对左侧背外侧前额叶皮层进行间歇性θ波爆发刺激可促进酒精使用障碍患者减少酒精摄入量并改善预后：一项随机、双盲、安慰剂对照临床试验。
Intermittent theta burst to the left dorsolateral prefrontal cortex promoted decreased alcohol consumption and improved outcomes in those with alcohol use disorder: A randomized, double-blind, placebo-controlled clinical trial.
作者信息
Durazzo Timothy C, Kraybill Eric P, Stephens Lauren H, McCalley Daniel M, Humphreys Keith, May April C, Padula Claudia B
机构信息
Sierra-Pacific Mental Illness Research and Education Clinical Centers, Veterans Affairs Palo Alto Healthcare System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA.
Sierra-Pacific Mental Illness Research and Education Clinical Centers, Veterans Affairs Palo Alto Healthcare System, 3801 Miranda Ave, Palo Alto, CA 94304, USA.
出版信息
Drug Alcohol Depend. 2025 May 1;270:112641. doi: 10.1016/j.drugalcdep.2025.112641. Epub 2025 Mar 1.
BACKGROUND
Over 60 % of individuals with alcohol use disorder (AUD) resume hazardous drinking within 6 months post-treatment, necessitating the development of more efficacious interventions. Accumulating evidence suggests transcranial magnetic stimulation (TMS) is a promising intervention for AUD. This randomized, double-blind, placebo-controlled trial assessed the efficacy of intermittent theta burst (iTBS), a form of TMS, as an adjunct treatment for AUD.
METHODS
Forty-nine Veterans with AUD (48 males, 1 female) were recruited from residential AUD and substance use disorder treatment. Participants were randomized to 20 sessions of Active (n = 25) or Sham (n = 24) iTBS (1200 pulses/session), targeting the left dorsolateral prefrontal cortex (DLPFC) administered over 14 days or less. Five participants were withdrawn unrelated to iTBS procedure adverse events. Participant alcohol/substance use was monitored for 6-months following final iTBS session.
RESULTS
Relative to participants who received Sham iTBS, those who received Active iTBS showed a significantly greater reduction in percent heavy drinking days and a trend for higher rate of continuous abstinence over 6-months. Among participants who resumed alcohol consumption, those in the Active group demonstrated significantly lower quantity and duration of alcohol consumption than Sham. Pre-study alcohol consumption variables were not related to post-iTBS treatment outcomes.
CONCLUSIONS
Findings indicated that Active left DLPFC iTBS, delivered over approximately 2-weeks, was a safe and efficient intervention for AUD that promoted significantly reduced heavy drinking and improved clinical outcomes compared to Sham over 6-months post-iTBS. This study provides novel data to inform and power future larger-scale, multi-site clinical trials employing iTBS for AUD.
背景
超过60%的酒精使用障碍（AUD）患者在治疗后6个月内恢复危险饮酒，因此需要开发更有效的干预措施。越来越多的证据表明，经颅磁刺激（TMS）是一种有前景的AUD干预方法。这项随机、双盲、安慰剂对照试验评估了间歇性theta爆发式刺激（iTBS，一种TMS形式）作为AUD辅助治疗的疗效。
方法
从住院的AUD和物质使用障碍治疗机构招募了49名患有AUD的退伍军人（48名男性，1名女性）。参与者被随机分为接受20次主动iTBS（n = 25）或假刺激iTBS（n = 24）（每次1200脉冲），针对左侧背外侧前额叶皮层（DLPFC），在14天或更短时间内进行。5名参与者因与iTBS程序不良事件无关的原因退出。在最后一次iTBS治疗后6个月监测参与者的酒精/物质使用情况。
结果
与接受假刺激iTBS的参与者相比，接受主动iTBS的参与者重度饮酒天数百分比显著降低，并且在6个月内持续戒酒率有升高趋势。在恢复饮酒的参与者中，主动组的酒精摄入量和饮酒持续时间明显低于假刺激组。研究前的酒精消费变量与iTBS治疗后的结果无关。
结论
研究结果表明，在大约2周内进行的主动左侧DLPFC的iTBS是一种安全有效的AUD干预措施，与假刺激相比，在iTBS后6个月内可显著减少重度饮酒并改善临床结果。本研究提供了新的数据，为未来采用iTBS治疗AUD的更大规模、多中心临床试验提供参考并提供动力支持。
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