Comparison of Anticraving Efficacy of Right and Left Repetitive Transcranial Magnetic Stimulation in Alcohol Dependence: A Randomized Double-Blind Study

Abstract

The objective of this study was to compare the anticraving efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) of the right versus left dorsolateral prefrontal cortex (DLPFC) in patients with alcohol dependence. Twenty patients with alcohol dependence syndrome were randomly allocated to receive either right or left rTMS over the right DLPFC (10 sessions at 10 Hz frequency; 20 trains per session; 4.9 seconds per train and intertrain interval 30 seconds) and were assessed on the Alcohol Craving Questionnaire (ACQ-NOW) to measure craving. Two-way repeated-measures analysis of variance for ACQ-NOW total score showed no main effect of group (F[1,18] = 0.0001 but significant main effect of time (F[1,18] = 185.91, p<0.0001, η(2) = 0.912). The interaction effect between group and time was not significant. There was significant reduction in craving scores in patients receiving either right or left rTMS with large effect size. However, there was no difference in anticraving efficacy between the two groups.

Repetitive Transcranial Magnetic Stimulation for Wernicke-Korsakoff Syndrome: A Case Report

“…Previous studies indicate high-frequency rTMS over the left DLPFC has a positive effect on cognition [3]. rTMS has also been reported to have anti-craving efficacy in various substance abuse disorders including alcohol dependence [489]. The patients with alcohol dependence have been displayed increased activity in the mesolimbic dopaminergic pathway, and the application of rTMS over the DLPFC is thought to have reduced craving by modulating the altered activity in the mesolimbic pathway through the meso-frontolimbic connections [489].…”

“…rTMS has also been reported to have anti-craving efficacy in various substance abuse disorders including alcohol dependence [489]. The patients with alcohol dependence have been displayed increased activity in the mesolimbic dopaminergic pathway, and the application of rTMS over the DLPFC is thought to have reduced craving by modulating the altered activity in the mesolimbic pathway through the meso-frontolimbic connections [489]. It was demonstrated that high-frequency rTMS over the right DLPFC has a positive effect on decreasing craving score in patients with alcohol dependence and it is presumed to be due to transsynaptic suppression of the left DLPFC via transcallosal connections [8].…”

“…It was demonstrated that high-frequency rTMS over the right DLPFC has a positive effect on decreasing craving score in patients with alcohol dependence and it is presumed to be due to transsynaptic suppression of the left DLPFC via transcallosal connections [8]. However, in a recent study comparing the anti-craving efficacy of rTMS over the right to the left DLPFC showed no significant difference and rTMS over the left DLPFC showed efficacy in severe cases of alcohol dependence compared to the right side [9]. It is considered that rTMS over left DLPFC affects craving circuits directly, whereas stimulation over the right affects it indirectly [9].…”

“…However, in a recent study comparing the anti-craving efficacy of rTMS over the right to the left DLPFC showed no significant difference and rTMS over the left DLPFC showed efficacy in severe cases of alcohol dependence compared to the right side [9]. It is considered that rTMS over left DLPFC affects craving circuits directly, whereas stimulation over the right affects it indirectly [9]. Accordingly, we performed high-frequency rTMS over the left DLPFC in WKS aiming to have a dual effect, which is to improve cognitive function and to decrease co-occurring alcohol craving.…”

Can the Effects of Noninvasive Brain Stimulation Alleviating Neuropsychiatric Symptoms Result From a Common Beneficial Regulation of the Hypothalamic-pituitary-adrenal Axis?

“…Targeting to the other hemisphere, the right DLPFC, with rTMS can also alleviate symptoms in depression [32], substance use disorders [33], posttraumatic stress disorders [4], and panic disorders [34]. Although the left PFC seems more vulnerable to high level of cortisol, the right PFC is also involved [35].…”