Alcohol Use Disorder
Conditions
Keywords
mri, rtms, tms, repetitive transcranial magnetic stimulation, mexico, magnetic resonance imaging, executive function
Brief summary
Alcohol Use Disorder (AUD) is a major public health problem that affects the physical, social, family, and mental integrity of the sufferer. Behavioral self-regulation is compromised in AUD, and a benefit has been reported with the application of repetitive transcranial magnetic stimulation and emotional self-regulation. The aim of this study is to investigate the efficacy of high-frequency rTMS to improve executive functions in patients in abstinence from AUD.
Detailed description
It is proposed that individuals predisposed to developing alcohol use disorder (AUD) exhibit alterations in executive functions, resulting from maladaptive cellular homeostatic processes and neuronal circuits activated by substance use. These alterations persist even after substance withdrawal (Nestler & Aghajanian, 1997). As a multifactorial disorder, AUD has been linked to family history of alcohol use (Khemiri et al., 2020; Peterson et al., 1990; Tarter et al., 1989) and individual traits such as poor cognitive test performance relative to controls (Shnitko et al., 2018; Goudriaan et al., 2011), which may predict heavy alcohol consumption or AUD development. These executive dysfunctions manifest as persistent negative behaviors that impede adaptive learning and reduced activation of the executive control network, both of which correlate with AUD severity (Mayhugh et al., 2014). Cognitive flexibility, a key executive function, enables adaptive adjustment of thoughts and behaviors in response to environmental demands (Uddin, 2021). Impaired cognitive flexibility is associated with AUD persistence and severity (Stalnaker et al., 2008), though recovery is observed after prolonged abstinence (Rourke & Grant, 1999). Thus, cognitive flexibility may serve as a promising treatment biomarker. McLellan et al. (2000) report that 40-60% of AUD patients relapse within the first year post-treatment, while at least 60% relapse within six months (Durazzo & Meyerhoff, 2017; Kirshenbaum et al., 2009; Maisto et al., 2006a; Meyerhoff & Durazzo, 2010). Given these challenges, non-invasive neuromodulation techniques like repetitive transcranial magnetic stimulation (rTMS) have emerged as adjunct therapies to standard treatments (Diana et al., 2017). For example, Addolorato et al. (2017) applied high-frequency (10 Hz) rTMS to the dorsolateral prefrontal cortex (DLPFC) in AUD patients and observed reduced alcohol consumption and increased abstinent days. Similarly, Del Felice et al. (2016) found that left DLPFC stimulation enhanced inhibitory control, selective attention, and mood in active alcohol users. Stimulating the DLPFC, a hub of the executive control network, may enhance its functional connectivity and improve cognitive flexibility in AUD patients. These effects align with findings that rTMS bolsters inhibitory control and attention (Del Felice et al., 2016; Diana et al., 2017). To explore this further, we propose a longitudinal study assessing cognitive/behavioral traits in AUD patients that may contribute to disorder development. We will also evaluate rTMS effects using neuropsychological tools and MRI to measure structural/functional brain changes. This study aims to investigate the short- and long-term clinical and cognitive effects of 10 Hz rTMS applied to the left DLPFC in abstinent AUD patients, alongside associated neurostructural and functional connectivity changes. Abstinent AUD patients will receive daily rTMS for four weeks. Clinical outcomes will be tracked for six months, with cognitive, structural, and functional connectivity measurements taken at baseline, post-intervention (4 weeks), and follow-up (6 months).
Interventions
DEVICERepetitive Transcranial Magnetic Stimulation
The investigators will use a Magstim Rapid 2 stimulator, Airfilled coil (AFC), 8 shape (magnetic field of 0.8 Teslas, 3Kg, pulse 0.5 ms) Each patient will receive high frequency 10 Hz stimulation at 100% of motor threshold over the dorsolateral prefrontal cortex (DLPFC) at 1500 pulses per session with 30 trains of 5 seconds and 0.5 ms stimuli and an inter-train distance of 15 seconds. In 2 daily sessions 4 days a week for 4 weeks.
The investigators will use a Magstim Rapid 2 stimulator, Airfilled coil (AFC), 8 shape (magnetic field of 0.8 Teslas, 3Kg, pulse 0.5 ms) Each patient will receive consistent treatment in 2 sessions a day for 20 consecutive business days for 4 weeks. The coil will be placed on the vertex target location.
Sponsors
National Council of Science and Technology, Mexico
Universidad Nacional Autonoma de Mexico
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
Single blind. The participants will be the only ones blinded. For placebo or sham we are using vertex as the non-clinical target.
Intervention model description
Single-blind randomize clincial trial with parallel groups.
Eligibility
Sex/Gender
ALL
Age
25 Years to 59 Years
Healthy volunteers
No
Inclusion criteria
* Men and women of 25 to 59 years old * The reading level of at least 6th grade of primary (equivalent to fifth grade of elementary school). * Alcohol users with and AUDIT ≥ 20 puntos * Abstinence from alcohol consumption from 8 weeks to 5 years, with CIWA-Ar scale scores ≤ 9 points. * No disabling neuropsychiatric conditions (i.e. Schizophrenia) * No substance use disorders except alcohol and nicotine. * BrAC (Breath Alcohol) = 0.00 mg/dl in each of the assessments. * No traces of alcohol consumption using urine test strips. * No contraindications for TMS therapy.
Exclusion criteria
* Individuals with symptoms of severe agitation or who are unable to cooperate in the study * History of epilepsy * Sudden onset of stroke, focal neurological findings such as hemiparesis, sensory loss, visual field deficits and lack of coordination. * Seizures or gait disturbances * History of severe psychiatric disorders. * Alterations in a conventional electroencephalogram. * Pacemakers or intracranial metallic objects. Elimination criteria * At the subject's request * The presence of adverse incidents that deteriorate the subject's health and would limit continuation of rTMS treatment. * Exacerbation of cognitive or behavioral symptoms during treatment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Wisconsin Card Sorting Task | Baseline, 4 weeks | Measured by Wisconsin Card Sorting Task (WCST) to evaluate cognitive flexibility |
| Change STROOP effect | Baseline, 4 weeks | Measured by STROOP test to evaluate control inhibition |
| Change Visoespatial Memory | Baseline, 4 weeks | Measured by Visoespatial Memory test to evaluate visoespatial memory |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Alcohol Craving (VAS) | Baseline, 4 weeks, 6 months | The craving will be measured using a 100 mm visual analogue scales |
| Changes in psychopathological symptoms | Baseline, 4 weeks, 6 months | Measured by the Symptoms Questionnaire 90 (SCL-90) |
| Changes in WHODAS score | Baseline, 4 weeks, 6 months | Measured by Disability Assessment Schedule (WHODAS) |
| Change in Taskswitching Task Switch cost | Baseline, 4 weeks | Measured by Taskswitching task to evaluate cognitive flexibility |
| Changes in Depression | Baseline, 4 weeks, 6 months | Measured by Hamilton Depression Rating Scale (HDRS) |
| Changes in functional connectivity | Baseline, 4 weeks | Functional connectivity of the dorsolateral prefrontal with the anterior cingulate cortex, measured with fMRI defined by the temporal correlation in the blood-oxygen-level-dependent signals of the regions. Higher correlations indicate stronger functional connectivity. |
| Changes in Anxiety | Baseline, 4 weeks, 6 months | Measured by Hamilton Anxiety Rating Scale (HARS) |
| Change in Flanker Task Flanker Efect | Baseline, 4 weeks | Measured by Flanker task to evaluate control inhibition |
| Change in Nback Task accuracy | Baseline, 4 weeks | Measured by Nback task to evaluate working memory |
Countries
Mexico
Contacts
Primary ContactAlejandra Lopez Castro, MD, MSc
Outcome results
None listed