title: Bilateral Transcranial Magnetic Stimulation of the Prefrontal Cortex Reduces Cocaine Intake: A Pilot Study.
abstract: BACKGROUND
  Chronic cocaine consumption is associated with a decrease in mesolimbic dopamine transmission that maintains drug intake. transcranial magnetic stimulation (TMS) is gaining reliability, a useful therapeutic tool in drug addiction, since it can modulate cortico-limbic activity resulting in reduction of drug craving.
  
  
  OBJECTIVE
  In the present study, we investigated the therapeutic effect of bilateral TMS of prefrontal cortex (PFC) in reducing cocaine intake, in a sample of treatment-seeking patients with current cocaine use disorder (DSM-V).
  
  
  METHODS
  Ten cocaine addicts (DSM-V) were randomly assigned to the active or sham stimulation protocol in a double-blind experimental design. Twelve repetitive TMS (rTMS) sessions were administered three times a week for 4 weeks at 100% of motor threshold, over bilateral PFC. Cocaine intake (ng/mg) was assessed by hair analysis at baseline (before treatment, T0), after 1 month (end of treatment, T1), 3 (T2), and 6 (T3) months later. All subjects received psychological support weekly.
  
  
  RESULTS
  The two-way ANOVA for repeated measures did not show a significant effect of the interaction between time and treatment (F 4,32 = 0.35; p = 0.87). Despite that result indicated no difference in the effect of the two conditions (active vs. sham) along time, a decreasing trend in cocaine consumption in active TMS group (F 3,23 = 3.42; p = 0.04) vs. sham (F 3,15 = 1.88; p = 0.20) was observed when we performed exploratory analysis with time as factor. Indeed, Post hoc comparisons showed a significant reduction in the amount of cocaine detected from the onset to 3 months later (T0-T2; p = 0.02) and to the end of treatment (T0-T3; p = 0.01) in addicts from the active group.
  
  
  CONCLUSIONS
  Bilateral rTMS of PFC at 10 Hz did not show a significant effect on cocaine intake compared to sham. However, a long-term reduction on cocaine intake in active TMS-treated patients was observed when we considered the time as factor. Further studies are required to confirm these encouraging but preliminary findings, in order to consolidate rTMS as a valid tool to treat cocaine addiction.
authors.affiliation: Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo , Palermo , Italy.
authors.forename: Corinna
authors.initials: C
authors.lastname: Bolloni
authors.affiliation: Laboratory of Cognitive Neuroscience 'G. Minardi', University of Sassari , Sassari , Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Panella
authors.affiliation: Ser.T, 'Health's House n.1', A.S.L. No. 1 Umbria , Perugia , Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Pedetti
authors.affiliation: Ser.T, 'Health's House n.1', A.S.L. No. 1 Umbria , Perugia , Italy.
authors.forename: Anna Grazia
authors.initials: AG
authors.lastname: Frascella
authors.affiliation: Legal Medicine, Forensic Science and Sports Medicine Section, Department of Surgical and Biomedical Science, University of Perugia , Perugia , Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Gambelunghe
authors.affiliation: Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo , Palermo , Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Piccoli
authors.affiliation: Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo , Palermo , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maniaci
authors.affiliation: Department of Health Promotion and Maternal Care 'G. D'Alessandro' University of Palermo , Palermo , Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Brancato
authors.affiliation: Department of Health Promotion and Maternal Care 'G. D'Alessandro' University of Palermo , Palermo , Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Cannizzaro
authors.affiliation: Laboratory of Cognitive Neuroscience 'G. Minardi', Department of Chemistry and Pharmacy, University of Sassari , Sassari , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Diana
keywords: PFC; cocaine use disorder; dopamine; rTMS