Zucchella Chiara, Mantovani Elisa, Federico Angela, Lugoboni Fabio, Tamburin Stefano
Neurology Unit, Department of Neurosciences, Verona University Hospital, Verona, Italy.
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Front Neurosci. 2020 Aug 18;14:729. doi: 10.3389/fnins.2020.00729. eCollection 2020.
Gambling disorder (GD) is the most common behavioral addiction and shares pathophysiological and clinical features with substance use disorders (SUDs). Effective therapeutic interventions for GD are lacking. Non-invasive brain stimulation (NIBS) may represent a promising treatment option for GD. This systematic review aimed to provide a comprehensive and structured overview of studies applying NIBS techniques to GD and problem gambling. A literature search using Pubmed, Web of Science, and Science Direct was conducted from databases inception to December 19, 2019, for studies assessing the effects of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (t-DCS) on subjects with GD or problem gambling. Studies using NIBS techniques on healthy subjects and those without therapeutic goals but only aiming to assess basic neurophysiology measures were excluded. A total of 269 articles were title and abstract screened, 13 full texts were assessed, and 11 were included, of which six were controlled and five were uncontrolled. Most studies showed a reduction of gambling behavior, craving for gambling, and gambling-related symptoms. NIBS effects on psychiatric symptoms were less consistent. A decrease of the behavioral activation related to gambling was also reported. Some studies reported modulation of behavioral measures (i.e., impulsivity, cognitive and attentional control, decision making, cognitive flexibility). Studies were not consistent in terms of NIBS protocol, site of stimulation, clinical and surrogate outcome measures, and duration of treatment and follow-up. Sample size was small in most studies. The clinical and methodological heterogeneity of the included studies prevented us from drawing any firm conclusion on the efficacy of NIBS interventions for GD. Further methodologically sound, robust, and well-powered studies are needed.
赌博障碍（GD）是最常见的行为成瘾，与物质使用障碍（SUDs）具有共同的病理生理和临床特征。目前缺乏针对GD的有效治疗干预措施。非侵入性脑刺激（NIBS）可能是一种有前景的GD治疗选择。本系统评价旨在全面、系统地综述应用NIBS技术治疗GD和问题赌博的研究。从数据库建立至2019年12月19日，利用PubMed、Web of Science和ScienceDirect进行文献检索，纳入评估重复经颅磁刺激（rTMS）和经颅直流电刺激（t-DCS）对GD或问题赌博患者影响的研究。排除使用NIBS技术对健康受试者以及无治疗目的仅评估基本神经生理学指标的研究。共筛选了269篇文章的标题和摘要，评估了13篇全文，纳入11篇，其中6篇为对照研究，5篇为非对照研究。大多数研究显示赌博行为、赌博渴望及与赌博相关的症状有所减少。NIBS对精神症状的影响不太一致。也有研究报道与赌博相关的行为激活有所减少。一些研究报告了行为指标（如冲动性、认知和注意力控制、决策、认知灵活性）的调节。在NIBS方案、刺激部位、临床和替代结局指标以及治疗和随访持续时间方面，各研究并不一致。大多数研究的样本量较小。纳入研究的临床和方法学异质性使我们无法就NIBS干预对GD的疗效得出任何确凿结论。需要进一步开展方法学严谨、有力的研究。
