17] who observed a decrease of general alcohol craving after 10 daily active right dorsolateral prefrontal cortex (DLPFC) HF-repetitive transcranial magnetic stimulation (rTMS) sessions, these results are indicative because time effects cannot be excluded due to the absence of a sham-group
The lack of a placebo-arm may limit firm conclusions, our findings suggest that accelerated HF-rTMS treatment positively affects general craving in recently detoxified patients (AUQ and Obsessive Compulsive Drinking Scale (OCDS))
Summary
Alcohol addiction is a chronic relapsing disorder. A possible contributing factor to relapse is alcohol craving, even when alcohol-dependent patients are effectively detoxified [1]. Craving is defined as a subjective experience of wanting to use drugs [2]. Tiffany (1990) [3] stated that conscious craving, which may be triggered by conditioned drug cues, only occurs when the automatic process of drug intake is interrupted. According to Grüsser et al (2004) [4], nonconscious appetitive reactions occur when patients are confronted with alcohol-related stimuli. These reactions might explain why alcohol-dependent patients relapse even though they do not always acknowledge experiencing craving [5]
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