Departments of Psychiatry (C.A.H., L.T.D., J.S.H.) and Neurosciences (C.A.H., L.T.D.), Medical University of South Carolina, Charleston, South Carolina; and Ralph Johnson VA Medical Center, Charleston, South Carolina (C.A.H.)
Departments of Psychiatry (C.A.H., L.T.D., J.S.H.) and Neurosciences (C.A.H., L.T.D.), Medical University of South Carolina, Charleston, South Carolina; and Ralph Johnson VA Medical Center, Charleston, South Carolina (C.A.H.).
Pharmacol Rev. 2018 Jul;70(3):661-683. doi: 10.1124/pr.116.013649.
Although the last 50 years of clinical and preclinical research have demonstrated that addiction is a brain disease, we still have no neural circuit-based treatments for substance dependence or cue reactivity at large. Now, for the first time, it appears that a noninvasive brain stimulation technique known as transcranial magnetic stimulation (TMS), which is Food and Drug Administration approved to treat depression, may be the first tool available to fill this critical void in addiction treatment development. The goals of this review are to 1) introduce TMS as a tool to induce causal change in behavior, cortical excitability, and frontal-striatal activity; 2) describe repetitive TMS (rTMS) as an interventional tool; 3) provide an overview of the studies that have evaluated rTMS as a therapeutic tool for alcohol and drug use disorders; and 4) outline a conceptual framework for target selection when designing future rTMS clinical trials in substance use disorders. The manuscript concludes with some suggestions for methodological innovation, specifically with regard to combining rTMS with pharmacotherapy as well as cognitive behavioral training paradigms. We have attempted to create a comprehensive manuscript that provides the reader with a basic set of knowledge and an introduction to the primary experimental questions that will likely drive the field of TMS treatment development forward for the next several years.
尽管过去 50 年的临床和临床前研究已经证明成瘾是一种脑部疾病，但我们仍然没有基于神经回路的物质依赖或线索反应治疗方法。现在，第一次出现了一种称为经颅磁刺激（TMS）的非侵入性脑刺激技术，这种技术已获得美国食品和药物管理局批准用于治疗抑郁症，它可能是第一个可用于填补成瘾治疗发展这一关键空白的工具。本综述的目的是：1）介绍 TMS 作为一种诱导行为、皮质兴奋性和额纹状体活动因果变化的工具；2）将重复经颅磁刺激（rTMS）描述为一种介入工具；3）概述评估 rTMS 作为酒精和药物使用障碍治疗工具的研究；4）概述在物质使用障碍的未来 rTMS 临床试验设计中选择目标的概念框架。本文最后提出了一些关于方法创新的建议，特别是关于将 rTMS 与药物治疗以及认知行为训练模式相结合的建议。我们试图撰写一篇全面的文章，为读者提供一套基本知识，并介绍未来几年可能推动 TMS 治疗发展领域的主要实验问题。
