Description

Alcohol dependence is a prevalent and debilitating condition characterized by a chronic inability to control alcohol consumption despite adverse consequences. Current treatment options have limited efficacy, and there is a pressing need for innovative approaches. Continuous Theta Burst Stimulation (cTBS) is a form of transcranial magnetic stimulation (TMS) that has shown promise in modulating brain activity associated with craving and addiction. This study aims to explore the effects of cTBS over the left frontopolar cortex on neurophysiological markers of craving in patients with alcohol dependence and to investigate the relationship between these effects and baseline brain connectivity.

The objectives of this study are on the one hand to evaluate the impact of cTBS TMS administration over the left frontopolar cortex on neurophysiological craving markers (such as heart rate, skin conductance and skin temperature in a VR-based craving induction) in patients with alcohol dependence and on the other hand to investigate the relationship between baseline structural and functional brain connectivity (as assessed by magnetic resonance imaging; MRI) and the physiological response to craving induction after TMS.

This study aims to include 34 patients diagnosed with alcohol dependence. Inclusion criteria include adults aged 18-65 with an ICD-10 diagnosis of alcohol dependence. Exclusion criteria include severe neurological disorders or contraindications to TMS or MRI.

Participants will receive 15 sessions of cTBS TMS treatment over one week, targeting the left frontopolar cortex. Physiological parameters will be assessed before and after the TMS application using Virtual Reality Cue Exposure and Craving Assessment (VR-CECA). Structural and functional MRI scans will be conducted at baseline to assess brain connectivity.

The primary outcome measure will be the change in heart rate during VR-CECA craving induction. Secondary outcomes include changes in self-reported craving, skin conductance, and temperature during VR-CECA and the correlation between baseline brain connectivity and changes in heart rate increase during VR.

This study hypothesizes that cTBS TMS treatment will reduce neurophysiological markers of craving in patients with alcohol dependence. Additionally, it is expected that baseline structural and functional connectivity will predict the degree of VR-induced heart rate increase after cTBS, providing insights into individual brain network variability in the effect of cTBS. TMS is generally well-tolerated, with the most common side effects being mild headaches and scalp discomfort.

This study aims to advance the understanding of the neurophysiological mechanisms underlying craving in alcohol dependence and to identify potential biomarkers for predicting craving reductions. If successful, this could lead to more targeted and effective interventions for alcohol dependence, ultimately improving patient outcomes.