| Popis: |
Background: There is no approved neurobiological treatment for cocaine-use disorder (CocUD). Previous preliminary clinical work suggests some benefit from repetitive transcranial magnetic stimulation (rTMS) of left dorsolateral prefrontal cortex (l-DLPFC), but all published studies to date have been limited by small sample sizes and short follow-up times. Methods: This is a retrospective observational study of 284 outpatients cohort meeting DSM-5 criteria for CocUD. At treatment entry, most were using cocaine every day or several times per week. All patients underwent three months of rTMS and were followed for up to 2 years, 8 months. Self-report, reports by family or significant others, and regular urine screens were used to assess drug use. Outcome: Median time to the first lapse (resumption of cocaine use) since the last rTMS session was 91 days. For most patients, TMS was re-administered weekly, then monthly, throughout follow-up. The decrease in frequency of rTMS sessions was not accompanied by an increase in lapses to cocaine use. Mean frequency of cocaine use was less than 1·0 day/month (median 0), while serious rTMS-related adverse events were infrequent, consistent with published reports from smaller studies. Interpretation: This is the first follow-up study to show that rTMS treatment is accompanied by long-lasting reductions in cocaine use in a large cohort. Funding. Novella Fronda Foundation, Human Science and Brain Research, Padua, Italy. Declaration of Interest: The authors have no conflicts of interest to disclose. Ethical Approval: The study protocol was approved by the Local Ethics Committee of University of Padua (Protocol 2551, number code: A0A52E7461375325ABBC1C2D9C54F844). |
