title: Add-on high frequency deep transcranial magnetic stimulation (dTMS) to bilateral prefrontal cortex reduces cocaine craving in patients with cocaine use disorder.
abstract: Cocaine dependence is a substantial public health problem. The aim of this study is to evaluate the effect of high frequency deep transcranial magnetic stimulation (dTMS) on craving in patients with cocaine use disorder (CUD).
  
  
  
  Seven men (mean age, 48.71 years; standard deviation [SD], 9.45; range 32-60 years) with CUD and no concurrent axis 1 or 2 disorder save nicotine abuse, underwent three sessions of alternate day 20Hz dTMS in 20 trains delivered to the dorsolateral prefrontal cortex (DLPFC) preferentially to the left hemisphere, for 12 sessions spread over one month, added to unchanged prior drug treatment. We used a visual analogue scale (VAS) to measure cocaine craving the week before, each week during, and one month after dTMS treatment.
  
  
  
  DLPFC stimulation significantly reduced craving over time: within-subjects main effect of time of treatment (ANOVA, F[3,18]=46.154; p<0.001; η(2)=0.88). The reduction of craving from baseline was significant at two weeks (p<0.001), and four weeks (p<0.001) of treatment, and at the week eight, four weeks after treatment interruption (p=0.003), although the increase of craving was significant from week four and eight (p=0.014).
  
  
  
  dTMS over left DLPFC reduced craving in CUD patients in a small sample that is to be considered preliminary. However, maintenance sessions would be needed to maintain the achieved results. Our findings highlight the potential of noninvasive neuromodulation as a therapeutic tool for cocaine addiction.
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Rapinesi
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy; Department of Psychiatric Rehabilitation, P. Alberto Mileno Onlus Foundation, Vasto, Italy. Electronic address: antonio.delcasale@uniroma1.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Del Casale
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Di Pietro
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Vittoria Rachele
authors.initials: VR
authors.lastname: Ferri
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Daria
authors.initials: D
authors.lastname: Piacentino
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Sani
authors.affiliation: ATID Ltd Advanced Technology Innovation Distribution, Rome, Italy.
authors.forename: Ruggero Nessim
authors.initials: RN
authors.lastname: Raccah
authors.affiliation: Department of Life Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Zangen
authors.affiliation: Department of Neurology and Psychiatry, Sapienza University of Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferracuti
authors.affiliation: Asl Roma 2, Osservatorio sulle Dipendenze e sui Disturbi Psichici Sotto Soglia, Rome, Italy.
authors.forename: Alessandro Emiliano
authors.initials: AE
authors.lastname: Vento
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Angeletti
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Brugnoli
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Kotzalidis
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000503:physiopathology* / Q000517:prevention & control; D066249:Craving / Q000502:physiology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: Cocaine use disorder; Craving; Deep Transcranial Magnetic Stimulation (dTMS); Dorsolateral Prefrontal Cortex (DLPFC)