Table 2:
Studies about rTMS of the DLPFC for addictive disorders.
| Studies | n | Participants | Design | Number of sessions | Stimulation site | Frequency (Hz) | Percentage MT (%) | Total pulses per session | Effects | Side effects | Location |
|---|---|---|---|---|---|---|---|---|---|---|---|
| DLPFC as the stimulation site | |||||||||||
| Eichhammer et al. (2003) | 14 | Nicotine dependent; motivated to quit smoking | Randomized, double-blind, sham-controlled, crossover study | 4 (2 Ac; 2 S) | Left DLPFC | 20 | 90 | 1000 | Significant reduction in smoking in the rTMS group. No effect on craving | Mild headaches | 5 cm |
| Amiaz et al. (2009) | 48 | Nicotine dependent; >20 cigarettes/day; motivated to quit smoking | Randomized, double-blind, sham-controlled study (active vs. sham rTMS/smoking-related vs. neutral) 10 daily sessions followed by a 4-week maintenance phase | 10 daily sessions | Left DLPFC | 10 | 100 | 1000 | Significant reduction in cue-induced craving, cigarette smoking and dependence when participants received exposure to smoking cues followed by rTMS | NS | 5 cm |
| Mishra et al. (2015) | 20 | Alcohol-dependent | Randomized, double-blind study | 10 daily sessions | Left and right DLPFC | 10 | 110 | 1000 | Significant reduction in craving after the last rTMS session in both group | Nightmare and middle insomnia after the eighth session of one patient | NS |
| Del Felice et al. (2016) | 17 | Alcohol dependence | Randomized, sham-controlled study | 2 (1 Ac and 1S) | Left DLPFC | 10 | 100 | 1000 | Significant improving inhibitory control task and selective attention and reduce depressive symptoms but not reduction in craving and alcohol intake | NS | 10–20 EEG system |
| Camprodon et al. (2007) | 6 | Cocaine dependence | Randomized, cross-over study | 2 (left or right side) | Left and right DLPFC | 10 | 90 | 2000 | Right but not left rTMS reduced craving | None | NS |
| Terraneo et al. (2016) | 32 | Cocaine dependence | Randomized, open-label study | 2 (left or control) | Left DLPFC | 15 | 100 | 2400 | Reduction in craving by active rTMS | Mild scalp discomfort | MRI |
| Sanna et al. (2019) | 25/22 | Cocaine use disorder | NS | 2 (2 Ac) | Bilateral PFC | iTBS/15 | 80/100 | 2400 and 600 | Reduction in craving and the intake of cocaine in both groups | Mild scalp discomfort | NS |
| Steele et al. (2019) | 19 | Cocaine use disorder | Open-label | 1 (1 Ac) | Left DLPFC | iTBS | 100 | 600 | Reduction both the amount and frequency of cocaine use | Occasional headaches | 10–20 EEG system |
| Li et al. (2013) | 10 | Not-treatment seeking, methamphetamine users | Randomized, single-blind, sham-controlled, crossover study | 2 (1 Ac and 1S) | Left DLPFC | 1 | NS | 900 | Increase in craving by active rTMS | Mild scalp discomfort | 6 cm |
| Su et al. (2017) | 30 | Methamphetamine dependence | Randomized, double-blind, sham-controlled study | 2 (1 Ac and 1S) | Left DLPFC | 10 | 80 | 1200 | No negative effects on cognitive function; reduction in craving for methamphetamine | Mild scalp discomfort | 5 cm |
| Liu et al. (2017) | 50 | Methamphetamine dependence | Randomized, single-blind, sham-controlled study | 5 (4 Ac and 1S) | Left and right DLPFC, P3 | 1 and 10 | 80 | 600 and 2000 | Reduction in cue-induced craving by active rTMS | None | NS |
| Liang et al. (2018) | 48 | Methamphetamine dependence | Randomized, double-blind, sham-controlled study | 2 (1 Ac and 1S) | Left DLPFC | 10 | 80 | 2000 | Reduction in cue-induced craving by active rTMS | Mild scalp discomfort | NS |
| Lin et al. (2019) | 105 | Methamphetamine dependence | Randomized, double-blind, sham-controlled study | 3 (1 Ac, 1S and 1 C) | Left DLPFC | 10 | 100 | 2000 | Improved sleep quality, alleviated depression and anxiety state by active rTMS | Mild dizziness or scalp pain | 10–20 EEG system |
| Liu et al. (2019) | 90 | Methamphetamine dependence | Randomized, single-blind study | 2 (1 Ac; 1 C) | Left DLPFC | 10 | 100 | 2000 | Reduction in cue-induced craving by active rTMS | NS | 5 cm |
| Yuan et al. (2020) | 73 | Methamphetamine dependence | Randomized, single-blind study | 2 (1 Ac; 1S) | Left DLPFC | 1 | 100 | 600 | Reduction in cue-induced craving and improvement of impulse inhibition by active rTMS | NS | 5 cm |
| Liu et al. (2020b) | 188 | Methamphetamine dependence | Randomized, single-blind study | 3 (1 Ac; 1S; 1 C) | Left DLPFC | 1 and 10 | 100 | 600 and 2000 | Reduction in cue-induced craving by active rTMS | NS | 10–20 EEG system |
| Shen et al. (2016) | 20 | Heroin dependence | Randomized, crossover, sham-controlled study | 2 (1 Ac; 1S) | Left DLPFC | 10 | 100 | 2000 | Reduction in cue-induced craving by active rTMS | None | 10–20 EEG system |
| Liu et al. (2020a) | 118 | Heroin dependence | Randomized, single-blind study | 3 (1 Ac; 1S; 1 C) | Left DLPFC | 1 and 10 | 100 | 600 and 2000 | Reduction in cue-induced craving by active rTMS | Mild dizziness, headache, neck pain, insomnia, etc. | 10–20 EEG system |
| Other stimulation sites | |||||||||||
| Ross et al. (2011) | 15 | Smokers: > 20 cigarettes per day | Randomized, cross-over open-label study. At the beginning of each session, participants smoked a cigarette. 1 h later, they underwent rTMS concurrently during exposure to neutral/smoking cues/smoking a cigarette | 3 (1 Hz SFG; 10 Hz SFG; 1 Hz motor cortex) | SFG or motor cortex (side not specified) | 1 and 10 | 90 | Greater number of pulses for the 10 Hz condition | Combination of smoking cues exposure and 10 HZ SFG rTMS increased craving | NS | 10–20 EEG system |
Ac = active; S = sham; C = control; MT = motor threshold; NS = not specified; SFG = superior frontal gyrus.