Transient alcohol craving suppression by rTMS of dorsal anterior cingulate: An fMRI and LORETA EEG study

doi:10.1016/j.neulet.2011.03.074

Neuroscience Letters

Volume 496, Issue 1, 27 May 2011, Pages 5-10

https://doi.org/10.1016/j.neulet.2011.03.074 Get rights and content

Abstract

It has recently become clear that alcohol addiction might be related to a brain dysfunction, in which a genetic background and environmental factors shape brain mechanisms involved with alcohol consumption. Craving, a major component determining relapses in alcohol abuse has been linked to abnormal activity in the orbitofrontal cortex, dorsal anterior cingulated cortex (dACC) and amygdala. We report the results of a patient who underwent rTMS targeting the dACC using a double cone coil in an attempt to suppress very severe intractable alcohol craving. Functional imaging studies consisting of fMRI and resting state EEG were performed before rTMS, after successful rTMS and after unsuccessful rTMS with relapse. Craving was associated with EEG beta activity and connectivity between the dACC and PCC in the patient in comparison to a healthy population, which disappeared after successful rTMS. Cue induced worsening of craving pre-rTMS activated the ACC-vmPFC and PCC on fMRI, as well as the nucleus accumbens area, and lateral frontoparietal areas. The nucleus accumbens, ACC-vmPFC and PCC activation disappeared on fMRI following successful rTMS. Relapse was associated with recurrence of ACC and PCC EEG activity, but in gamma band, in comparison to a healthy population. On fMRI nucleus accumbens, ACC and PCC activation returned to the initial activation pattern. A pathophysiological approach is described to suppress alcohol craving temporarily by rTMS directed at the anterior cingulate. Linking functional imaging changes to craving intensity suggests this approach warrants further exploration.

Highlights

► ACC and PCC are phase synchronized on EEG during alcohol craving. ► Alcohol craving is characterized by increased activity in the ACC and PCC on EEG. ► Cue induced worsening of craving pre-rTMS activated the ACC-VMPFC on fMRI. ► Hyperactivity in the ACC craving associated with craving disappeared after rTMS. ► Relapse was associated with recurrence of ACC and PCC activity.

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^☆: Disclaimer: The authors have no financial interest in any of the methods or treatments described in this manuscript.

View full text

Transient alcohol craving suppression by rTMS of dorsal anterior cingulate: An fMRI and LORETA EEG study☆

Abstract

Highlights

Prog. Brain Res.

Drug Alcohol Depend.

Psychiatry Res.

Neuroimage

Biol. Psychiatry

Trends Cogn. Sci.

Addict. Behav.

Repeated high-frequency transcranial magnetic stimulation over the dorsolateral prefrontal cortex reduces cigarette craving and consumption

Addiction

Using state-dependency of transcranial magnetic stimulation (TMS) to investigate letter selectivity in the left posterior parietal cortex: a comparison of TMS-priming and TMS-adaptation paradigms

Eur. J. Neurosci.

rTMS of the left dorsolateral prefrontal cortex modulates dopamine release in the ipsilateral anterior cingulate cortex and orbitofrontal cortex

PLoS ONE