Repetitive Transcranial Magnetic Stimulation for Alcohol Use Disorder

Overview

This study looked at whether repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation treatment, could help adults with alcohol use disorder when added to their usual treatment. Nine adults receiving abstinence-oriented care received 10 sessions of stimulation over the right front part of the brain. Drinking severity, mood, craving and quality of life were assessed before treatment, immediately after the 10 sessions, and again at one and three months. Brain scans were also obtained at these visits to examine whether stimulation was associated with changes in brain connections. The study had no comparison group, so the results cannot show whether any change was caused by the stimulation.

This was a single-arm, open-label pilot study conducted at a single medical centre in Taiwan. Adults aged 20 to 65 years with DSM-5 alcohol use disorder were enrolled during inpatient or outpatient abstinence-oriented care, after the treating physician confirmed that acute withdrawal had stabilized. Stimulation was delivered over the right dorsolateral prefrontal cortex at the F4 position using a Magstim Rapid2 system with a figure-of-eight D70 mm air film coil: 10 sessions at 10 Hz and 110% of the visually determined resting motor threshold, 60 trains of five seconds each, 3,000 pulses per session over approximately 30 minutes, delivered on consecutive weekdays. Concomitant pharmacological and psychosocial treatment continued as usual care and was not protocolized. Assessments were conducted at baseline, after the tenth session, and at one and three months, and comprised clinical measures (Alcohol Use Disorders Identification Test, Patient Health Questionnaire-9, craving visual analogue scales, WHOQOL-BREF) and multimodal magnetic resonance imaging (resting-state functional MRI, diffusion tensor imaging and magnetic resonance spectroscopy). The study was originally approved as a one-year, randomized, double-blind, sham-controlled trial with a larger planned sample. Funding constraints and difficulty recruiting this population prevented completion of that design, and the study was conducted as a single-arm, open-label pilot with follow-up to three months. The trial was registered retrospectively.