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. 2019 Sep:104:118-140.
doi: 10.1016/j.neubiorev.2019.06.007. Epub 2019 Jul 2.

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

Hamed Ekhtiari  1 , Hosna Tavakoli  2 , Giovanni Addolorato  3 , Chris Baeken  4 , Antonello Bonci  5 , Salvatore Campanella  6 , Luis Castelo-Branco  7 , Gaëlle Challet-Bouju  8 , Vincent P Clark  9 , Eric Claus  10 , Pinhas N Dannon  11 , Alessandra Del Felice  12 , Tess den Uyl  13 , Marco Diana  14 , Massimo di Giannantonio  15 , John R Fedota  16 , Paul Fitzgerald  17 , Luigi Gallimberti  18 , Marie Grall-Bronnec  8 , Sarah C Herremans  4 , Martin J Herrmann  19 , Asif Jamil  20 , Eman Khedr  21 , Christos Kouimtsidis  22 , Karolina Kozak  23 , Evgeny Krupitsky  24 , Claus Lamm  25 , William V Lechner  26 , Graziella Madeo  27 , Nastaran Malmir  28 , Giovanni Martinotti  15 , William M McDonald  29 , Chiara Montemitro  30 , Ester M Nakamura-Palacios  31 , Mohammad Nasehi  32 , Xavier Noël  6 , Masoud Nosratabadi  33 , Martin Paulus  34 , Mauro Pettorruso  15 , Basant Pradhan  35 , Samir K Praharaj  36 , Haley Rafferty  7 , Gregory Sahlem  37 , Betty Jo Salmeron  27 , Anne Sauvaget  38 , Renée S Schluter  39 , Carmen Sergiou  40 , Alireza Shahbabaie  20 , Christine Sheffer  41 , Primavera A Spagnolo  42 , Vaughn R Steele  16 , Ti-Fei Yuan  43 , Josanne D M van Dongen  40 , Vincent Van Waes  44 , Ganesan Venkatasubramanian  45 , Antonio Verdejo-García  46 , Ilse Verveer  40 , Justine W Welsh  29 , Michael J Wesley  47 , Katie Witkiewitz  10 , Fatemeh Yavari  20 , Mohammad-Reza Zarrindast  48 , Laurie Zawertailo  23 , Xiaochu Zhang  49 , Yoon-Hee Cha  34 , Tony P George  23 , Flavio Frohlich  50 , Anna E Goudriaan  51 , Shirley Fecteau  52 , Stacey B Daughters  50 , Elliot A Stein  16 , Felipe Fregni  7 , Michael A Nitsche  53 , Abraham Zangen  54 , Marom Bikson  55 , Colleen A Hanlon  37
Affiliations

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

Hamed Ekhtiari et al. Neurosci Biobehav Rev. 2019 Sep.

Abstract

There is growing interest in non-invasive brain stimulation (NIBS) as a novel treatment option for substance-use disorders (SUDs). Recent momentum stems from a foundation of preclinical neuroscience demonstrating links between neural circuits and drug consuming behavior, as well as recent FDA-approval of NIBS treatments for mental health disorders that share overlapping pathology with SUDs. As with any emerging field, enthusiasm must be tempered by reason; lessons learned from the past should be prudently applied to future therapies. Here, an international ensemble of experts provides an overview of the state of transcranial-electrical (tES) and transcranial-magnetic (TMS) stimulation applied in SUDs. This consensus paper provides a systematic literature review on published data - emphasizing the heterogeneity of methods and outcome measures while suggesting strategies to help bridge knowledge gaps. The goal of this effort is to provide the community with guidelines for best practices in tES/TMS SUD research. We hope this will accelerate the speed at which the community translates basic neuroscience into advanced neuromodulation tools for clinical practice in addiction medicine.

Keywords: Addiction; NIBS; Non-invasive brain stimulation; Psychiatry; Substance use disorder; Transcranial electrical stimulation; Transcranial magnetic stimulation; rTMS; tDCS; tES.

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Conflict of interest statement

Declaration of Competing Interest

Flavio Frohlich is the founder, majority owner, and Chief Scientific Officer of Pulvinar Neuro LLC. Michael Nitsche is a member of the Scientific Advisory Board of Neuroelectrics. Colleen A. Hanlon has served as a consultant for Brain Research and Development Services (Brainsway). Other authors reported no conflict of interest.

Figures

Fig. 1.
Fig. 1.
Three major non-invasive brain stimulation technologies. Repeated transcranial magnetic stimulation (rTMS) in its both conventional and deep forms and also transcranial direct current stimulation (tDCS) have been used frequently in addiction medicine trials. Other forms of the transcranial electrical stimulation (tES), like transcranial alternating current stimulation (tACS) have not been used in published addiction medicine trials (till June 1, 2018).
Fig. 2.
Fig. 2.
PRISMA flow diagrams for published rTMS (panel A) and tDCS (panel B) trials in drug addiction.
Fig. 3.
Fig. 3.
Contribution by country of tDCS/rTMS studies (n = 84) for addiction medicine, color coded for type of stimulation (Y axis represents number of studies).
Fig. 4.
Fig. 4.
The number of tDCS/rTMS studies from each country color coded according to substance type (n = 84 but 3 studies included 2 drugs).
Fig. 5.
Fig. 5.
Brain targets for TMS/tDCS trials in addiction medicine. Right panel: Seventy seven out of 84 published TMS/tDCS studies (till June 1, 2018) selected DLPFC as the target of stimulation including right, left, or bilateral DLPFC. Each trial with bilateral stimulation counted in both right and left categories. In 13 tDCS studies, one of the electrodes was placed on right supraorbital area (counted as frontal pole). All deep TMS (dTMS) studies are bilateral with both high and low frequency (HF and LF) TMS. Left panel: The number of TMS and tDCS studies in each target. DLPFC, dorsolateral prefrontal cortex; ACC, anterior cingulate cortex; FP, frontal pole; SFG, superior frontal gyrus; IFG, inferior frontal gyrus; TP, temporoparietal and M1, motor cortex.
Fig. 6.
Fig. 6.
Phases of recovery during which tDCS/rTMS was administered, divided amongst SUD groups.
Fig. 7.
Fig. 7.
Major groups of outcome measures in 84 tDCS/rTMS studies.
See this image and copyright information in PMC

References

    1. Addolorato G, Antonelli M, Cocciolillo F, Vassallo GA, Tarli C, Sestito L, … Di Giuda D, 2017. Deep transcranial magnetic stimulation of the dorsolateral prefrontal cortex in alcohol use disorder patients: effects on dopamine transporter availability and alcohol intake. Eur. Neuropsychopharmacol 27 (5), 450–461. 10.1016/j.euroneuro.2017.03.008. - DOI - PubMed
    1. Adinoff B, Gu H, Merrick C, McHugh M, Jeon-Slaughter H, Lu H, … Stein EA, 2015. Basal hippocampal activity and its functional connectivity predicts cocaine relapse. Biol. Psychiatry 78 (7), 496–504. 10.1016/j.biopsych.2014.12.027. - DOI - PMC - PubMed
    1. Ahn S, Mellin JM, Alagapan S, Alexander ML, Gilmore JH, Jarskog LF, Frohlich F, 2019a. Targeting reduced neural oscillations in patients with schizophrenia by transcranial alternating current stimulation. Neuroimage 186, 126–136. 10.1016/j.neuroimage.2018.10.056. - DOI - PMC - PubMed
    1. Ahn S, Prim JH, Alexander ML, McCulloch KL, Frohlich F, 2019b. Identifying and engaging neuronal oscillations by transcranial alternating current stimulation in patients with chronic low back pain: a randomized, crossover, double-blind, sham-controlled pilot study. J. Pain 20 (3). 10.1016/j.jpain.2018.09.004.277.e271-277.e211. - DOI - PMC - PubMed
    1. Alagapan S, Schmidt SL, Lefebvre J, Hadar E, Shin HW, Frӧhlich F, 2016. Modulation of cortical oscillations by low-frequency direct cortical stimulation is state-dependent. PLoS Biol. 14 (3), e1002424 10.1371/journal.pbio.1002424. - DOI - PMC - PubMed

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