Sorkhou Maryam, Stogios Nicolette, Sayrafizadeh Negar, Hahn Margaret K, Agarwal Sri Mahavir, George Tony P
Institute of Medical Sciences (IMS), University of Toronto, Canada.
Temerty Faculty of Medicine, University of Toronto, Canada.
Drug Alcohol Depend Rep. 2022 Jul 9;4:100076. doi: 10.1016/j.dadr.2022.100076. eCollection 2022 Sep.
While several pharmacological and behavioral treatments are available for alcohol use disorder (AUD), they may not be effective for all patients. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of rTMS and tDCS for craving in AUD.
EMBASE, Cochrane Library, PsycINFO, and PubMed databases were searched for original, peer-reviewed research articles in the English language published between January 2000 and January 2022. Randomized controlled trials (RCTs) reporting changes in alcohol craving among patients with AUD were selected. Random-effects meta-analysis was employed to pool data.
Changes in alcohol craving were extracted from 15 RCTs. Six studies assessed the efficacy of rTMS while nine studies examined tDCS. Results demonstrated that in comparison to sham stimulation, active rTMS to the DLPFC yields small but significant reductions in alcohol craving (standardized mean difference [SMD] = -0.27, = .03). However, DLPFC stimulation via tDCS was not superior to sham stimulation in producing changes in alcohol craving (SMD = -0.08, = .59).
Our meta-analysis suggests that rTMS may be superior to tDCS in reducing alcohol craving in patients with AUD. However, additional research is needed to identify optimal stimulation parameters for both non-invasive neuromodulatory techniques in AUD.
虽然有几种药物和行为疗法可用于治疗酒精使用障碍（AUD），但它们可能并非对所有患者都有效。本系统评价和荟萃分析的目的是评估重复经颅磁刺激（rTMS）和经颅直流电刺激（tDCS）对AUD患者渴望感的疗效和安全性。
检索了EMBASE、Cochrane图书馆、PsycINFO和PubMed数据库，以查找2000年1月至2022年1月期间发表的英文原创、同行评审研究文章。选择报告AUD患者酒精渴望感变化的随机对照试验（RCT）。采用随机效应荟萃分析来汇总数据。
从15项RCT中提取了酒精渴望感的变化。6项研究评估了rTMS的疗效，9项研究考察了tDCS。结果表明，与假刺激相比，对背外侧前额叶皮质（DLPFC）进行主动rTMS可使酒精渴望感有虽小但显著的降低（标准化均值差[SMD]= -0.27，P = 0.03）。然而，通过tDCS刺激DLPFC在引起酒精渴望感变化方面并不优于假刺激（SMD = -0.08，P = 0.59）。
我们的荟萃分析表明，在降低AUD患者的酒精渴望感方面，rTMS可能优于tDCS。然而，需要更多研究来确定这两种用于AUD的非侵入性神经调节技术的最佳刺激参数。
