title: A Randomized Placebo-Controlled Trial of Targeted Prefrontal Cortex Modulation with Bilateral tDCS in Patients with Crack-Cocaine Dependence.
abstract: BACKGROUND
  Transcranial direct current stimulation over the dorsolateral prefrontal cortex has been shown to be clinically useful in the treatment of drug addiction.
  
  
  METHODS
  We conducted a double-blind randomized clinical trial aiming to assess the effects of bilateral dorsolateral prefrontal cortex transcranial direct current stimulation (left cathodal/right anodal) on crack-cocaine addiction. We defined craving as the primary outcome, and other clinical measurements, including depressive and anxiety symptoms, and quality of life, as secondary outcomes. Seventeen male crack-cocaine users (mean age 30.4 ± 9.8 SD) were randomized to receive 5 sessions of active transcranial direct current stimulation (2 mA, 35 cm(2), for 20 minutes), every other day, and 19 males (mean age 30.3 ± 8.4 SD) to receive sham-transcranial direct current stimulation (placebo) as control group.
  
  
  RESULTS
  Craving scores were significantly reduced in the transcranial direct current stimulation group after treatment when compared with sham-transcranial direct current stimulation (P = .028) and baseline values (P = .003), and decreased linearly over 4 weeks (before, during, and after treatment) in the transcranial direct current stimulation group only (P = .047). Changes of anxiety scores towards increase in the sham-transcranial direct current stimulation and decrease in the transcranial direct current stimulation group (P = .03), and of the overall perception of quality of life (P = .031) and of health (P = .048) towards decrease in the sham-transcranial direct current stimulation group and increase in the transcranial direct current stimulation group differed significantly between groups.
  
  
  CONCLUSIONS
  Repetitive bilateral transcranial direct current stimulation over the dorsolateral prefrontal cortex reduced craving for crack-cocaine use, decreased anxiety, and improved quality of life. We hypothesize that transcranial direct current stimulation effects may be associated with increased prefrontal processing and regulation of craving behavior.
authors.affiliation: Laboratory of Cognitive Sciences and Neuropsychopharmacology, Program of Post-Graduation in Physiological Sciences, Federal University of Espírito Santo, Vitória-ES, Brazil (Dr Batista, Ms Klauss, and Dr Palacios); Spaulding Neuromodulation Center, Department of Physical Medicine & Rehabilitation, Massachusetts General Hospital, Spaulding Neuromodulation Center, Harvard Medical School, Boston, MA (Dr Fregni); Berenson-Allen Center for Non-invasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr Fregni); Laboratory of Neuroplasticity, University Medical Center, Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany (Dr Nitsche); Leibniz Research Centre for Working Environment and Human Resources, Dortmund, Germany (Dr Nitsche); Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany (Dr Nitsche).
authors.forename: Edson Kruger
authors.initials: EK
authors.lastname: Batista
authors.affiliation: Laboratory of Cognitive Sciences and Neuropsychopharmacology, Program of Post-Graduation in Physiological Sciences, Federal University of Espírito Santo, Vitória-ES, Brazil (Dr Batista, Ms Klauss, and Dr Palacios); Spaulding Neuromodulation Center, Department of Physical Medicine & Rehabilitation, Massachusetts General Hospital, Spaulding Neuromodulation Center, Harvard Medical School, Boston, MA (Dr Fregni); Berenson-Allen Center for Non-invasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr Fregni); Laboratory of Neuroplasticity, University Medical Center, Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany (Dr Nitsche); Leibniz Research Centre for Working Environment and Human Resources, Dortmund, Germany (Dr Nitsche); Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany (Dr Nitsche).
authors.forename: Jaisa
authors.initials: J
authors.lastname: Klauss
authors.affiliation: Laboratory of Cognitive Sciences and Neuropsychopharmacology, Program of Post-Graduation in Physiological Sciences, Federal University of Espírito Santo, Vitória-ES, Brazil (Dr Batista, Ms Klauss, and Dr Palacios); Spaulding Neuromodulation Center, Department of Physical Medicine & Rehabilitation, Massachusetts General Hospital, Spaulding Neuromodulation Center, Harvard Medical School, Boston, MA (Dr Fregni); Berenson-Allen Center for Non-invasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr Fregni); Laboratory of Neuroplasticity, University Medical Center, Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany (Dr Nitsche); Leibniz Research Centre for Working Environment and Human Resources, Dortmund, Germany (Dr Nitsche); Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany (Dr Nitsche).
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.affiliation: Laboratory of Cognitive Sciences and Neuropsychopharmacology, Program of Post-Graduation in Physiological Sciences, Federal University of Espírito Santo, Vitória-ES, Brazil (Dr Batista, Ms Klauss, and Dr Palacios); Spaulding Neuromodulation Center, Department of Physical Medicine & Rehabilitation, Massachusetts General Hospital, Spaulding Neuromodulation Center, Harvard Medical School, Boston, MA (Dr Fregni); Berenson-Allen Center for Non-invasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr Fregni); Laboratory of Neuroplasticity, University Medical Center, Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany (Dr Nitsche); Leibniz Research Centre for Working Environment and Human Resources, Dortmund, Germany (Dr Nitsche); Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany (Dr Nitsche).
authors.forename: Michael A
authors.initials: MA
authors.lastname: Nitsche
authors.affiliation: Laboratory of Cognitive Sciences and Neuropsychopharmacology, Program of Post-Graduation in Physiological Sciences, Federal University of Espírito Santo, Vitória-ES, Brazil (Dr Batista, Ms Klauss, and Dr Palacios); Spaulding Neuromodulation Center, Department of Physical Medicine & Rehabilitation, Massachusetts General Hospital, Spaulding Neuromodulation Center, Harvard Medical School, Boston, MA (Dr Fregni); Berenson-Allen Center for Non-invasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr Fregni); Laboratory of Neuroplasticity, University Medical Center, Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany (Dr Nitsche); Leibniz Research Centre for Working Environment and Human Resources, Dortmund, Germany (Dr Nitsche); Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany (Dr Nitsche). emnpalacios@gmail.com.
authors.forename: Ester Miyuki
authors.initials: EM
authors.lastname: Nakamura-Palacios
mesh_terms: D000328:Adult; D001007:Anxiety / Q000503:physiopathology / Q000628:therapy; D019970:Cocaine-Related Disorders / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D016578:Crack Cocaine; D066249:Craving; D003863:Depression / Q000503:physiopathology / Q000628:therapy; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D017397:Prefrontal Cortex / Q000503:physiopathology; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012720:Severity of Illness Index; D065908:Transcranial Direct Current Stimulation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D016578:Crack Cocaine
keywords: crack-cocaine; craving; dorsolateral prefrontal cortex; quality of life; tDCS