The Use of Neuromodulation in the Treatment of Cocaine Dependence

Abstract

Cocaine related disorders are currently among the most devastating mental diseases, as they impoverish all spheres of life resulting in tremendous economic, social and moral costs. Despite multiple efforts to tackle cocaine dependence, pharmacological as well as cognitive therapies have had limited success. In this review, we discuss the use of recent neuromodulation techniques, such as conventional repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS) and the use of H coils for deep rTMS for the treatment of cocaine dependence. Moreover, we discuss attempts to identify optimal brain targets underpinning cocaine craving and withdrawal for neurodisruption treatment, as well as some weaknesses in the literature, such as the absence of biomarkers for individual risk classification and the inadequacy of treatment outcome measures, which may delay progress in the field. Finally, we present some genetic markers candidates and objective outcome measures which could be applied in combination with TMS treatment of cocaine dependence. We anticipate future research in this area combining genetic and physiological markers, neurodisruption, and clinical behavioral measures.

Add-on high frequency deep transcranial magnetic stimulation (dTMS) to bilateral prefrontal cortex reduces cocaine craving in patients with cocaine use disorder

“…As a consequence, the electrical field generated by dTMS was found in a human brain model to be considerably wider than that of rTMS [24], and this was confirmed in a subsequent human study [25]. Given the putative biological substrate of substance use disorders, which involves interactions and connections between the PFC and striate/accumbens [26], it is sensible to hypothesize that dTMS is more likely to benefit CUD than classical rTMS [27].…”

Dissociable Effects of Cocaine Dependence on Reward Processes: The Role of Acute Cocaine and Craving

“…In addition to evaluating psychotherapeutic interventions, our paradigm may prove useful for understanding alternative therapeutic approaches and determining who is more likely to respond. For example, it has been suggested that the LHb is a suitable target for substance dependence in general (Yadid et al, 2013) and for cocaine use specifically (Alba-Ferrara et al, 2014). Use of a similar paradigm may help determine variability in baseline/ pretreatment function that could serve as a response biomarker, perhaps also including predicting individuals at risk for drug dependence.…”

Transcranial Magnetic Stimulation and Deep Brain Stimulation in the Treatment of Alcohol Dependence

“…It is also implicit that to reveal such mechanism of action, a clear model of the neural pathways underpinning alcohol dependence should be demonstrated. The neural circuits underlying addiction have been largely elucidated (22), and we recently summarized how they can be approached by neuromodulation therapies (23). The molecular mechanism of alcohol’s effects on the brain is complex and its target proteins include, but are not limited to, ion channels, neurotransmitter receptors, and intracellular signaling proteins.…”

“…The nature of the changes in reward circuits during development of addictions has become increasingly clear in recent years (23). In animal models, addictive drugs share the property of voluntary self-administration correlated with enhancement in the functioning of the reward circuitry of the brain, encompassing dopaminergic projections from the ventral tegmental area to nucleus accumbens and ventral pallidum via the medial forebrain bundle (24,27).…”