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TMS RESEARCH: A novel approach for treating cocaine addiction

TMS could be a useful treatment option for cocaine use disorder.

Addiction and TMS Mechanism of action

That cocaine is a highly addictive drug which can have extremely serious effects on one’s mental and physical health is a well-known fact. That there, at present, is no approved medical treatment for cocaine-use disorder (CocUD), and that behavioral interventions have proven to be of limited use is also widely documented in various trials. The question is, could non-invasive brain stimulation be a possibility? An Italian research-team, led by Professors Luigi Gallimberti and Antonelli Bonci, has for more than 5 years investigated whether TMS may serve as a useful treatment option for CocUD. The clinical results compiled from over 1,000 patients have now paved the way for a randomized, double-blinded sham-controlled study. 

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Graziella Madeo is a neuroscientist currently working as the Scientific Coordinator at Fondazione Novella Fronda, and a Neurology Consultant at Studio Gallimberti-Bonci&Partners. She joined the research team in 2018 after years of research in brain stimulation techniques in the Parkinson’s disease field. Her overall goal has always been to translate research findings from animal models to humans. “TMS offers us a promising tool to modulate brain circuitry activity in humans and possibly change the course of many neuropsychiatric disorders, including cocaine addiction, which is a disease of brain circuits,” she explains: “As a scientist I am interested in understanding why TMS is effective for cocaine addicts and how we can improve the therapeutic options.”

The largest cohort of CocUD patients

Although the sample sizes in early clinical studies were limited, the results did indicate that the researchers might be on to something. Larger sample sizes and prolonged follow-up times are, however, needed to confirm the findings. An important step has been to conduct a retrospective chart review study which was achieved earlier in 2019. It is the largest available so far, involving 284 CocUD patients who all received three months of TMS treatment for their addiction and were observed  retrospectively for up to 2 years and 8 months. 

Prolonged drugfree stretches 

“The study showed that TMS treatment was accompanied by long-lasting reductions in cocaine use, with the first resumption of cocaine use occurring after an average of 91 days since the beginning of TMS treatment. For the cohort of addicts who were treated as usual, in the form of individual or group therapy, the first lapse to cocaine was reported at 50 days,” says Graziella Madeo.

During the follow-up period, TMS was first re-administered weekly then monthly, prophylactically or if a relapse of cocaine use occurred. “Interestingly, we observed that the decrease in frequency of TMS was not accompanied by an increase in relapses to cocaine use. Over time we observed longer stretches of abstinence between relapses. Therefore, the gradual decrease of TMS sessions did not leave patients more vulnerable to relapses,” says Graziella Madeo.

Reduced frequency of cocaine use

Another crucial observation was the drop-down of cocaine use: “The mean frequency of cocaine use was less than 1 day per month compared to the weekly frequency of use before the treatment,” says Graziella Madeo. She also points out that “TMS can be safely administered, as serious TMS related adverse events were infrequent, both during the actual treatment and the follow-up period”. Do the findings indicate that this could lead to an approved treatment in the future? Graziella Madeo is optimistic: “We do believe that it has the potential to be an FDA cleared or CE approved protocol for cocaine addiction.”

Necessary: double-blinded studies

The Italian research team has, over the course of 5 years, followed more than 1,000 CocUD patients, but Graziella Madeo points out that
double-blinded studies are both warranted and necessary to examine the effectiveness and safety of neuromodulation and how to further improve the technology. “To our knowledge, there are already double-blind studies with proper control groups on the way, which could hopefully help to further advance TMS as an option for cocaine addiction and improve the availability of neuromodulation techniques in the public health care system.”

The article was originally printed in TMS Update by MagVenture Issue 1. The views and opinions expressed in this article do not necessarily reflect the official policy or position of MagVenture or any of its affiliates. The usage of rTMS for any other purpose than the cleared indication, in the country in which the product is intended to be used, is considered investigational.

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