Sahlem Gregory L, Kim Bohye, Baker Nathaniel L, Wong Brendan L, Caruso Margaret A, Campbell Lauren A, Kaloani Irakli, Sherman Brian J, Ford Tiffany J, Musleh Ahmad H, Kim Jane P, Williams Nolan R, Manett Andrew J, Kratter Ian H, Short Edward B, Killeen Terese K, George Mark S, McRae-Clark Aimee L
Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA.
Departments of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
medRxiv. 2023 Jul 12:2023.07.10.23292461. doi: 10.1101/2023.07.10.23292461.
Cannabis use disorder (CUD) is a common and consequential disorder. When applied to the dorsolateral prefrontal cortex (DLPFC), repetitive transcranial magnetic stimulation (rTMS) reduces craving across substance use disorders and may have a therapeutic clinical effect when applied in serial sessions. The present study sought to preliminarily determine whether serial sessions of rTMS applied to the DLPFC had a therapeutic effect in CUD.
This study was a two-site, phase-2, double-blind, randomized-controlled-trial. Seventy-two treatment-seeking participants (37.5% Women, mean age 30.2±9.9SD) with ≥moderate-CUD were randomized to active or sham rTMS (Beam-F3, 10Hz, 20-total-sessions, with cannabis cues) while undergoing a three-session motivational enhancement therapy intervention. The primary outcome was the change in craving between pre- and post-treatment (Marijuana Craving Questionnaire Short-Form-MCQ-SF). Secondary outcomes included the number of weeks of abstinence and the number of days-per-week of cannabis use during 4-weeks of follow-up.
There were no significant differences in craving between conditions. Participants who received active rTMS reported numerically, but not significantly, more weeks of abstinence in the follow-up period than those who received sham rTMS (15.5%-Active; 9.3%-Sham; rate ratio = 1.66 [95% CI: 0.84, 3.28]; =0.14). Participants who received active rTMS reported fewer days-per-week of cannabis use over the final two-weeks of the follow-up period (Active vs. Sham: -0.72; Z=-2.33, =0.02).
This trial suggests rTMS is safe and feasible in individuals with CUD and may have a therapeutic effect on frequency of cannabis use, though further study is needed with additional rTMS-sessions and a longer follow-up period.
大麻使用障碍（CUD）是一种常见且后果严重的疾病。重复经颅磁刺激（rTMS）应用于背外侧前额叶皮层（DLPFC）时，可减少各种物质使用障碍中的渴望感，且连续疗程应用时可能具有治疗临床效果。本研究旨在初步确定连续疗程的rTMS应用于DLPFC对CUD是否具有治疗效果。
本研究是一项双中心、2期、双盲、随机对照试验。72名寻求治疗的参与者（女性占37.5%，平均年龄30.2±9.9标准差）患有≥中度CUD，在接受为期三疗程的动机增强疗法干预时，被随机分配接受活性或假rTMS（Beam-F3，10Hz，共20个疗程，伴有大麻线索）。主要结局是治疗前后渴望感的变化（大麻渴望问卷简表-MCQ-SF）。次要结局包括戒断周数以及随访4周期间每周使用大麻的天数。
不同治疗条件下的渴望感无显著差异。接受活性rTMS的参与者在随访期报告的戒断周数在数值上多于接受假rTMS的参与者，但差异不显著（活性组为15.5%；假手术组为9.3%；率比 = 1.66 [95% CI：0.84, 3.28]；P = 0.14）。接受活性rTMS的参与者在随访期最后两周报告的每周使用大麻天数较少（活性组与假手术组：-0.72；Z = -2.33，P = 0.02）。
该试验表明rTMS在患有CUD的个体中是安全可行的，并且可能对大麻使用频率具有治疗效果，不过需要进一步研究增加rTMS疗程和延长随访期。
