Effect of High-Frequency Transcranial Magnetic Stimulation on Craving in Substance Use Disorder: A Meta-Analysis

Abstract

Repetitive transcranial magnetic stimulation (rTMS), a noninvasive, neuromodulatory tool, has been used to reduce craving in different substance use disorders. There are some studies that have reported conflicting and inconclusive results; therefore, this meta-analysis was conducted to evaluate the effect of high-frequency rTMS on craving in substance use disorder and to investigate the reasons behind the inconsistency across the studies. The authors searched clinical trials from MEDLINE, Cochrane databases, and International Clinical Trials Registry Platform. The PRISMA guidelines, as well as recommended meta-analysis practices, were followed in the selection process, analysis, and reporting of the findings. The effect estimate used was the standardized mean difference (Hedge's g), and heterogeneity across the considered studies was explored using subgroup analyses. The quality assessment was done using the Cochrane risk of bias tool, and sensitivity analysis was performed to check the influences on effect size by statistical models. After screening and assessment of eligibility, finally 10 studies were included for meta-analysis, which includes six studies on alcohol and four studies on nicotine use disorder. The random-model analysis revealed a pooled effect size of 0.75 (95% CI=0.29 to 1.21, p=0.001), whereas the fixed-model analysis showed a large effect size of 0.87 (95% CI=0.63 to 1.12, p<0.00001). Subgroup analysis for alcohol use disorder showed an effect size of -0.06 (95% CI=-0.89 to 0.77, p=0.88). In the case of nicotine use disorder, random-model analysis revealed an effect size of 1.00 (95% CI=0.48 to 1.55, p=0.0001), whereas fixed-model analysis also showed a large effect size of 0.96 (95% CI=0.71 to 1.22). The present meta-analysis identified a beneficial effect of high-frequency rTMS on craving associated with nicotine use disorder but not alcohol use disorder.

Effects of repetitive transcranial magnetic stimulation (rTMS) on craving and substance consumption in patients with substance dependence: a systematic review and meta‐analysis

“…S2 ) which was supported by a non‐significant value from Egger's test ( P = 0.75). Despite a non‐significant meta‐regression on the effect of addictive substance type (see above), post‐hoc meta‐analysis was conducted for each substance separately in an exploratory approach, given previous evidence that stimulation effects may differ between substance type . This analysis yielded a large effect size for illicit drug dependence, followed by a medium effect size for nicotine dependence and a small effect size for alcohol dependence (Supporting information, Fig.…”

“…One meta‐analysis published in 2016 included eight studies, and concluded that excitatory rTMS of the right DLPFC has a significant anti‐craving effect . Another meta‐analysis published in 2017 based on 10 studies showed a significant anti‐craving effect of excitatory rTMS of either left or right DLPFC in patients with substance dependence .…”

Effects of Non-invasive Neuromodulation on Executive and Other Cognitive Functions in Addictive Disorders: A Systematic Review

“…As previously described the prefrontal cortex exerts top down control over the reward areas via corticostriatal loops (Morein-zamir and Robbins, 2014 ). In line with this neurobiology, an extensive body of literature indicates that rTMS and tDCS decrease craving levels after one session of tDCS or rTMS over the prefrontal cortex (for reviews see: Herremans and Baeken, 2012 ; Jansen et al, 2013 ; Bellamoli et al, 2014 ; Gorelick et al, 2014 ; Hone-Blanchet et al, 2015 ; Maiti et al, 2017 ; Trojak et al, 2017 ). Moreover, the prefrontal cortex is crucially involved in executive functioning (Cole and Schneider, 2007 ).…”

Transcranial electrical and magnetic stimulation (tES and TMS) for addiction medicine: A consensus paper on the present state of the science and the road ahead

“…While these non-invasive brain stimulation (NIBS) techniques are still in an early stage of development for SUDs, there is a growing international community of investigators who are attempting to optimize, evaluate, and validate their use as novel treatments for individuals seeking treatment for SUDs. Three meta-analyses show preliminary but promising results with tES/TMS in addiction medicine (Jansen et al, 2013;Maiti et al, 2017;Slotema et al, 2010). While, other non-electromagnetic technologies for NIBS, such as ultrasound and near infrared light, may offer benefits in the future, they are less well developed and have not been studied for SUDs at present, and therefore are not included in this review.…”