Rapinesi Chiara, Kotzalidis Georgios D, Serata Daniele, Del Casale Antonio, Bersani Francesco S, Solfanelli Andrea, Scatena Paola, Raccah Ruggero N, Brugnoli Roberto, Digiacomantonio Vittorio, Carbonetti Paolo, Fensore Claudio, Tatarelli Roberto, Angeletti Gloria, Ferracuti Stefano, Girardi Paolo
Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
Prim Care Companion CNS Disord. 2013;15(1). doi: 10.4088/PCC.12m01438. Epub 2012 Feb 7.
Craving for alcohol is associated with abnormal activation in the dorsolateral prefrontal cortex. Deep transcranial magnetic stimulation (dTMS) has shown promise in the treatment of depression. There are few treatment options for treatment-resistant dysthymic disorder comorbid with alcohol use disorder.
To investigate the possible anticraving efficacy of bilateral dorsolateral prefrontal cortex high-frequency dTMS in 3 patients with comorbid long-term DSM-IV-TR dysthymic disorder and alcohol use disorder.
Three patients with alcohol use disorder with dysthymic disorder in their detoxification phase (abstaining for > 1 month) underwent twenty 20-minute sessions of 20 Hz dTMS over the dorsolateral prefrontal cortex over 28 days between 2011 and 2012. Alcohol craving was rated with the Obsessive Compulsive Drinking Scale and depressive symptoms with the Hamilton Depression Rating Scale.
All 3 patients responded unsatisfactorily to initial intravenous antidepressant and antianxiety combinations but responded after 10 dTMS sessions, improving on both anxiety-depressive symptoms and craving. This improvement enabled us to reduce antidepressant dosages after dTMS cycle completion.
High-frequency bilateral dorsolateral prefrontal cortex dTMS with left prevalence was found to produce significant anticraving effects in alcohol use disorder comorbid with dysthymic disorder. The potential of dTMS for reducing craving in patients with substance use disorder deserves to be further investigated.
对酒精的渴望与背外侧前额叶皮质的异常激活有关。深部经颅磁刺激（dTMS）已显示出治疗抑郁症的潜力。对于与酒精使用障碍共病的难治性心境恶劣障碍，治疗选择很少。
探讨双侧背外侧前额叶皮质高频dTMS对3例共病长期DSM-IV-TR心境恶劣障碍和酒精使用障碍患者的抗渴望疗效。
2011年至2012年期间，3例处于戒酒期（戒酒超过1个月）且患有心境恶劣障碍的酒精使用障碍患者，在背外侧前额叶皮质接受了20次、每次20分钟、频率为20Hz的dTMS治疗，为期28天。使用强迫性饮酒量表评估酒精渴望程度，使用汉密尔顿抑郁量表评估抑郁症状。
所有3例患者对初始的静脉注射抗抑郁药和抗焦虑药联合治疗反应不佳，但在接受10次dTMS治疗后有反应，焦虑抑郁症状和渴望程度均有所改善。这种改善使我们能够在dTMS疗程结束后减少抗抑郁药的剂量。
发现高频双侧背外侧前额叶皮质dTMS（左侧为主）对与心境恶劣障碍共病的酒精使用障碍有显著的抗渴望作用。dTMS在减少物质使用障碍患者渴望方面的潜力值得进一步研究。
