Martinez Diana, Urban Nina, Grassetti Alex, Chang Dinissa, Hu Mei-Chen, Zangen Abraham, Levin Frances R, Foltin Richard, Nunes Edward V
Columbia University College of Physicians and Surgeons, The New York State Psychiatric Institute, New York, NY, United States.
Research Foundation for Mental Hygeine, New York, NY, United States.
Front Psychiatry. 2018 Mar 16;9:80. doi: 10.3389/fpsyt.2018.00080. eCollection 2018.
Previous studies have shown that repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex may serve as a potential treatment for cocaine use disorder (CUD), which remains a public health problem that is refractory to treatment. The goal of this pilot study was to investigate the effect of rTMS on cocaine self-administration in the laboratory. In the self-administration sessions, CUD participants chose between cocaine and an alternative reinforcer (money) in order to directly measure cocaine-seeking behavior. The rTMS was delivered with the H7 coil, which provides stimulation to the medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC). These brain regions were targeted based on previous imaging studies demonstrating alterations in their activation and connectivity in CUD.
Volunteers with CUD were admitted to an inpatient unit for the entire study and assigned to one of three rTMS groups: high frequency (10 Hz), low frequency (1 Hz), and sham. Six participants were included in each group and the rTMS was delivered on weekdays for 3 weeks. The cocaine self-administration sessions were performed at three time points: at baseline (pre-TMS, session 1), after 4 days of rTMS (session 2), and after 13 days of rTMS (session 3). During each self-administration session, the outcome measure was the number of choices for cocaine.
The results showed a significant group by time effect ( = 0.02), where the choices for cocaine decreased between sessions 2 and 3 in the high frequency group. There was no effect of rTMS on cocaine self-administration in the low frequency or sham groups.
Taken in the context of the existing literature, these results contribute to the data showing that high frequency rTMS to the prefrontal cortex may serve as a potential treatment for CUD.
先前的研究表明，对背外侧前额叶皮层进行重复经颅磁刺激（rTMS）可能是治疗可卡因使用障碍（CUD）的一种潜在方法，而可卡因使用障碍仍是一个难以治疗的公共卫生问题。这项初步研究的目的是调查rTMS对实验室中可卡因自我给药的影响。在自我给药环节，患有可卡因使用障碍的参与者在可卡因和另一种强化物（金钱）之间进行选择，以便直接测量其觅药行为。rTMS通过H7线圈进行，该线圈可刺激内侧前额叶皮层（mPFC）和前扣带回皮层（ACC）。基于先前的影像学研究表明这些脑区在可卡因使用障碍中其激活和连接性发生改变，故而将这些脑区作为靶点。
患有可卡因使用障碍的志愿者在整个研究期间入住住院部，并被分配到三个rTMS组之一：高频（10Hz）、低频（1Hz）和假刺激组。每组包括6名参与者，rTMS在工作日进行，持续3周。可卡因自我给药环节在三个时间点进行：基线期（rTMS前，第1次给药）、rTMS治疗4天后（第2次给药）和rTMS治疗13天后（第3次给药）。在每次自我给药环节中，观察指标是选择可卡因的次数。
结果显示存在显著的组×时间效应（P = 0.02），高频组在第2次和第3次给药之间选择可卡因的次数减少。低频组或假刺激组中rTMS对可卡因自我给药没有影响。
结合现有文献来看，这些结果进一步证明高频rTMS刺激前额叶皮层可能是治疗可卡因使用障碍的一种潜在方法。
