Journal: Biological Psychiatry (2022)
Authors: M Harel, I Perini, R Kämpe, U Alyagon, H Shalev, I Besser, R Kampe, WH Sommer, M Heilig, A Zangen
Alcohol addiction is associated with a high disease burden, and treatment options are limited.
In a proof-of-concept study, the authors used Deep TMS to target circuitry associated with the pathophysiology of alcohol addiction and evaluated clinical outcomes and associated neural signatures using fMRI.
In this double-blind, sham-controlled, randomized clinical trial the authors evaluate clinical and neurobiological effects induced by high-frequency (10Hz) Deep TMS over 3 weeks of treatment and 12 weeks of follow-up. Clinical response is determined using self-report levels of craving and alcohol consumption validated by urine measures, while fMRI is employed to identify alterations in brain connectivity.
Both craving following treatment and pHDD during follow-up were significantly lower in the Active vs. Sham control group (pHDD=2.9±0.8% vs 10.6±1.9%, p=0.037). Active Deep TMS was associated with decreased resting state functional connectivity of the dorsal ACC with the caudate nucleus, and decreased connectivity of the mPFC to subgenual ACC.
This study provides initial proof-of-concept for Deep TMS targeting midline frontocortical structures as a treatment for alcohol addiction. The data strongly supports a rationale for a full-scale confirmatory multicenter trial. Therapeutic benefits of Deep TMS appear to be associated with persistent changes in brain network activity.