Repetitive Transcranial Magnetic Stimulation for Alcohol Craving in Alcohol Use Disorders: A Meta-analysis.

IF 4.2 3区医学 Q1 SUBSTANCE ABUSE

Journal of Addiction Medicine Pub Date : 2024-12-12 DOI:10.1097/ADM.0000000000001416

Michael Treiber, Eva-Maria Tsapakis, Konstantinos Fountoulakis

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Abstract

Aims: We aimed to evaluate the immediate and up to 3 months' effect of multiple-session repetitive transcranial magnetic stimulation (rTMS) on alcohol craving in AUD.

Methods: We performed a systematic review and random effects meta-analysis. We included randomized controlled trials with at least 10 sessions of rTMS and postintervention alcohol craving assessment. We evaluated the immediate and up to 3 months' effects of active rTMS versus sham stimulation.

Results: Twelve studies met inclusion criteria, including 475 participants across both treatment and control groups. rTMS reduced alcohol craving over sham stimulation immediately post-treatment (SMD = -0.79, 95% CI: -1.53 to -0.04, P = 0.04, I2 = 93%). Concerning a maintenance effect, our meta-analysis revealed a medium effect for active rTMS in reduction of alcohol craving at 3-month follow-up (SMD = -0.44, 95% CI: -0.77 to 0.11, P < 0.01, I2 = 38%). Our subgroup analysis revealed that rTMS targeting the medial prefrontal cortex (SMD = -2.12, 95% CI: -4.34 to 0.09, P = 0.06, I2 = 94%) may be more effective than stimulating the right dorsolateral prefrontal cortex (SMD = -1.04, 95% CI: -2.56 to 0.48, P = 0.18, I2 = 96%) or left dorsolateral prefrontal cortex (SMD = -0.27, 95% CI: -0.60 to 0.05, P = 0.10, I2 = 0%) immediately after treatment.

Conclusion: A minimum of 10 sessions of rTMS reduced alcohol craving immediately after treatment; this effect seems to be sustained over a 3-month period. We provide limited evidence of superiority for rTMS targeting the medial prefrontal cortex.

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重复经颅磁刺激治疗酒精使用障碍患者的酒精渴望：一项荟萃分析

目的：我们旨在评估多次重复经颅磁刺激（rTMS）对AUD患者酒精渴望的即时和长达3个月的影响。方法：我们进行了系统综述和随机效应荟萃分析。我们纳入了至少10次rTMS和干预后酒精渴望评估的随机对照试验。我们评估了主动rTMS与假刺激的即时和长达3个月的效果。结果：12项研究符合纳入标准，包括治疗组和对照组的475名参与者。rTMS在治疗后立即减少了假性刺激对酒精的渴望（SMD = -0.79, 95% CI: -1.53至-0.04,P = 0.04, I2 = 93%）。关于维持效应，我们的荟萃分析显示，在3个月的随访中，主动rTMS在减少酒精渴望方面具有中等效果（SMD = -0.44, 95% CI: -0.77至0.11,P < 0.01, I2 = 38%）。我们的亚组分析显示，治疗后立即刺激内侧前额叶皮质（SMD = -2.12, 95% CI: -4.34至0.09,P = 0.06, I2 = 94%）的rTMS可能比刺激右侧背外侧前额叶皮质（SMD = -1.04, 95% CI: -2.56至0.48,P = 0.18, I2 = 96%）或左侧背外侧前额叶皮质（SMD = -0.27, 95% CI: -0.60至0.05,P = 0.10, I2 = 0%）更有效。结论：至少10次的rTMS治疗后立即减少了对酒精的渴望；这种效果似乎可以持续3个月。我们提供有限的证据表明rTMS的优势针对内侧前额皮质。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Addiction Medicine 医学-药物滥用

CiteScore

6.10

自引率

9.10%

发文量

260

审稿时长

>12 weeks

期刊介绍： The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.