Journal: Brain Stimulation (2018)
Authors: Muir O, Jacowitz A, MacMillan C, Tendler A
Background:
rTMS can decrease cravings for drugs in a cue dependent fashion. dTMS is efficacious in smoking cessation with sustained quitting when combined with exposure therapy. However, no studies have utilized real world exposure to increase cravings prior to treatment with cocaine use disorder (CUD) patients
Objective:
To describe the treatment of a CUD patient with dTMS using the H1 coil combined with exposure therapy.
Methods:
A 45 year–old male with CUD, twice weekly cocaine binges for 16 months, was escorted to individualized drug triggering situations prior to dTMS treatments. Craving data were collected prior to exposure, after exposure and after treatment. Self–report measures were used to collect data on the patient’s overall mood and quality of life. Urine toxicology was collected regularly to track use. The patient received thirteen total treatments of dTMS 5 days a week for 3 weeks. Stimulation with H1 coil was administered to the left prefrontal cortex (LPFC) at 80% MT intermittent theta burst (iTBS) 600 pulses followed by medial prefrontal cortex (MPFC) stimulation at 100% MT 10hz 5 sec train with 15 sec intertrain interval, 1000 pulses. During treatment, the patient read a motivational script for cocaine cessation.
Results:
The patient reported a 50% reduction in cravings over time, an 18% decrease in related health concerns and a 100% decrease in depression symptomatology. Urine toxicology demonstrated 82 days sobriety.
Conclusions:
dTMS treatment of LPFC and MPFC after exposure to patient specific triggers is a promising intervention for CUD. Further controlled studies are warranted.
Full Publication: Treatment of cocaine use disorder with dTMS and in-vivo exposure: Case report – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation
