A Randomized Placebo-Controlled Trial of Targeted Prefrontal Cortex Modulation with Bilateral tDCS in Patients with Crack-Cocaine Dependence

Edson Kruger Batista, Jaisa Klauss, Felipe Fregni, Michael A Nitsche, Ester Miyuki Nakamura-Palacios, Edson Kruger Batista, Jaisa Klauss, Felipe Fregni, Michael A Nitsche, Ester Miyuki Nakamura-Palacios

Abstract

Background: Transcranial direct current stimulation over the dorsolateral prefrontal cortex has been shown to be clinically useful in the treatment of drug addiction.

Methods: We conducted a double-blind randomized clinical trial aiming to assess the effects of bilateral dorsolateral prefrontal cortex transcranial direct current stimulation (left cathodal/right anodal) on crack-cocaine addiction. We defined craving as the primary outcome, and other clinical measurements, including depressive and anxiety symptoms, and quality of life, as secondary outcomes. Seventeen male crack-cocaine users (mean age 30.4 ± 9.8 SD) were randomized to receive 5 sessions of active transcranial direct current stimulation (2 mA, 35 cm(2), for 20 minutes), every other day, and 19 males (mean age 30.3 ± 8.4 SD) to receive sham-transcranial direct current stimulation (placebo) as control group.

Results: Craving scores were significantly reduced in the transcranial direct current stimulation group after treatment when compared with sham-transcranial direct current stimulation (P = .028) and baseline values (P = .003), and decreased linearly over 4 weeks (before, during, and after treatment) in the transcranial direct current stimulation group only (P = .047). Changes of anxiety scores towards increase in the sham-transcranial direct current stimulation and decrease in the transcranial direct current stimulation group (P = .03), and of the overall perception of quality of life (P = .031) and of health (P = .048) towards decrease in the sham-transcranial direct current stimulation group and increase in the transcranial direct current stimulation group differed significantly between groups.

Conclusions: Repetitive bilateral transcranial direct current stimulation over the dorsolateral prefrontal cortex reduced craving for crack-cocaine use, decreased anxiety, and improved quality of life. We hypothesize that transcranial direct current stimulation effects may be associated with increased prefrontal processing and regulation of craving behavior.

Keywords: crack-cocaine; craving; dorsolateral prefrontal cortex; quality of life; tDCS.

© The Author 2015. Published by Oxford University Press on behalf of CINP.

Figures

Figure 1.
Figure 1.
Diagram of the general procedure: eligible crack-cocaine users were recruited from the clinics for treatment of drug dependence, signed the term of consent, and were randomized to receive repetitive bilateral (cathode left/anode right over the dorsolateral prefrontal cortex) transcranial direct current stimulation (tDCS; 2 mA, 35cm2, stimulation for 20min) every other day for a total of 5 sessions. Craving to the use of crack-cocaine was examined once per week for 4 weeks (the week before treatment, during the second and third treatment weeks, and the week after treatment). a, anode; A, anterior; BS, brain stimulation; c, cathode; HAM-D, Hamilton Scale for Depression; HAM-A, Hamilton Scale for Anxiety; L, left; P, posterior; R, right; WHOQOL, Quality of Life.
Figure 2.
Figure 2.
Craving is shown as mean score ± SEMs in the week before treatment, the second and third weeks during the treatment, and the week after treatment with bilateral repetitive transcranial direct current stimulation (tDCS; 2mA, 35cm2: cathode left/anode right over the dorsolateral prefrontal cortex; stimulation for 20min every other day for a total of 5 sessions; n=17) or placebo (sham-tDCS; n=19) in crack-cocaine addicts in the left figure (linear regression: 4.412 - 0.617X, r2=0.058, P=.047). Inbox: mean scores of craving shown the week before and the week after treatment in the real and sham-tDCS groups. *P=.028, **P=.003 (Bonferroni-corrected t tests test following repeated-measures ANOVA adjusted for baseline).

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