Klauss Jaisa, Penido Pinheiro Leon Cleres, Silva Merlo Bruna Lima, de Almeida Correia Santos Gerson, Fregni Felipe, Nitsche Michael A, Miyuki Nakamura-Palacios Ester
Laboratory of Cognitive Sciences and Neuropsychopharmacology, Program of Postgraduation in Physiological Sciences,Federal University of Espírito Santo,Vitória-ES,Brazil.
Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation and Massachusetts General Hospital, Spauding Rehabilitation Hospital,Harvard Medical School,Boston, MA,USA.
Int J Neuropsychopharmacol. 2014 Nov;17(11):1793-803. doi: 10.1017/S1461145714000984. Epub 2014 Jul 10.
Preliminary small studies have shown that transcranial direct current stimulation (tDCS) reduces craving in alcoholic subjects. It is unclear whether tDCS also leads to changes in clinically meaningful outcomes for alcohol dependence in a properly powered phase II randomized clinical trial. We aimed to investigate whether repetitive tDCS changes the risk of alcohol use relapse in severe alcoholics from outpatient services. Thirty-five subjects were randomized to receive active bilateral [left cathodal/right anodal over the dorsolateral prefrontal cortex (dlPFC)] repetitive (five consecutive days) tDCS (2 mA, 35 cm2, two times daily stimulation for 13 min with a 20-min interval) or sham-tDCS. There were two dropouts before treatment. From 33 alcoholic subjects, 17 (mean age 45.5±8.9 s.d., 16 males) were randomized to sham and 16 (44±7.8 s.d., 16 males) to real tDCS treatment. By the end of the six months of follow-up, two subjects treated with sham (11.8%) and eight treated with real tDCS (50%) were still alcohol-abstinent [p=0.02, Long-rank (Mantel-Cox) Test, HR=0.35 (95% CI, 0.14-0.85)]. No differences with regard to changes on scores of craving, frontal function, global mental status, depressive or anxiety symptoms were observed between groups. However, subjects from the tDCS group improved with regard to their overall perception of quality of life (p=0.02), and increased their scores in the environment domain (p=0.04) after treatment. Bilateral tDCS over dlPFC reduces relapse probability in severe alcoholic subjects and results in improved perception of quality of life.
初步的小型研究表明，经颅直流电刺激（tDCS）可降低酒精成瘾者的渴求感。在一项样本量充足的II期随机临床试验中，tDCS是否也会导致酒精依赖的临床有意义结局发生改变尚不清楚。我们旨在研究重复经颅直流电刺激（rTMS）是否会改变门诊严重酗酒者酒精使用复发的风险。35名受试者被随机分为接受主动双侧[背外侧前额叶皮质（dlPFC）左侧阴极/右侧阳极]重复（连续五天）tDCS（2 mA，35 cm2，每日两次刺激，每次13分钟，间隔20分钟）或假tDCS。治疗前有两名受试者退出。33名酗酒受试者中，17名（平均年龄45.5±8.9标准差，16名男性）被随机分配到假刺激组，16名（44±7.8标准差，16名男性）被分配到真正的tDCS治疗组。到随访六个月结束时，接受假刺激治疗的两名受试者（11.8%）和接受真正tDCS治疗的八名受试者（50%）仍保持戒酒状态[p = 0.02，长秩（Mantel-Cox）检验，HR = 0.35（95% CI，0.14 - 0.85）]。两组在渴求感、额叶功能、整体精神状态、抑郁或焦虑症状评分的变化方面未观察到差异。然而，tDCS组受试者在生活质量的总体感知方面有所改善（p = 0.02），并且在治疗后环境领域的得分有所提高（p = 0.04）。双侧dlPFC的tDCS可降低严重酗酒者的复发概率，并改善生活质量感知。
