Edinoff Amber N, Sall Saveen, Roberts T Dean, Tomlinson Henry H, Soileau Lenise G, Jackson Eric D, Murnane Kevin S, Wenger Danielle M, Cornett Elyse M, Toms Jaime, Kumbhare Deepak, Kaye Adam M, Kaye Alan D
Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
Louisiana Addiction Research Center, Shreveport, LA 71103, USA.
Neurol Int. 2023 Feb 27;15(1):325-338. doi: 10.3390/neurolint15010021.
The increasing prevalence of stimulant use disorder (StUD) involving methamphetamine and cocaine has been a growing healthcare concern in the United States. Cocaine usage is associated with atherosclerosis, systolic and diastolic dysfunction, and arrhythmias. Furthermore, approximately one of every four MIs is cocaine-induced among patients aged 18 to 45. Methamphetamine use has been associated with nerve terminal damage in the dopaminergic system resulting in impaired motor function, cognitive decline, and co-morbid psychiatric disorders. Current treatment options for StUD are extremely limited, and there are currently no FDA-approved pharmacotherapies. Behavioral interventions are considered first-line treatment; however, in a recent meta-analysis comparing behavioral treatment options for cocaine, contingency management programs provided the only significant reduction in use. Current evidence points to the potential of various neuromodulation techniques as the next best modality in treating StUD. The most promising evidence thus far has been transcranial magnetic stimulation which several studies have shown to reduce risk factors associated with relapse. Another more invasive neuromodulation technique being studied is deep-brain stimulation, which has shown promising results in its ability to modulate reward circuits to treat addiction. Results showing the impact of transcranial magnetic stimulation (TMS) in the treatment of StUD are limited by the lack of studies conducted and the limited understanding of the neurological involvement driving addiction-based diseases such as StUD. Future studies should seek to provide data on consumption-reducing effects rather than craving evaluations.
在美国，涉及甲基苯丙胺和可卡因的兴奋剂使用障碍（StUD）患病率不断上升，这已成为日益严重的医疗保健问题。使用可卡因与动脉粥样硬化、收缩和舒张功能障碍以及心律失常有关。此外，在18至45岁的患者中，约四分之一的心肌梗死是由可卡因引起的。使用甲基苯丙胺与多巴胺能系统中的神经末梢损伤有关，导致运动功能受损、认知能力下降和共病精神障碍。目前针对StUD的治疗选择极为有限，目前尚无美国食品药品监督管理局（FDA）批准的药物疗法。行为干预被视为一线治疗方法；然而，在最近一项比较可卡因行为治疗方案的荟萃分析中，应急管理方案是唯一能显著减少使用量的方案。目前的证据表明，各种神经调节技术有可能成为治疗StUD的下一个最佳方式。迄今为止，最有前景的证据是经颅磁刺激，多项研究表明它能降低与复发相关的风险因素。正在研究的另一种侵入性更强的神经调节技术是深部脑刺激，它在调节奖赏回路以治疗成瘾方面已显示出有前景的结果。经颅磁刺激（TMS）治疗StUD的效果研究结果受到研究数量不足以及对驱动成瘾性疾病（如StUD）的神经学参与了解有限的限制。未来的研究应致力于提供关于减少使用量效果的数据，而不是渴望评估的数据。
