Rakesh Gopalkumar, Adams Thomas G, Ballard Dylan H, McLouth Christopher J, Rush Craig R
Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, USA.
Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
J Addict Dis. 2025 Aug 4:1-13. doi: 10.1080/10550887.2025.2541165.
Methamphetamine use disorder (MUD) currently lacks FDA-approved treatments. Previous studies involving transcranial magnetic stimulation (TMS) over the left dorsolateral prefrontal cortex (L.dlPFC) have shown promise in TMS's effectiveness at decreasing craving for methamphetamine. Theta burst stimulation (TBS), which includes intermittent (iTBS) and continuous (cTBS) protocols, is increasingly being used for substance use disorders, including MUD. Previous reviews of TMS in MUD performed subgroup meta-analyses of studies that delivered TBS in MUD. However, these meta-analyses included studies with overlapping participant cohorts, limiting their validity. To address this limitation, we reviewed randomized controlled trials (RCTs) using unique patient cohorts from PubMed/Medline, EMBASE, and Google Scholar until September 1, 2024, comparing the impact of TBS versus sham on cue-induced methamphetamine craving in patients with MUD. We performed a meta-analysis with four eligible RCTs that delivered iTBS. Results suggest iTBS was more effective in reducing cue-induced methamphetamine craving than sham iTBS (standardized mean difference [SMD] in change = 1.04; 95% CI [0.16, 1.92]). Two additional RCTs without sham control arms were reviewed, and one demonstrated a significant reduction in craving following accelerated iTBS. Future studies should examine whether neuroimaging-targeted iTBS can impact outcome measures other than craving, such as methamphetamine use, by measuring return to use. Exploring accelerated iTBS and cTBS for MUD, targeting alternative cortical sites such as the frontal pole, and studying their effects on relevant MUD biomarkers is also pertinent. This review demonstrates the effectiveness of TBS for MUD, emphasizing its potential to advance treatment options for MUD.
甲基苯丙胺使用障碍（MUD）目前缺乏美国食品药品监督管理局（FDA）批准的治疗方法。先前涉及对左侧背外侧前额叶皮质（L.dlPFC）进行经颅磁刺激（TMS）的研究表明，TMS在降低对甲基苯丙胺的渴望方面具有一定效果。包括间歇性（iTBS）和连续性（cTBS）方案的theta爆发刺激（TBS）越来越多地用于物质使用障碍，包括MUD。先前对MUD中TMS的综述对在MUD中实施TBS的研究进行了亚组荟萃分析。然而，这些荟萃分析纳入了参与者队列重叠的研究，限制了其有效性。为解决这一局限性，我们检索了截至2024年9月1日来自PubMed/Medline、EMBASE和谷歌学术的使用独特患者队列的随机对照试验（RCT），比较TBS与假刺激对MUD患者线索诱导的甲基苯丙胺渴望的影响。我们对四项实施iTBS的符合条件的RCT进行了荟萃分析。结果表明，iTBS在减少线索诱导的甲基苯丙胺渴望方面比假iTBS更有效（变化的标准化平均差[SMD]=1.04；95%置信区间[0.16，1.92]）。我们还审查了另外两项没有假对照臂的RCT，其中一项表明加速iTBS后渴望显著降低。未来的研究应通过测量复吸情况，研究针对神经影像学的iTBS是否能影响除渴望之外的其他结局指标，如甲基苯丙胺的使用。探索针对MUD的加速iTBS和cTBS，以额叶等其他皮质部位为靶点，并研究它们对相关MUD生物标志物的影响也很有意义。本综述证明了TBS对MUD的有效性，强调了其推进MUD治疗选择的潜力。
