Psychiatry and Neuroscience Department, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
Soterix Medical Inc., New York City, NY, USA.
Eur J Neurosci. 2021 May;53(9):3212-3230. doi: 10.1111/ejn.15172. Epub 2021 Mar 18.
Impaired inhibitory control accompanied by enhanced salience attributed to drug-related cues, both associated with function of the dorsolateral prefrontal cortex (dlPFC), are hallmarks of drug addiction, contributing to worse symptomatology including craving. dlPFC modulation with transcranial direct current stimulation (tDCS) previously showed craving reduction in inpatients with cocaine use disorder (CUD). Our study aimed at assessing feasibility of a longer tDCS protocol in CUD (15 versus the common five/10 sessions) and replicability of previous results. In a randomized double-blind sham-controlled protocol, 17 inpatients with CUD were assigned to either a real-tDCS (right anodal/left cathodal) or a sham-tDCS condition for 15 sessions. Following the previous report, primary outcome measures were self-reported craving, anxiety, depression, and quality of life. Secondary measures included sleepiness, readiness to change drug use, and affect. We also assessed cognitive function including impulsivity. An 88% retention rate demonstrated feasibility. Partially supporting the previous results, there was a trend for self-reported craving to decrease in the real-tDCS group more than the sham-group, an effect that would reach significance with 15 subjects per group. Quality of life and impulsivity improved over time in treatment in both groups. Daytime sleepiness and readiness to change drug use showed significant Group × Time interactions whereby improvements were noted only in the real-tDCS group. One-month follow-up suggested transient effects of tDCS on sleepiness and craving. These preliminary results suggest the need for including more subjects to show a unique effect of real-tDCS on craving and examine the duration of this effect. After replication in larger sample sizes, increased vigilance and motivation to change drug use in the real-tDCS group may suggest fortification of dlPFC-supported executive functions.
药物相关线索引起的抑制控制受损和突显增强与背外侧前额叶皮层（dlPFC）的功能有关，这是药物成瘾的标志，导致更严重的症状，包括渴望。先前的研究表明，经颅直流电刺激（tDCS）对 dlPFC 的调节可减少可卡因使用障碍（CUD）住院患者的渴望。我们的研究旨在评估在 CUD 中使用更长 tDCS 方案（15 次而非常见的 5/10 次）的可行性，并复制以前的结果。在一项随机、双盲、假刺激对照方案中，17 名 CUD 住院患者被分配到真实 tDCS（右阳极/左阴极）或假 tDCS 条件下进行 15 次治疗。按照之前的报告，主要的结果测量是自我报告的渴望、焦虑、抑郁和生活质量。次要措施包括嗜睡、改变药物使用的意愿和情绪。我们还评估了认知功能，包括冲动性。88%的保留率表明该方案具有可行性。部分支持以前的结果，真实 tDCS 组的自我报告渴望较假刺激组有下降的趋势，每组 15 名受试者的效果将达到显著水平。两组的生活质量和冲动性随着治疗时间的推移而改善。白天嗜睡和改变药物使用的意愿在治疗中表现出显著的组间交互作用，只有在真实 tDCS 组中才会出现改善。一个月的随访表明 tDCS 对嗜睡和渴望的影响是暂时的。这些初步结果表明，需要纳入更多的受试者来显示真实 tDCS 对渴望的独特影响，并检查这种影响的持续时间。在更大的样本量中复制后，真实 tDCS 组中增加的警觉性和改变药物使用的意愿可能表明 dlPFC 支持的执行功能得到了加强。
