Intermittent Theta Burst Stimulation of the Prefrontal Cortex in Cocaine Use Disorder: A Pilot Study

Transcranial Magnetic Stimulation (TMS) is earning a role in the therapeutic arsenal of
cocaine use disorder (CUD). A widespread and still growing number of studies have
reported beneficial use of repeated TMS (rTMS) in reduction of craving, intake and
cue-induced craving in cocaine addicts. In spite of these encouraging findings, many
issues are still unresolved such as brain area to be stimulated, laterality of the effects,
coil geometry and stimulation protocols/parameters. Intermittent theta burst stimulation
(iTBS) is a more tolerable protocol administered at lower intensities and shorter intervals
than conventional rTMS protocols. Yet, its effects on cocaine craving and length of
abstinence in comparison with standard high frequency (10–15 Hz) protocols have never
been evaluated so far. In the present paper, we describe the effect of the bilateral iTBS
of the prefrontal cortex (PFC) in a population (n = 25) of treatment-seeking cocaine
addicts, in an outpatient setting, and compare them with 15 Hz stimulation of the
same brain area (n = 22). The results indicate that iTBS produces effects on cocaine
consumption and cocaine craving virtually superimposable to the 15 Hz rTMS group.
Both treatments had low numbers of dropouts and similar side-effects, safety and
tolerability profiles. While larger studies are warranted to confirm these observations,
iTBS appears to be a valid approach to be considered in treatment-seeking cocaine
addicts, especially in light of its brief duration (3 min) vs. 15 Hz stimulation (15 min). The
use of iTBS would allow increasing the number of patients treated per day with current
rTMS devices, thus reducing patient discomfort and hopefully reducing drop-out rates
without compromising clinical effectiveness.