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外2017 (IF 3.222)高频rTMS刺激左DLPFC治疗冰毒成瘾Min Zhao CCY-I
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Contents lists available at ScienceDirect Drug and Alcohol Dependence journal homepage: www.elsevier.com/locate/drugalcdep Full length article High frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex for methamphetamine use disorders: A randomised clinical trial Hang Sua, Na Zhonga, Hong Gana, Jijun Wanga, Hui Hana, Tianzhen Chena, Xiaotong Lia, Xiaolu Ruana, Youwei Zhua, Haifeng Jianga, Min Zhaoa,b,c, a Collaborative Innovation Center for Brain Science, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China b Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China c Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China A R T I C L E I N F O Keywords: Methamphetamine Craving Repetitive transcranial magnetic stimulation Dorsolateral prefrontal cortex Cognitive function A B S T R A C T Background: Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation and modulation electrophysiological technique, it can change cortical excitability of target brain region, modulate neuron plasticity and brain connections. Previous researches indicated that rTMS could reduce cue-induced craving in drug addiction. Objective: In this study, we employed real and sham rTMS of the left dorsolateral prefrontal cortex (DLPFC) to test whether it could reduce cue-induced craving for methamphetamine (MA) and influence cognitive function in a randomised clinical trial. Methods: Thirty MA-addicted patients were randomized to receive 5 sessions of 8 min sham or 10 Hz rTMS to the left DLPFC. Subjects rated their craving at baseline, after exposed to MA-associated cues and after rTMS sessions. Results: Real rTMS over the left DLPFC reduced craving significantly after 5 sessions of rTMS as compared to sham stimulation. Furthermore, real rTMS improved verbal learning and memory and social cognition in MA- addicted patients. Conclusions: The present study suggests that 10 Hz rTMS of the left DLPFC may reduce craving and have no negative effects on cognitive function in MA-addicted patients, supporting the safety of rTMS in treating MA addiction. 1. Introduction Methamphetamine (MA) abuse causes huge public health conse- quences all over the world (Crime, 2015). It is estimated that there are 3 millions drug users in China and 57.1% of the drug users are amphetamine-type stimulants (ATS) users by the end of 2015 (Committee, 2015). There is no effective medical treatment for ATS addiction until now. Therefore, finding new treatment approaches for MA users is an urgent matter. Craving reflects an expectation to get drugs and terminate with- drawal symptoms or unpleasant feelings immediately. Both aversive internal and external stimuli can induce craving even after periods of sustained abstinence. Craving has been hypothesized to play an important role in sustained drug use and relapse (Hartz et al., 2001). In a series of prospective studies, it was found to be highly predictive of drug addiction, such as nicotine, heroin and methamphetamine (Bedi et al., 2011; de Jong et al., 2006; Hartz et al., 2001). Furthermore, it has been used primarily as a surrogate outcome measure, with craving reduction interpreted as treatment success. MA craving is mediated largely through a network of interconnected structures, including the ventral tegmental area (VTA), nucleus accumbens (NAc), amygdala, striatum, and prefrontal cortex (PFC) (Degoulet et al., 2013; Li et al., 2015; Morales et al., 2015). The PFC mainly involved in a variety of cognitive process, including inhibitory control, executive function and craving (Koob and Volkow, 2010). PFC dysfunction will lead to impulse, obsessive-compulsive symptom and attention deficit (Arnsten et al., 2012). Previous studies found that lesions of the frontal cortex and its functionally distinct and interacting sub-regions showed selective deficits in inhibitory control (Solbakk and Lovstad, 2014). Prefrontal dysfunction is also an im- http://dx.doi.org/10.1016/j.drugalcdep.2017.01.037 Received 31 October 2016; Received in revised form 14 December 2016; Accepted 26 January 2017 Corresponding author at: Min Zhao, MD. and Ph.D Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, China. E-mail addresses: drminzhao@smhc.org.cn, drzhaomin@sh163.net (M. Zhao). Drug and Alcohol Dependence 175 (2017) 84–91 Available online 29 March 2017 0376-8716/ 2017 Elsevier B.V. All rights reserved. MARK

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