Dong Ling, Chen Wen-Cai, Su Hang, Wang Mei-Ling, Du Cong, Jiang Xing-Ren, Mei Shu-Fang, Chen Si-Jing, Liu Xiu-Jun, Liu Xue-Bing
Wuhan Mental Health Center, Wuhan, Hubei Province, China.
Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China.
Front Psychiatry. 2023 May 25;14:1156149. doi: 10.3389/fpsyt.2023.1156149. eCollection 2023.
Polydrug abuse is common among opioid users. Individuals who use both heroin and methamphetamine (MA) have been shown to experience a wide range of cognitive deficits. Previous research shows that repetitive transcranial magnetic stimulation (rTMS) can change cerebral cortical excitability and regulate neurotransmitter concentration, which could improve cognitive function in drug addiction. However, the stimulation time, location, and possible mechanisms of rTMS are uncertain.
56 patients with polydrug use disorder were randomized to receive 20 sessions of 10 Hz rTMS ( = 19), iTBS ( = 19), or sham iTBS ( = 18) to the left DLPFC. All patients used MA and heroin concurrently. Cognitive function was assessed and several related proteins including EPI, GABA-Aα5, IL-10, etc. were quantified by ELISA before and after the treatment.
Baseline RBANS scores were lower than normal for age (77.25; IQR 71.5-85.5). After 20 treatment sessions, in the iTBS group, the RBANS score increased by 11.95 (95% CI 0.02-13.90, = 0.05). In particular, there were improvements in memory and attention as well as social cognition. Following treatment, serum EPI and GABA-Aα5 were reduced and IL-10 was elevated. The improvement of immediate memory was negatively correlated with GABA-Aα5 ( = -0.646, = 0.017), and attention was positively correlated with IL-10 ( = 0.610, = 0.027). In the 10 Hz rTMS group, the improvement of the RBANS total score (80.21 ± 14.08 before vs.84.32 ± 13.80 after) and immediate memory (74.53 ± 16.65 before vs.77.53 ± 17.78 after) was statistically significant compared with the baseline ( 0.05). However, compared with the iTBS group, the improvement was small and the difference was statistically significant. There was no statistically significant change in the sham group (78.00 ± 12.91 before vs.79.89 ± 10.92 after; 0.05).
Intermittent theta burst stimulation to the left DLPFC may improve cognitive function in polydrug use disorder patients. Its efficacy appears to be better than that of 10 Hz rTMS. The improvement of cognitive function may be related to GABA-Aα5 and IL-10. Our findings preliminarily demonstrate the clinical value of iTBS to the DLPFC to augment neurocognitive recovery in polydrug use disorders.
多药滥用在阿片类药物使用者中很常见。同时使用海洛因和甲基苯丙胺（MA）的个体已被证明存在广泛的认知缺陷。先前的研究表明，重复经颅磁刺激（rTMS）可以改变大脑皮质兴奋性并调节神经递质浓度，这可能改善药物成瘾中的认知功能。然而，rTMS的刺激时间、位置和可能的机制尚不确定。
56例多药使用障碍患者被随机分为三组，分别接受20次10Hz的rTMS（n = 19）、间歇性θ波爆发刺激（iTBS，n = 19）或假iTBS（n = 18），刺激左侧背外侧前额叶皮质（DLPFC）。所有患者均同时使用MA和海洛因。在治疗前后评估认知功能，并通过酶联免疫吸附测定（ELISA）对包括肾上腺素（EPI）、γ-氨基丁酸Aα5（GABA-Aα5）、白细胞介素-10（IL-10）等几种相关蛋白进行定量分析。
基线时Rivermead行为记忆测试（RBANS）评分低于同龄人正常水平（77.25；四分位间距71.5 - 85.5）。经过20次治疗后，iTBS组的RBANS评分增加了11.95（95%置信区间0.02 - 13.90，P = 0.05）。特别是在记忆、注意力以及社会认知方面有改善。治疗后，血清EPI和GABA-Aα5降低，IL-10升高。即时记忆的改善与GABA-Aα5呈负相关（r = -0.646，P = 0.017），注意力与IL-10呈正相关（r = 0.610，P = 0.027）。在10Hz rTMS组中，与基线相比，RBANS总分（治疗前80.21±14.08 vs.治疗后84.32±13.80）和即时记忆（治疗前74.53±16.65 vs.治疗后77.53±17.78）的改善具有统计学意义（P < 0.05）。然而，与iTBS组相比，改善较小且差异具有统计学意义。假刺激组无统计学显著变化（治疗前78.00±12.91 vs.治疗后79.89±10.92；P > 0.05）。
对左侧DLPFC进行间歇性θ波爆发刺激可能改善多药使用障碍患者的认知功能。其疗效似乎优于10Hz rTMS。认知功能的改善可能与GABA-Aα5和IL-10有关。我们的研究结果初步证明了对DLPFC进行iTBS在增强多药使用障碍患者神经认知恢复方面的临床价值。
Zotero 插件
