Barr Mera S, Fitzgerald Paul B, Farzan Faranak, George Tony P, Daskalakis Zafiris J
Schizophrenia Program, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Ontario, Canada.
Curr Drug Abuse Rev. 2008 Nov;1(3):328-39. doi: 10.2174/1874473710801030328.
Recent studies support an association between substance use disorders (SUDs) and cortical excitability. Transcranial magnetic stimulation (TMS) is a non-invasive tool that can be used to assess cortical physiological processes (e.g., inhibition, excitation) and has proven to be a useful diagnostic tool in brain disorders associated with alterations in cortical excitability. In this manuscript, we review studies that employ TMS to evaluate cortical excitability in patients with SUDs. Furthermore, we discuss preliminary studies that examine repetitive TMS (rTMS) as a potential treatment for patients with SUDs. Although the use of TMS to evaluate and to treat those individuals with SUDs is in its early stages, these studies reveal significant alterations in both cortical inhibition and excitation. Specifically, elevated cortical inhibition was reported in both cocaine and nicotine dependent individuals, while one study demonstrated an increase in cortical excitability in those who use 3, 4-methylenedioxymethamphetamine (MDMA). Furthermore, three studies examining rTMS as a potential treatment in cocaine and nicotine addiction report decreases in the level of cravings and in the number of cigarettes smoked following rTMS administration to the dorsal lateral prefrontal cortex. Thus, TMS has provided early interesting findings vis à vis cortical excitability in SUDs. Moreover, preliminary evidence suggests that rTMS is efficacious in the treatment of cocaine and nicotine addiction. Further work is needed to enhance our understanding of the altered neurophysiology in SUDs as well as the ways in which rTMS treatment can be directed to optimize treatment.
近期研究支持物质使用障碍（SUDs）与皮质兴奋性之间存在关联。经颅磁刺激（TMS）是一种非侵入性工具，可用于评估皮质生理过程（如抑制、兴奋），并且已被证明是一种用于诊断与皮质兴奋性改变相关的脑部疾病的有用工具。在本手稿中，我们回顾了使用TMS评估SUDs患者皮质兴奋性的研究。此外，我们还讨论了将重复经颅磁刺激（rTMS）作为SUDs患者潜在治疗方法的初步研究。尽管使用TMS评估和治疗SUDs患者尚处于早期阶段，但这些研究揭示了皮质抑制和兴奋方面的显著改变。具体而言，在可卡因和尼古丁依赖个体中均报告了皮质抑制增强，而一项研究表明，使用3,4-亚甲基二氧甲基苯丙胺（摇头丸）的个体皮质兴奋性增加。此外，三项将rTMS作为可卡因和尼古丁成瘾潜在治疗方法的研究报告称，对背外侧前额叶皮质进行rTMS治疗后，渴望程度和吸烟量均有所下降。因此，TMS在SUDs的皮质兴奋性方面提供了早期有趣的发现。此外，初步证据表明rTMS对治疗可卡因和尼古丁成瘾有效。需要进一步开展工作，以加深我们对SUDs中神经生理学改变的理解，以及如何指导rTMS治疗以优化治疗效果。
