Departments of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
Neuroimaging and Interventional Radiology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
Prog Neuropsychopharmacol Biol Psychiatry. 2020 Aug 30;102:109950. doi: 10.1016/j.pnpbp.2020.109950. Epub 2020 Apr 24.
Transcranial Direct Current Stimulation (tDCS) is a promising new adjuvant approach in the treatment of Alcohol Use Disorders (AUDs) that has the potential to ameliorate the aberrations secondary to chronic alcohol use. In this study, using a randomized, double-blind, sham-controlled, parallel-arm design, we examined the effects of prefrontal tDCS on resting-state functional magnetic resonance imaging (rsfMRI) and its correlates with impulsivity and time to first lapse in subjects with AUDs.
Patients with AUD as per DSM-5 criteria were randomly allocated to receive a five-day course of either verum-tDCS (n = 12) or sham-tDCS (n = 12). Of them, 21 patients (verum/sham = 11/10) participated in both baseline and post-intervention 10-min rsfMRI sessions. Outside the scanner, subjects also performed the Stop-Signal Task at two time-points (baseline and post-intervention), which provided a measure of changes in impulsivity following tDCS. After completion of the post-intervention scan, all subjects were discharged and were followed-up for 90 days post-discharge or until lapse to first alcohol use.
Graph theoretical analysis of rsfMRI data revealed that verum-tDCS (but not sham) resulted in a significant increase in the global efficiency of brain networks with a concurrent significant reduction in global clustering; network-based statistical analysis identified a significant increase in the functional connectivity of a specific sub-network involving prefrontal regions. Furthermore, increased global efficiency of brain networks following verum tDCS predicted a significantly reduced likelihood of relapse. In addition, a reduction in the global clustering had a significant positive correlation with a reduction in the measure of impulsivity.
The present study adds further support to the increasing evidence base for the clinical utility of tDCS in AUDs. Importantly, we observed improvement in both whole-brain network efficiency as well as inter-regional connectivity within a specific local prefrontal sub-network that is relevant to the neurobiology of AUDs. Replication and extension of these promising leads from the present study can facilitate clinical translation of tDCS, given its advantages (i.e. safety, cost-effectiveness, administration ease with potential for remotely-supervised / home-based application) for treating patients with AUDs.
经颅直流电刺激（tDCS）是一种有前途的新辅助治疗方法，可用于治疗酒精使用障碍（AUD），具有改善慢性酒精使用引起的异常的潜力。在这项研究中，我们采用随机、双盲、假刺激对照、平行臂设计，研究了前额叶 tDCS 对 AUD 患者静息态功能磁共振成像（rsfMRI）的影响及其与冲动性和首次复发时间的相关性。
根据 DSM-5 标准，将 AUD 患者随机分配接受为期 5 天的真刺激-tDCS（n=12）或假刺激-tDCS（n=12）治疗。其中，21 名患者（真刺激/假刺激=11/10）参与了基线和干预后 10 分钟 rsfMRI 扫描。在扫描仪外，患者还在两个时间点（基线和干预后）进行停止信号任务，以提供 tDCS 后冲动性变化的测量。完成干预后扫描后，所有患者出院，并在出院后 90 天或首次饮酒复发时进行随访。
rsfMRI 数据的图论分析显示，真刺激-tDCS（而非假刺激）导致脑网络全局效率显著增加，同时全局聚类显著降低；基于网络的统计分析确定了一个涉及前额叶区域的特定子网络的功能连接显著增加。此外，真刺激 tDCS 后脑网络全局效率的增加预测复发的可能性显著降低。此外，全局聚类的减少与冲动性测量的减少呈显著正相关。
本研究为 tDCS 在 AUD 中的临床应用提供了更多证据支持。重要的是，我们观察到，在与 AUD 神经生物学相关的特定前额叶子网络内，整个大脑网络效率以及区域间连接都得到了改善。鉴于 tDCS 在治疗 AUD 患者方面具有安全性、成本效益高、易于管理且具有远程监督/家庭应用的潜力等优势，本研究中这些有前途的结果的复制和扩展可以促进 tDCS 的临床转化。
