title: Transcranial Magnetic Stimulation and Deep Brain Stimulation in the treatment of alcohol dependence.
abstract: Alcohol dependence is a major social, economic, and public health problem. Alcoholism can lead to damage of the gastrointestinal, nervous, cardiovascular, and respiratory systems and it can be lethal, costing hundreds of billions to the health care system. Despite the existence of cognitive-behavioral therapy, psychosocial interventions, and spiritually integrated treatment to treat it, alcohol dependence has a high relapse rate and poor prognosis, albeit with high interindividual variability. In this review, we discuss the use of two neuromodulation techniques, namely repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation (DBS), and their advantages and disadvantages compared to first-line pharmacological treatment for alcohol dependence. We also discuss rTMS and DBS targets for alcohol dependence treatment, considering experimental animal and human evidence, with careful consideration of methodological issues preventing the identification of feasible targets for neuromodulation treatments, as well as inter-individual variability factors influencing alcoholism prognosis. Lastly, we anticipate future research aiming to tailor the treatment to each individual patient by combining neurofunctional, neuroanatomical and neurodisruptive techniques optimizing the outcome.
authors.affiliation: Roskamp Laboratory of Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neuroscience, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: L
authors.initials: L
authors.lastname: Alba-Ferrara
authors.affiliation: Institute for Research in Psychiatry, Department of Psychiatry and Behavioral Neuroscience, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: F
authors.initials: F
authors.lastname: Fernandez
authors.affiliation: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
authors.forename: R
authors.initials: R
authors.lastname: Salas
authors.affiliation: Roskamp Laboratory of Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neuroscience, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: de Erausquin
keywords: DBS; addiction; alcoholism; habenula; liver transplant; nucleus accumbens; rTMS