Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy.
Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italy.
Addict Behav. 2019 Jun;93:246-249. doi: 10.1016/j.addbeh.2019.02.013. Epub 2019 Feb 14.
Repetitive Transcranial Magnetic Stimulation (rTMS) shows the potential to modulate local brain activity, thus resulting in a modulatory action on neurocircuitries implicated in the pathophysiology of Gambling Disorder (GD). We report the case of a GD patient treated with two weeks of high frequency (15 Hz) rTMS over the dorsolateral prefrontal cortex (DLPFC). At baseline and after rTMS treatment the patient underwent a SPECT examination with (123)I-FP-CIT tracer, to test changes in dopamine transporter (DAT) availability. The patient was followed up for six months, to explore safety and clinical correlates of a weekly high frequency rTMS maintenance treatment. Over the six-month follow-up the patient reported no episodes of gambling relapse. Also, the patient did not report craving for gambling or gambling-related symptoms. After two weeks of left DLPFC-rTMS treatment, we found a decrease in DAT availability in striatal regions, that represents a putative neurobiological substrate of dopaminergic pathways modulation. This study suggests that high frequency DLPFC-rTMS deserves further investigations in larger samples, using controlled study designs, to assess its real potential as a treatment for GD.
重复经颅磁刺激（rTMS）显示出调节局部大脑活动的潜力，从而对赌博障碍（GD）病理生理学中涉及的神经回路产生调节作用。我们报告了一名 GD 患者接受两周高频（15Hz）rTMS 治疗背外侧前额叶皮层（DLPFC）的案例。在基线和 rTMS 治疗后，患者接受了（123）I-FP-CIT 示踪剂 SPECT 检查，以测试多巴胺转运体（DAT）可用性的变化。对患者进行了六个月的随访，以探索每周高频 rTMS 维持治疗的安全性和临床相关性。在六个月的随访期间，患者没有报告赌博复发的情况。此外，患者没有报告对赌博的渴望或与赌博相关的症状。在左 DLPFC-rTMS 治疗两周后，我们发现纹状体区域的 DAT 可用性下降，这代表了多巴胺能通路调节的潜在神经生物学基础。这项研究表明，高频 DLPFC-rTMS 值得在更大的样本中进一步研究，采用对照研究设计，以评估其作为 GD 治疗的真正潜力。
