Opinion

Rehabilitating the addicted brain with transcranial magnetic stimulation

Abstract

Substance use disorders (SUDs) are one of the leading causes of morbidity and mortality worldwide. In spite of considerable advances in understanding the neural underpinnings of SUDs, therapeutic options remain limited. Recent studies have highlighted the potential of transcranial magnetic stimulation (TMS) as an innovative, safe and cost-effective treatment for some SUDs. Repetitive TMS (rTMS) influences neural activity in the short and long term by mechanisms involving neuroplasticity both locally, under the stimulating coil, and at the network level, throughout the brain. The long-term neurophysiological changes induced by rTMS have the potential to affect behaviours relating to drug craving, intake and relapse. Here, we review TMS mechanisms and evidence that rTMS is opening new avenues in addiction treatments.

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Acknowledgements

Supported by the US National Institute on Drug Abuse Intramural Research Program (A.B., L.L.), the Division of Intramural Clinical and Biological Research of the National Institute on Alcohol Abuse and Alcoholism (L.L.), the University of Sassari Department of Antidrug Policies and the Ministero dell'Istruzione dell'Università e della Ricerca (MIUR) (M.D.), the Dr Ralph and Marian Falk Medical Research Trust and NIH grants R01MH106512 and S10OD020080 (T.R.) and NIH grants R00EB015445 and R01MH111829 (A.N.). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or other funding organizations.

Author information

Affiliations

  1. 'G. Minardi' Laboratory for Cognitive Neuroscience, Department of Chemistry and Pharmacy, University of Sassari, 07100 Sassari, Italy.

    • Marco Diana
  2. Shirley Ryan AbilityLab, Center for Brain Stimulation, the Department of Physical Medicine and Rehabilitation and the Department of Neurobiology, Northwestern University, Chicago, Illinois 60611, USA.

    • Tommi Raij
  3. Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy.

    • Miriam Melis
  4. Massachusetts General Hospital (MGH)/Massachusetts Institute of Technology (MIT)/Harvard Medical School (HMS) Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, Massachusetts 02129, USA.

    • Aapo Nummenmaa
  5. Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, US National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research (NIAAA DICBR) and US National Institute on Drug Abuse Intramural Research Program (NIDA IRP), NIH (National Institutes of Health), Bethesda, Maryland 20892, USA; and at the Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island 02912, USA.

    • Lorenzo Leggio
  6. US National Institute on Drug Abuse Intramural Research Program (NIDA IRP); and at the Departments of Neuroscience and Psychiatry, Johns Hopkins University, Baltimore, Maryland 21224, USA.

    • Antonello Bonci

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Contributions

A.B. made substantial contribution to discussion of content and reviewed or edited the manuscript before submission.

M D., T.R., M.M. A.N. and L.L. contributed to the writing of the manuscript.

Competing interests

The authors declare no competing financial interests.

Corresponding author

Correspondence to Antonello Bonci.

Glossary

Conventional rTMS

A form of TMS sequences where the pulses are given at regular intervals (for example, 1 Hz or 20 Hz).

Direct mechanism

(D-mechanism). A mechanism in TMS in which the pyramidal neurons are directly activated by the TMS-induced E-fields.

Electric field

(E-field). The field induced by the TMS coil. When the E-field interacts with a conducting medium, this drives electric currents.

Indirect mechanism

(I-mechanism). A mechanism in TMS in which the pyramidal neurons are activated trans-synaptically, that is, indirectly.

Motor threshold

(MT). The minimum TMS intensity that must be applied to the motor cortex to induce a peripheral muscle contraction.

Quadripulse stimulation

(QPS). A form of patterned TMS where the TMS pulses are arranged in more complex patterns than in conventional rTMS.

Repetitive paired-pulse TMS

(rppTMS). A form of patterned TMS where the TMS pulses are arranged in more complex patterns than in conventional rTMS.

Repetitive TMS

(rTMS). A form of TMS in which individual TMS pulses are presented at regular time intervals (for example, 1 Hz, 20 Hz). Also known as 'conventional rTMS'.

Theta burst stimulation

(TBS). A form of patterned TMS where the TMS pulses are arranged in more complex patterns than in conventional rTMS.

TMS navigator

A device that enables accurate tracking of the TMS coil position relative to the subject's head. Often integrated with MRI of the subject's head.