Sarah Herremans Addiction Therapy-2014 Chicago, USA August 4 - 6, 2014.

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Presentation transcript:

Sarah Herremans Addiction Therapy-2014 Chicago, USA August 4 - 6, 2014

Sarah Herremans, MD 2 The effect of HF-rTMS in alcohol-dependent patients: Results from an fMRI study

Introduction Study design & results Conclusions 3

Key structures in addiction 4 Koob & Volkow, 2010 DLPFC

rTMS & alcohol craving in detoxified alcoholic patients Mishra et al., 2010: -> 10 daily sessions, HF-rTMS (10 Hz) right DLPFC, 1000 pulses per day, SHAM-controlled =>  subjective craving,  relapse rate Herremans et al., 2012: -> 1 session, HF-rTMS (20 Hz) right DLPFC, 1560 pulses, sham (=PLACEBO)-controlled  No effect on subjective craving  Increase of attentional control during Go-NoGo task 5

Repetitive transcranial magnetic stimulation (rTMS) 6

transcranial magnetic stimulations (rTMS) 7

Can one and fifteen HF-rTMS sessions influence the craving neurocircuitry in detoxified alcohol dependent patients during a cue-exposure? 8

Introduction Study design & results Conclusions 9

Demographic data 20 alcohol-dependent patients Detoxified < CIWA-AR 11 males / 9 females Age: 46,5 y (SD: 10,0) Duration alcohol problem: 13.0 y (SD:9.9) 10

Study design – evaluation of 1 HF-rTMS session 11 fMRI Event Related design XX one sham – controlled HF-rTMS session 12 pts -> real stimulation 8 pts -> sham stimulation XX … … HF-rTMS: 20Hz 1560 p/session 110% MT Right DLPFC VAS “How much do you crave for an alcoholic beverage right now on a scale from 0 to 10?”

Study design – ACCELERATED evaluation of 15 HF-rTMS sessions 12 fMRI Event Related design XX 15 active HF-rTMS sessions 20 patients -> 2 drop-outs XX … … HF-rTMS: 20Hz 1560 p/session 110% MT Right DLPFC

Results: Baseline 13

Baseline Alcohol cue > Neutral cue 14 P<0.001; AlphaSim corrected voxel: 176 Inferior frontal gyrus (BA47) left Inferior temporal gyrus (BA37) right Medial Frontal gyrus (BA6) left Superior parietal lobule (BA7) left/right No increase in craving

Results: one sham-controlled HF-rTMS session 15

Demographic data Real stimulation (12)Sham stimulation (8) AgeM=48.0 SD=9.9 M=44.4 SD=8.7 Gender (M/F)8/44/4 Benzodiazepine free days before stimulation M=15.1 SD=5.2 M=12.5 SD=2.7 % MTM=57.6 SD=10.6 M=64.1 SD=6.4 VAS before cue-exposure (0=>10) M=2.3 SD=2.7 M=2.6 SD=3.4 VAS after cue-exposure (0=>10) M=2.5 SD=3.0 M=2.8 SD=3.5 16

Results: 1 sham controlled session 17 INTERACTION: Pre_Post x Sham_Real F=7.4; p<0.01; AlphaSim corrected voxel: 71 Nucleus Accumbens Insula BA6

Results: 1 REAL stimulation 18 Nucleus Accumbens Insula Precentral gyrus (BA 6) No effect on VAS-craving (deltaVAS) T=2.4;p<0.01 No effect of sham stimulation

Key structures in addiction 19 Koob & Volkow, 2010 DLPFC

Results: 15 active HF-rTMS sessions in an accelerated paradigm 20

Treatment effect of 15 active rTMS sessions 21 2 drop-outs T=2.6; p<0.01 alphaSim voxel corrected: 482  craving (AUQ,OCDS): p<0.05 Superior Parietal lobule (BA7) deltaVAS during fMRI

Key structures in addiction 22 Koob & Volkow, 2010 DLPFC

Introduction Study design & results Conclusions 23

1 active HF-rTMS session Placebo - controlled design No effect on cue-induced craving  Nucleus Accumbens  Insula  BA 6 No effect of sham stimulation 24

15 active HF-rTMS sessions Accelerated HF-rTMS protocol Open study:  craving outside fMRI No effect on cue-induced craving  superior parietal lobule 25

General conclusions HF-rTMS => cue-induced craving HF-rTMS => craving neurocircuit (Koob & Volkow,2010) But: HF-rTMS => salience and attention network HF-rTMS => subjective craving 26 salience attribution to & attention at alcoholic stimuli

Limitations Relatively small sample No control group for the treatment part Hospitalized patients seldom report craving when confronted with alcoholic stimuli (Wilson et al., 2004) 27

Thank you for your attention! QUESTIONS? Collaborators: Chris Baeken, MD, PhD Peter Van Schuerbeek, Msc Marie-Anne Vanderhasselt, PhD Frieda Matthys, MD Rudi De Raedt, PhD 28

Addiction Therapy – 2015 Website: addictiontherapy.conferenceseries.com Meet the eminent gathering once again at Addiction Therapy-2015 Florida, USA August 3 - 5, 2015