Abstract
Background
Cocaine use disorder (CUD) is a global condition lacking effective treatment. Repetitive
transcranial magnetic stimulation (rTMS) may reduce craving and frequency of cocaine
use, but little is known about its efficacy and neural effects. We sought to elucidate
short- and long-term clinical benefits of 5-Hz rTMS as an add-on to standard treatment
in patients with CUD and discern underlying functional connectivity effects using
magnetic resonance imaging.
Methods
A total of 44 patients with CUD were randomly assigned to complete the 2-week double-blind
randomized controlled trial (acute phase) (sham [n = 20, 2 female] and active [n = 24, 4 female]), in which they received two daily sessions of rTMS on the left dorsolateral
prefrontal cortex (PFC). Subsequently, 20 patients with CUD continued to an open-label
maintenance phase for 6 months (two weekly sessions for up to 6 mo).
Results
rTMS plus standard treatment for 2 weeks significantly reduced craving (baseline:
3.9 ± 3.6; 2 weeks: 1.5 ± 2.4, p = .013, d = 0.77) and impulsivity (baseline: 64.8 ± 16.8; 2 weeks: 53.1 ± 17.4, p = .011, d = 0.79) in the active group. We also found increased functional connectivity between
the left dorsolateral PFC and ventromedial PFC and between the ventromedial PFC and
right angular gyrus. Clinical and functional connectivity effects were maintained
for 3 months, but they dissipated by 6 months. We did not observe reduction in positive
results for cocaine in urine; however, self-reported frequency and grams consumed
for 6 months were reduced.
Conclusions
With this randomized controlled trial, we show that 5-Hz rTMS has potential promise
as an adjunctive treatment for CUD and merits further research.
Keywords
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Article Info
Publication History
Published online: January 25, 2021
Accepted:
January 14,
2021
Received in revised form:
December 4,
2020
Received:
November 30,
2020
Identification
Copyright
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