Nardone Raffaele, Sebastianelli Luca, Versace Viviana, Ferrazzoli Davide, Brigo Francesco, Schwenker Kerstin, Saltuari Leopold, Trinka Eugen
Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy.
Psychiatry Res. 2022 Apr;310:114431. doi: 10.1016/j.psychres.2022.114431. Epub 2022 Feb 5.
The knowledge about the effects of cannabis on human cortical brain processes is increasing. In this regard, transcranial magnetic stimulation (TMS) enables the evaluation of central nervous system function, including drug effects. Moreover, repetitive TMS (rTMS) has been used therapeutically in several substance use disorders. In this scoping review, we summarize and discuss studies that have employed TMS and rTMS techniques in users of cannabis for recreational purposes. In subjects with a history of persistent cannabis use, TMS studies showed reduced short-interval cortical inhibition (SICI). This observation points more at neurobiological changes of chronic cannabis use than to a direct effect of cannabis on gamma-aminobutyric acid (GABA) A receptors. Moreover, individuals vulnerable to becoming long-term users of cannabis may also have underlying pre-existing abnormalities in SICI. Of note, the use of cannabis is associated with an increased risk of schizophrenia, and the down-regulation of GABAergic function may play a role. Less frequent cannabis use and spontaneous craving were observed following rTMS applied to the dorsolateral prefrontal cortex (DLPFC). There is emerging evidence that the posterior cingulate cortex and the precuneus are potential targets for rTMS intervention in cannabis use disorder. However, larger and randomized trials should corroborate these encouraging findings.
关于大麻对人类大脑皮质过程影响的知识正在不断增加。在这方面，经颅磁刺激（TMS）能够评估中枢神经系统功能，包括药物的影响。此外，重复经颅磁刺激（rTMS）已被用于治疗多种物质使用障碍。在本综述中，我们总结并讨论了在娱乐性大麻使用者中采用TMS和rTMS技术的研究。在有持续使用大麻史的受试者中，TMS研究显示短间隔皮质抑制（SICI）降低。这一观察结果更多地指向慢性大麻使用的神经生物学变化，而非大麻对γ-氨基丁酸（GABA）A受体的直接作用。此外，易成为长期大麻使用者的个体在SICI方面可能也存在潜在的既往异常。值得注意的是，使用大麻会增加患精神分裂症的风险，而GABA能功能的下调可能起了一定作用。对背外侧前额叶皮质（DLPFC）进行rTMS后，观察到大麻使用频率降低且自发渴望减少。有新证据表明，后扣带回皮质和楔前叶是rTMS干预大麻使用障碍的潜在靶点。然而，需要更大规模的随机试验来证实这些令人鼓舞的发现。
