Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands.
Amsterdam Institute for Addiction Research, Amsterdam, the Netherlands.
Addiction. 2023 Jan;118(1):71-85. doi: 10.1111/add.16025. Epub 2022 Sep 7.
Alcohol use disorder (AUD) is a chronic disorder with high relapse rates. There are currently few clinical trials of high frequency repetitive transcranial magnetic stimulation (HF-rTMS) to reduce alcohol use among AUD patients, and results are mixed. The current study tested the effect of 10 add-on sessions of HF-rTMS over the right dorsolateral pre-frontal cortex (DLPFC) on alcohol use and craving.
Single-center, single blind sham-controlled parallel-group RCT (n = 80), with 3 and 6 months follow-up.
Clinical treatment center in Amsterdam, the Netherlands.
Eighty detoxified and abstinent AUD inpatients in clinical treatment (20 females, average age = 44.35 years).
Ten sessions of active or sham HF-rTMS (60 10 Hz trains of 5 sec at 110% motor threshold) over the right DLPFC on 10 consecutive work-days.
The primary outcome measure is the number of abstinent days over 6-month follow-up (FU). Secondary outcome measures are craving over 6-month FU (alcohol urge questionnaire and obsessive-compulsive drinking scale), time to first relapse over 6-month FU and grams of alcohol consumed over 6-month FU. Additional outcome measures: full abstinence over 6-month FU and treatment success over 12-month FU.
HF-rTMS did not affect the number of abstinent days over 6 months FU [sham = 124 ± 65.9 days, active = 115 ± 69.8 days, difference: 9 days, 95% confidence interval (CI) = Poisson model: 0.578-3.547]. Moreover, HF-rTMS did not affect craving (AUQ/OCDS) (sham = 15.38/5.28, active = 17.48/4.75, differences = 2.1/-0.53, 95% CI mixed-effects model = -9.14 to 2.07/-1.44 to 2.40).
There was no clear evidence that high-frequency repetitive transcranial magnetic stimulation over the right dorsolateral pre-frontal cortex treatment has a long-term positive effect on alcohol use or craving as add-on treatment for alcohol use disorder. High treatment response at 6-month follow-up could have limited the possibility to find an effect.
酒精使用障碍（AUD）是一种高复发率的慢性疾病。目前，很少有临床试验采用高频重复经颅磁刺激（HF-rTMS）来减少 AUD 患者的饮酒量，且结果不一。本研究测试了右侧背外侧前额叶皮层（DLPFC）接受 10 次附加 HF-rTMS 治疗对饮酒和渴求的影响。
单中心、单盲假对照平行组 RCT（n=80），随访 3 个月和 6 个月。
荷兰阿姆斯特丹的临床治疗中心。
80 名接受临床治疗的戒毒和戒酒的 AUD 住院患者（20 名女性，平均年龄 44.35 岁）。
在 10 个连续工作日内，对右侧 DLPFC 进行 10 次 HF-rTMS 治疗（60 个 10 Hz 刺激，每个刺激持续 5 秒，刺激强度为 110%运动阈值）。
主要结局测量指标是 6 个月随访期间的无饮酒天数（FU）。次要结局测量指标是 6 个月 FU 期间的渴求（酒精渴求问卷和强迫性饮酒量表）、6 个月 FU 期间的首次复发时间和 6 个月 FU 期间的饮酒量。附加结局测量指标：6 个月 FU 期间的完全戒酒和 12 个月 FU 期间的治疗成功。
HF-rTMS 对 6 个月 FU 期间的无饮酒天数没有影响[假刺激组=124±65.9 天，真刺激组=115±69.8 天，差异=9 天，95%置信区间（CI）=泊松模型：0.578-3.547]。此外，HF-rTMS 对渴求（AUQ/OCDS）没有影响（假刺激组=15.38/5.28，真刺激组=17.48/4.75，差异=2.1/-0.53，95%混合效应模型 CI=-9.14 至 2.07/-1.44 至 2.40）。
高频重复经颅磁刺激右侧背外侧前额叶皮层治疗作为酒精使用障碍的附加治疗，对饮酒或渴求没有明显的长期积极影响。6 个月随访时的高治疗反应可能限制了发现效果的可能性。
