Can deep transcranial magnetic stimulation (DTMS) be used to treat substance use disorders (SUD)? A systematic review

Abstract

BackgroundDeep transcranial magnetic stimulation (DTMS) is a non-invasive method of stimulating widespread cortical areas and, presumably, deeper neural networks. The current study assessed the effects of DTMS in the treatment of substance use disorders (SUD) using a systematic review.MethodsElectronic literature search (PsycInfo, Medline until April 2017) identified k = 9 studies (k = 4 randomized-controlled trials, RCTs, with inactive sham and k = 5 open-label studies). DTMS was most commonly applied using high frequency/intensity (10–20 Hz/100–120% of the resting motor threshold, MT) protocols for 10–20 daily sessions in cases with alcohol, nicotine or cocaine use disorders. The outcome measures were craving and dependence (according to standardized scales) or consumption (frequency, abstinence or results of biological assays) at the end of the daily treatment phases and at the last follow-up.ResultsAcute and longer-term (6–12 months) reductions in alcohol craving were observed after 20 sessions (20 Hz, 120% MT) relative to baseline in k = 4 open-label studies with comorbid SUD and major depressive disorder (MDD). In k = 2 RCTs without MDD, alcohol consumption acutely decreased after 10–12 sessions (10–20 Hz, 100–120% MT) relative to baseline or to sham. Alcohol craving was reduced only after higher frequency/intensity DTMS (20 Hz, 120% MT) relative to sham in k = 1 RCT. Nicotine consumption was reduced and abstinence was increased after 13 sessions (10 Hz, 120% MT) and at the 6-month follow-up relative to sham in k = 1 RCT. Cocaine craving was reduced after 12 sessions (15 Hz, 100% MT) and at the 2-month follow-up relative to baseline in k = 1 open-label study while consumption was reduced after 12 sessions (10 Hz, 100% MT) relative to baseline but not to sham in k = 1 RCT.ConclusionsHigh-frequency DTMS may be effective at treating some SUD both acutely and in the longer-term. Large RCTs with inactive sham are required to determine the efficacy and the optimal stimulation parameters of DTMS for the treatment of SUD.

Weight loss induced by deep transcranial magnetic stimulation in obesity: A randomized, double‐blind, sham‐controlled study

“…When applied at a low frequency (LF; ≤ 1 Hz), TMS suppresses cortical excitability, while high‐frequency (HF) TMS (≥5 Hz) enhances cortical excitability . Repetitive TMS has been found to have therapeutic benefits for several neuropsychiatric disorders, and has recently been proposed as a potential treatment in addiction disorders . To stimulate deep brain regions, Zangen et al developed the H‐coil.…”

“…13 Repetitive TMS has been found to have therapeutic benefits for several neuropsychiatric disorders, and has recently been proposed as a potential treatment in addiction disorders. [15][16][17] To stimulate deep brain regions, Zangen et al 18 developed the H-coil. Compared to conventional coils, the H-coil contains an array of elements which are contoured to the shape of the skull, allowing deeper (up to 4.5-5.5 cm from the skull vs. 1.5 cm of the standard coils) and larger volumes of brain stimulation, affecting both cortical and subcortical regions.…”

Antidepressant outcomes of high-frequency repetitive transcranial magnetic stimulation (rTMS) with F8-coil and deep transcranial magnetic stimulation (DTMS) with H1-coil in major depression: a systematic review and meta-analysis

“…However, relative to the focal stimulation achieved with the F8-coil, the H1-coil is less focal [6]. A consistent reduction of symptoms in some substance use disorders indirectly suggests that the H-coils may target deeper reward pathways [7] although the issue of depth is not resolved yet. The literature so far suggests that the H1-coil produces consistent short-term antidepressant effects in MDD [8, 9] and is FDA-approved for treatment-resistant unipolar MDD since 2013.…”

Safety and tolerability of repeated sessions of deep transcranial magnetic stimulation in obesity

“…For these properties, rTMS, especially deep TMS, has been shown to have therapeutic benefits for several neuropsychiatric disorders [ 6 ], and has recently been proposed as a potential treatment in neuropsychiatric disorders associated with intracerebral dopamine deficiency, such as addiction disorders [ 7 – 9 ], control of food craving [ 10 ] and obesity [ 11 , 12 ].…”