Transcranial Magnetic Stimulation for the Treatment of Cocaine Addiction: A Systematic Review.

Alezandra Torres-Castaño,Pedro Serrano-Pérez,Yolanda Álvarez-Pérez,Lilisbeth Perestelo-Pérez,Javier Cudeiro-Mazaira,Amado Rivero-Santana,Ana Toledo-Chávarri,Vanesa Ramos-García,Iván Padrón-González,Andrea Duarte-Díaz

doi:10.3390/jcm10235595

Abstract

Long-term cocaine use is associated with cognitive deficits and neuro-psychiatric pathologies. Repetitive transcranial magnetic stimulation (rTMS) is an emerging therapeutic strategy relating to changes in brain activity. It stimulates the prefrontal cortex and is involved in inhibitory cognitive control, decision making and care. This systematic review aims to evaluate and synthesize the evidence on the safety, effectiveness, and cost-effectiveness of rTMS for the treatment of cocaine addiction. A systematic review of the literature was carried out. The following electronic databases were consulted from inception to October 2020: MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials and Web of Science. Randomised controlled trials, non-randomised controlled trials and case-series and full economic evaluations were included. Twelve studies were included. No identified study reported data on cost-effectiveness. Significant results of the efficacy of TMS have been observed in terms of the reduction of craving to consume and the number of doses consumed. No serious adverse effects have been observed. Despite the low quality of the studies, the first results were observed in terms of reduction of cocaine use and craving. In any case, this effect is considered moderate. Studies with larger sample sizes and longer follow-ups are required.

Highlights

The results showed that the two stimulation protocols significantly reduced consumption measured by urine analysis (p
Taking into account data obtained by mean of optogenetic stimulation in a rat model of cocaine addiction [12], it is tempting to speculate on the possibility that the activation of a hypofunctional prefrontal cortex, produces a regulation on dysfunctional reward circuits
High-frequency stimulation delivered on the frontal cortex of rats induces dopamine release throughout the mesolimbic and mesostriatal circuits [50,51,52]. This suggests that the therapeutic benefit observed in humans using high-frequency transcranial magnetic stimulation (TMS) over the dorsolateral prefrontal cortex cortex (DLPFC) could be related to a regulation of dopamine activity

Summary

Introduction

Cocaine use disorder (CUD) is a significant health problem, with about 12–21 million users worldwide in 2014 [1,2]. Chronic cocaine use can cause damage and changes to the prefrontal cortex (PFC) [3], including a significant reduction in brain volume [4,5], cortical hypoactivity [6,7], impaired executive functions, and dysregulation of neurotransmitter systems [8,9,10]. Intense and uncontrollable craving from consuming a substance [13]. This desire is one of the key characteristics of substance dependence, which has been shown to be one of the most important contributors to relapse. Several types of evidence indicate that substance dependence involves the dopaminergic system, causing a hypodopaminergic state in the mesolimbic system [14]

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