Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina; Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson VA Medical Center, Charleston, South Carolina.
Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2018 Jul;3(7):599-609. doi: 10.1016/j.bpsc.2018.03.016. Epub 2018 Apr 10.
Elevated frontal and striatal reactivity to drug cues is a transdiagnostic hallmark of substance use disorders. The goal of these experiments was to determine if it is possible to decrease frontal and striatal reactivity to drug cues in both cocaine users and heavy alcohol users through continuous theta burst stimulation (cTBS) to the left ventromedial prefrontal cortex (VMPFC).
Two single-blinded, within-subject, active sham-controlled experiments were performed wherein neural reactivity to drug/alcohol cues versus neutral cues was evaluated immediately before and after receiving real or sham cTBS (110% resting motor threshold, 3600 pulses, Fp1 location; N = 49: 25 cocaine users [experiment 1], 24 alcohol users [experiment 2]; 196 total functional magnetic resonance imaging scans). Generalized psychophysiological interaction and three-way repeated-measures analysis of variance were used to evaluate cTBS-induced changes in drug cue-associated functional connectivity between the left VMPFC and eight regions of interest: ventral striatum, left and right caudate, left and right putamen, left and right insula, and anterior cingulate cortex.
In both experiments, there was a significant interaction between treatment (real/sham) and time (pre/post). In both experiments, cue-related functional connectivity was significantly attenuated following real cTBS versus sham cTBS. There was no significant interaction with region of interest for either experiment.
This is the first sham-controlled investigation to demonstrate, in two populations, that VMPFC cTBS can attenuate neural reactivity to drug and alcohol cues in frontostriatal circuits. These results provide an empirical foundation for future clinical trials that may evaluate the efficacy, durability, and clinical implications of VMPFC cTBS to treat addictions.
对药物线索的额皮质和纹状体反应增强是物质使用障碍的一种跨诊断特征。这些实验的目的是确定通过左腹内侧前额叶皮层（VMPFC）的连续 theta 爆发刺激（cTBS）是否可以降低可卡因使用者和重度酒精使用者对药物线索的额皮质和纹状体反应。
进行了两项单盲、自身对照、主动假对照实验，其中在接受真实或假 cTBS（110%静息运动阈值，3600 个脉冲，Fp1 位置；N=49：25 名可卡因使用者[实验 1]，24 名酒精使用者[实验 2]；共 196 次功能性磁共振成像扫描）前后，评估药物/酒精线索与中性线索的神经反应。广义心理生理相互作用和三向重复测量方差分析用于评估左 VMPFC 与 8 个感兴趣区域（腹侧纹状体、左和右尾状核、左和右壳核、左和右岛叶、前扣带皮层）之间药物线索相关功能连接的 cTBS 诱导变化。
在两项实验中，处理（真实/假）和时间（前后）之间存在显著的交互作用。在两项实验中，真实 cTBS 后与假 cTBS 后，线索相关的功能连接显著减弱。对于两个实验，都没有与感兴趣区域的显著交互作用。
这是第一项在两个群体中进行的假对照研究，证明 VMPFC cTBS 可以减弱额皮质和纹状体回路对药物和酒精线索的神经反应。这些结果为未来可能评估 VMPFC cTBS 治疗成瘾的疗效、持久性和临床意义的临床试验提供了经验基础。
