da Silva Morgana Croce, Conti Catarine Lima, Klauss Jaisa, Alves Luana Gaburro, do Nascimento Cavalcante Henrique Mineiro, Fregni Felipe, Nitsche Michael A, Nakamura-Palacios Ester Miyuki
Laboratory of Cognitive Sciences and Neuropsychopharmacology, Program of Post-Graduation in Physiological Sciences, Federal University of Espírito Santo, Vitória, ES, Brazil.
J Physiol Paris. 2013 Dec;107(6):493-502. doi: 10.1016/j.jphysparis.2013.07.003. Epub 2013 Jul 25.
Transcranial Direct Current Stimulation (tDCS) has been shown to reduce acute substance craving in drug addicts, and improve cognition in neuropsychiatric patients. Here we aimed to explore further tDCS induced behavioral and neurophysiological modulation including assessment of relapse rate over a prolonged time course in alcoholism. We examined the effects of repeated anodal tDCS (2mA, 35 cm(2), 20min) over the left dorsolateral prefrontal cortex (DLPFC) on relapse to the use of alcohol in alcoholics from outpatient services, who received additional routine clinical treatment. Furthermore, event related potentials (ERPs), cognitive and frontal executive processes, craving, depressive and anxiety symptoms were obtained before and after treatment. From thirteen alcoholic subjects, seven were randomized to sham-tDCS and six to real tDCS treatment (once a week for five consecutive weeks). Depressive symptoms and craving were reduced to a larger extent in the tDCS group compared to the sham group (p=0.005 and p=0.015, respectively). On the other hand, active tDCS was able to block the increase in neural activation triggered by alcohol related and neutral cues in prefrontal cortex (PFC) as indexed by ERP as seen in the sham-tDCS group. Finally, there was a trend for increased change in executive function in the tDCS group compared to the sham-tDCS group (p=0.082), and, similarly, a trend for more relapses in the tDCS group compared to sham tDCS (four alcoholic subjects (66.7%) vs. one (14.3%), p=0.053).These results confirm the previous findings of tDCS effects on craving in alcoholism and also extend these findings as we showed also tDCS-related mood improvement. However, potential increase in relapse is possible; thus the clinical value of an increase in craving and improvement in depression and executive function needs to be carefully assessed in further studies; including investigation of optimal parameters of stimulation.
经颅直流电刺激（tDCS）已被证明可减少吸毒成瘾者对毒品的急性渴求，并改善神经精神疾病患者的认知功能。在此，我们旨在进一步探索tDCS诱导的行为和神经生理调节，包括评估酒精中毒患者在较长时间内的复发率。我们研究了对来自门诊服务的酒精中毒患者，在其左背外侧前额叶皮质（DLPFC）重复进行阳极tDCS（2mA，35平方厘米，20分钟）对酒精复吸的影响，这些患者同时接受额外的常规临床治疗。此外，在治疗前后获取了事件相关电位（ERP）、认知和额叶执行过程、渴求、抑郁和焦虑症状。在13名酒精中毒受试者中，7人被随机分配到假tDCS组，6人接受真正的tDCS治疗（连续五周每周一次）。与假刺激组相比，tDCS组的抑郁症状和渴求程度降低得更为明显（分别为p = 0.005和p = 0.015）。另一方面，如假tDCS组所示，主动tDCS能够阻断前额叶皮质（PFC）中由酒精相关和中性线索触发的神经激活增加，这通过ERP来衡量。最后，与假tDCS组相比，tDCS组的执行功能变化有增加的趋势（p = 0.082），同样，与假tDCS相比，tDCS组的复发趋势也更大（4名酒精中毒受试者（66.7%） vs. 1名（14.3%），p = 0.053）。这些结果证实了之前关于tDCS对酒精中毒渴求影响的研究发现，并且还扩展了这些发现，因为我们还表明了tDCS与情绪改善有关。然而，复发可能会有潜在增加；因此，在进一步的研究中需要仔细评估渴求增加、抑郁改善和执行功能改善的临床价值；包括对最佳刺激参数的研究。
