A randomized controlled trial of targeted prefrontal cortex modulation with tDCS in patients with alcohol dependence
Open accessAbstract
Preliminary small studies have shown that transcranial direct current stimulation (tDCS) reduces craving in alcoholic subjects. It is unclear whether tDCS also leads to changes in clinically meaningful outcomes for alcohol dependence in a properly powered phase II randomized clinical trial. We aimed to investigate whether repetitive tDCS changes the risk of alcohol use relapse in severe alcoholics from outpatient services. Thirty-five subjects were randomized to receive active bilateral [left cathodal/right anodal over the dorsolateral prefrontal cortex (dlPFC)] repetitive (five consecutive days) tDCS (2 mA, 35 cm2, two times daily stimulation for 13 min with a 20-min interval) or sham-tDCS. There were two dropouts before treatment. From 33 alcoholic subjects, 17 (mean age 45.5±8.9 s.d., 16 males) were randomized to sham and 16 (44±7.8 s.d., 16 males) to real tDCS treatment. By the end of the six months of follow-up, two subjects treated with sham (11.8%) and eight treated with real tDCS (50%) were still alcohol-abstinent [p=0.02, Long-rank (Mantel-Cox) Test, HR=0.35 (95% CI, 0.14-0.85)]. No differences with regard to changes on scores of craving, frontal function, global mental status, depressive or anxiety symptoms were observed between groups. However, subjects from the tDCS group improved with regard to their overall perception of quality of life (p=0.02), and increased their scores in the environment domain (p=0.04) after treatment. Bilateral tDCS over dlPFC reduces relapse probability in severe alcoholic subjects and results in improved perception of quality of life.
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While 3 of the tDCS studies found a decrease in alcohol cravings compared to sham stimulation, one study found a lower relapse rate in the brain stimulation group but with no difference in alcohol cravings at 6-month follow-up.
“While 3 of these studies found a decrease in alcohol cravings compared to sham stimulation [36,44,60], one study found a lower relapse rate in the brain stimulation group but with no difference in alcohol cravings at 6-month follow-up [59].”
From Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary (2022) · cites this paper as [59]
Ultimately, 3 of the 4 tDCS studies found more relapses in the intervention group at 4-week, 6-month, and 12-month follow-up.
“Ultimately, 3 of the 4 studies in this group found more relapses in the intervention group at 4-week, 6-month, and 12-month follow-up [44,59,60].”
From Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary (2022) · cites this paper as [59]
All 4 studies that used brain stimulation as an intervention were conducted in Brazil, an upper middle-income country.
“As a clear example, all 4 studies [36,44,59,60] that used brain stimulation as an intervention were conducted in Brazil, an upper middle-income country.”
From Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary (2022) · cites this paper as [59]
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- Authors
- Klauss, J., Penido Pinheiro, L. C., Silva Merlo, B. L., Correia Santos, G. D. A., Fregni, F., Nitsche, M. A., & Miyuki Nakamura-Palacios, E.
- Affiliations
- Universidade Federal do Espírito Santo (BR)
- Beth Israel Deaconess Medical Center (US)
- Universitätsmedizin Göttingen (DE)
- Venue
- The International Journal of Neuropsychopharmacology
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-07-10
- Volume
- 17
- Issue
- 11
- Pages
- 1793-1803
- ISSN
- 1461-1457 (ISSN-L)
- 1469-5111
- OpenAlex
- W2153481993
- Cited by
- 178
- References
- 50
- Citations by year
- 2026: 4 · 2025: 16 · 2024: 9 · 2023: 16 · 2022: 18 · 2021: 17 · 2020: 19 · 2019: 13 · 2018: 23 · 2017: 14 · 2016: 18 · 2015: 11
- FWCI
- 7.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The International Journal of Neuropsychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
- GRO (submittedVersion, cc-by)
- Funders
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
- Conselho Nacional de Desenvolvimento Científico e Tecnológico
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Keywords
- transcranial direct current stimulation, alcoholism, alcohol relapse, dorsolateral prefrontal cortex, craving, alcohol abstinence, quality of life, non-pharmacological treatment
- MeSH terms
- Adult, Alcoholism, Double-Blind Method, Female, Follow-Up Studies, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Proportional Hazards Models, Treatment Outcome, Prefrontal Cortex, Transcranial Direct Current Stimulation
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