Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy.
Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy.
Addict Behav. 2021 Jan;112:106657. doi: 10.1016/j.addbeh.2020.106657. Epub 2020 Sep 13.
Despite intense neuroscience research on the neurobiological underpinnings of Gambling Disorder (GD) and gambling-related decision-making, effective treatments targeting these dysfunctions are still lacking. Non Invasive Brain Stimulation (NIBS) techniques, such as transcranial Direct Current Stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS), selectively modulate activity of brain circuits and have the potential to reverse alterations sustaining GD symptoms. Therefore, the aim of this systematic review was to determine the impact of different NIBS interventions on gambling-related decision processes.
We conducted a comprehensive and translational search in three online databases (MEDLINE via PubMed, Scopus, Web of Science), in accordance with the PRISMA guidelines. We included studies applying neuromodulation (TMS, tDCS) techniques in GD patients or assessing gambling-related decision-making in healthy subjects. In addition, we explored the potential impact of NIBS in drug-induced GD (e.g., Parkinson's Disease).
Twenty-seven studies have been included. We summarized results to detect the impact of different targets and stimulation/inhibition protocols in terms of gambling-related decision-making. The majority of both tDCS and TMS studies targeted the dorsolateral prefrontal cortex. Although heterogeneous in protocols and parameters, results from tDCS and TMS studies converge in indicating that the stimulation (instead of inhibition) of prefrontal regions could be beneficial to contrast dysfunctional gambling-related decision processes.
NIBS interventions show promise to be further tested in controlled clinical settings for the treatment of behavioral addictions. Further studies are also necessary to investigate connectivity changes and laterality issues (unilateral versus bilateral; left versus right) of NIBS application in GD.
尽管神经科学领域对赌博障碍（GD）的神经生物学基础和与赌博相关的决策进行了深入研究，但针对这些功能障碍的有效治疗方法仍很缺乏。非侵入性脑刺激（NIBS）技术，如经颅直流电刺激（tDCS）和经颅磁刺激（TMS），选择性地调节脑回路的活动，并有潜力逆转维持 GD 症状的改变。因此，本系统综述的目的是确定不同的 NIBS 干预措施对与赌博相关的决策过程的影响。
我们按照 PRISMA 指南，在三个在线数据库（通过 PubMed 的 MEDLINE、Scopus、Web of Science）中进行了全面和转化的搜索。我们纳入了应用神经调节（TMS、tDCS）技术治疗 GD 患者或评估健康受试者与赌博相关的决策的研究。此外，我们还探讨了 NIBS 在药物诱导的 GD（如帕金森病）中的潜在影响。
共纳入了 27 项研究。我们总结了结果，以检测不同靶点和刺激/抑制方案对与赌博相关的决策的影响。tDCS 和 TMS 研究的大多数都针对背外侧前额叶皮层。尽管在方案和参数上存在异质性，但 tDCS 和 TMS 研究的结果都表明，刺激（而不是抑制）前额区域可能有助于对比功能失调的与赌博相关的决策过程。
NIBS 干预措施有希望在对照临床环境中进一步测试，用于治疗行为成瘾。还需要进一步的研究来调查 NIBS 在 GD 中的连通性变化和侧化问题（单侧与双侧；左与右）。
