Laboratoire de Psychologie Médicale et D'Addictologie, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium; ULB Neuroscience Institute (UNI), Belgium.
Laboratoire de Psychologie Médicale et D'Addictologie, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium; ULB Neuroscience Institute (UNI), Belgium; CHU Brugmann, Psychiatry Institute, Brussels, Belgium; Faculty of Psychology, Université Libre de Bruxelles (ULB), Brussels, Belgium.
Brain Stimul. 2021 Nov-Dec;14(6):1531-1543. doi: 10.1016/j.brs.2021.10.386. Epub 2021 Oct 20.
Approximately half of all people with alcohol use disorder (AUD) relapse into alcohol reuse in the next few weeks after a withdrawal treatment. Brain stimulation and cognitive training represent recent forms of complementary interventions in the context of AUD.
To evaluate the clinical efficacy of five sessions of 2 mA bilateral transcranial direct current stimulation (tDCS) for 20 min over the dorsolateral prefrontal cortex (DLPFC) (left cathodal/right anodal) combined with alcohol cue inhibitory control training (ICT) as part of rehabilitation. The secondary outcomes were executive functioning (e.g. response inhibition) and craving intensity, two mechanisms strongly related to abstinence.
A randomized clinical trial with patients (n = 125) with severe AUD at a withdrawal treatment unit. Each patient was randomly assigned to one of four conditions, in a 2 [verum vs. sham tDCS] x 2 [alcohol cue vs. neutral ICT] factorial design. The main outcome of treatment was the abstinence rate after two weeks or more (up to one year).
Verum tDCS improved the abstinence rate at the 2-week follow-up compared to the sham condition, independently of the training condition (79.7% [95% CI = 69.8-89.6] vs. 60.7% [95% CI = 48.3-73.1]; p = .02). A priori contrasts analyses revealed higher abstinence rates for the verum tDCS associated with alcohol cue ICT (86.1% [31/36; 95% CI = 74.6-97.6]) than for the other three conditions (64% [57/89; 95% CI = 54-74]). These positive clinical effects on abstinence did not persist beyond two weeks after the intervention. Neither the reduction of craving nor the improvement in executive control resulted specifically from prefrontal-tDCS and ICT.
AUD patients who received tDCS applied to DLPFC showed a significantly higher abstinence rate during the weeks following rehabilitation. When combined with alcohol specific ICT, brain stimulation may provide better clinical outcomes.
ClinicalTrials.gov number NCT03447054 https://clinicaltrials.gov/ct2/show/NCT03447054.
大约一半的酒精使用障碍（AUD）患者在戒断治疗后的几周内会重新饮酒。脑刺激和认知训练是 AUD 背景下最近出现的补充干预形式。
评估 5 次 2 mA 双侧经颅直流电刺激（tDCS），每次 20 分钟，作用于背外侧前额叶皮质（DLPFC）（左阴极/右阳极），联合酒精线索抑制控制训练（ICT）作为康复的一部分，对临床疗效。次要结局为执行功能（如反应抑制）和渴求强度，这两个机制与戒酒密切相关。
一项在戒断治疗单位的严重 AUD 患者中进行的随机临床试验。每位患者均按 2 [真刺激 vs. 假刺激 tDCS] x 2 [酒精线索 vs. 中性 ICT] 析因设计随机分配至四个条件之一。主要治疗结果是两周或更长时间（最长可达一年）后的戒酒率。
与假刺激条件相比，真刺激 tDCS 可独立于训练条件提高两周时的戒酒率（79.7%[95%CI=69.8-89.6] vs. 60.7%[95%CI=48.3-73.1]；p=0.02）。预先设定的对比分析显示，真刺激 tDCS 联合酒精线索 ICT 的戒酒率更高（86.1%[31/36；95%CI=74.6-97.6]），而其他三种条件的戒酒率为 64%[57/89；95%CI=54-74]。这些与戒酒相关的积极临床效果在干预后两周内并未持续。渴求的减少和执行控制的改善均不是由前额叶 tDCS 和 ICT 特异性引起的。
接受 DLPFC 经颅直流电刺激的 AUD 患者在康复后的几周内戒酒率显著提高。当与酒精特异性 ICT 结合使用时，脑刺激可能会提供更好的临床效果。
ClinicalTrials.gov 编号 NCT03447054 https://clinicaltrials.gov/ct2/show/NCT03447054。
