title: Transcranial magnetic stimulation of dorsolateral prefrontal cortex reduces cocaine use: A pilot study.
abstract: Recent animal studies demonstrate that compulsive cocaine seeking strongly reduces prelimbic frontal cortex activity, while optogenetic stimulation of this brain area significantly inhibits compulsive cocaine seeking, providing a strong rationale for applying brain stimulation to reduce cocaine consumption. Thus, we employed repetitive transcranial magnetic stimulation (rTMS), to test if dorsolateral prefrontal cortex (DLPFC) stimulation might prevent cocaine use in humans. Thirty-two cocaine-addicted patients were randomly assigned to either the experimental group (rTMS) on the left DLPFC, or to a control group (pharmacological agents) during a 29-day study (Stage 1). This was followed by a 63-day follow-up (Stage 2), during which all participants were offered rTMS treatment. Amongst the patients who completed Stage 1, 16 were in the rTMS group (100%) and 13 in the control group (81%). No significant adverse events were noted. During Stage 1, there were a significantly higher number of cocaine-free urine drug tests in the rTMS group compared to control (p=0.004). Craving for cocaine was also significantly lower in the rTMS group compared to the controls (p=0.038). Out of 13 patients who completed Stage 1 in the control group, 10 patients received rTMS treatment during Stage 2 and showed significant improvement with favorable outcomes becoming comparable to those of the rTMS group. The present preliminary findings support the safety of rTMS in cocaine-addicted patients, and suggest its potential therapeutic role for rTMS-driven PFC stimulation in reducing cocaine use, providing a strong rationale for developing larger placebo-controlled studies. Trial name: Repetitive transcranial magnetic stimulation (rTMS) in cocaine abusers, URL:〈http://www.isrctn.com/ISRCTN15823943?q=&filters=&sort=&offset=8&totalResults=13530&page=1&pageSize=10&searchType=basic-search〉,
  
  
  BACKGROUND
  ISRCTN15823943.
authors.affiliation: IRCCS San Camillo, Venezia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Terraneo
authors.affiliation: National Institute on Drug Abuse (NIDA) Intramural Research Program, Baltimore, MD, United States; Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, MD, United States; Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Leggio
authors.affiliation: Department of Neuroscience, University of Padua, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Saladini
authors.affiliation: Department of Neuroscience, University of Padua, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Ermani
authors.affiliation: National Institute on Drug Abuse (NIDA) Intramural Research Program, Baltimore, MD, United States; Solomon H. Snyder Neuroscience Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States. Electronic address: antonello.bonci@nih.gov.
authors.forename: Antonello
authors.initials: A
authors.lastname: Bonci
authors.affiliation: IRCCS San Camillo, Venezia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Gallimberti
mesh_terms: D000328:Adult; D003042:Cocaine / Q000008:administration & dosage / Q000652:urine; D019970:Cocaine-Related Disorders / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D066249:Craving; D003863:Depression / Q000503:physiopathology / Q000628:therapy; D018765:Dopamine Uptake Inhibitors / Q000008:administration & dosage / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010865:Pilot Projects; D017397:Prefrontal Cortex / Q000503:physiopathology; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D018765:Dopamine Uptake Inhibitors; D003042:Cocaine
keywords: Addiction; Cocaine use disorder; Craving; Optogenetics; Prefrontal cortex; Repeated transcranial magnetic stimulation