Ibrahim Christine, Rubin-Kahana Dafna S, Pushparaj Abhiram, Musiol Martin, Blumberger Daniel M, Daskalakis Zafiris J, Zangen Abraham, Le Foll Bernard
Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
Front Pharmacol. 2019 Jul 2;10:720. doi: 10.3389/fphar.2019.00720. eCollection 2019.
Substance use disorders (SUDs) are a growing public health concern with only a limited number of approved treatments. However, even approved treatments are subject to limited efficacy with high long-term relapse rates. Current treatment approaches are typically a combination of pharmacotherapies and behavioral counselling. Growing evidence and technological advances suggest the potential of brain stimulation techniques for the treatment of SUDs. There are three main brain stimulation techniques that are outlined in this review: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS). The insula, a region of the cerebral cortex, is known to be involved in critical aspects underlying SUDs, such as interoception, decision making, anxiety, pain perception, cognition, mood, threat recognition, and conscious urges. This review focuses on both the preclinical and clinical evidence demonstrating the role of the insula in addiction, thereby demonstrating its promise as a target for brain stimulation. Future research should evaluate the optimal parameters for brain stimulation of the insula, through the use of relevant biomarkers and clinical outcomes for SUDs.
物质使用障碍（SUDs）是一个日益严重的公共卫生问题，目前仅有有限数量的获批治疗方法。然而，即便获批的治疗方法也存在疗效有限、长期复发率高的问题。当前的治疗方法通常是药物疗法与行为咨询相结合。越来越多的证据和技术进步表明，脑刺激技术在治疗物质使用障碍方面具有潜力。本综述概述了三种主要的脑刺激技术：经颅磁刺激（TMS）、经颅直流电刺激（tDCS）和深部脑刺激（DBS）。脑岛是大脑皮层的一个区域，已知其参与物质使用障碍的关键方面，如内感受、决策、焦虑、疼痛感知、认知、情绪、威胁识别和有意识冲动。本综述聚焦于临床前和临床证据，这些证据证明了脑岛在成瘾中的作用，从而表明其作为脑刺激靶点的前景。未来的研究应通过使用与物质使用障碍相关的生物标志物和临床结果，评估脑岛脑刺激的最佳参数。
