Effect of Repetitive TMS on Executive Function in Alcohol Use Disorder
44 patients around the world
Available in Mexico
It is proposed that individuals predisposed to developing alcohol use disorder (AUD)
exhibit alterations in executive functions, resulting from maladaptive cellular
homeostatic processes and neuronal circuits activated by substance use. These alterations
persist even after substance withdrawal (Nestler & Aghajanian, 1997). As a multifactorial
disorder, AUD has been linked to family history of alcohol use (Khemiri et al., 2020;
Peterson et al., 1990; Tarter et al., 1989) and individual traits such as poor cognitive
test performance relative to controls (Shnitko et al., 2018; Goudriaan et al., 2011),
which may predict heavy alcohol consumption or AUD development.
These executive dysfunctions manifest as persistent negative behaviors that impede
adaptive learning and reduced activation of the executive control network, both of which
correlate with AUD severity (Mayhugh et al., 2014). Cognitive flexibility, a key
executive function, enables adaptive adjustment of thoughts and behaviors in response to
environmental demands (Uddin, 2021). Impaired cognitive flexibility is associated with
AUD persistence and severity (Stalnaker et al., 2008), though recovery is observed after
prolonged abstinence (Rourke & Grant, 1999). Thus, cognitive flexibility may serve as a
promising treatment biomarker.
McLellan et al. (2000) report that 40-60% of AUD patients relapse within the first year
post-treatment, while at least 60% relapse within six months (Durazzo & Meyerhoff, 2017;
Kirshenbaum et al., 2009; Maisto et al., 2006a; Meyerhoff & Durazzo, 2010). Given these
challenges, non-invasive neuromodulation techniques like repetitive transcranial magnetic
stimulation (rTMS) have emerged as adjunct therapies to standard treatments (Diana et
al., 2017). For example, Addolorato et al. (2017) applied high-frequency (10 Hz) rTMS to
the dorsolateral prefrontal cortex (DLPFC) in AUD patients and observed reduced alcohol
consumption and increased abstinent days. Similarly, Del Felice et al. (2016) found that
left DLPFC stimulation enhanced inhibitory control, selective attention, and mood in
active alcohol users.
Stimulating the DLPFC, a hub of the executive control network, may enhance its functional
connectivity and improve cognitive flexibility in AUD patients. These effects align with
findings that rTMS bolsters inhibitory control and attention (Del Felice et al., 2016;
Diana et al., 2017). To explore this further, we propose a longitudinal study assessing
cognitive/behavioral traits in AUD patients that may contribute to disorder development.
We will also evaluate rTMS effects using neuropsychological tools and MRI to measure
structural/functional brain changes.
This study aims to investigate the short- and long-term clinical and cognitive effects of
10 Hz rTMS applied to the left DLPFC in abstinent AUD patients, alongside associated
neurostructural and functional connectivity changes. Abstinent AUD patients will receive
daily rTMS for four weeks. Clinical outcomes will be tracked for six months, with
cognitive, structural, and functional connectivity measurements taken at baseline,
post-intervention (4 weeks), and follow-up (6 months).
Universidad Nacional Autonoma de Mexico
1Research sites
44Patients around the world
This study is for people with
Substance Use Disorders
Alcohol Use Disorder
Requirements for the patient
To 59 Years
All Gender
Medical requirements
Men and women of 25 to 59 years old.
The reading level of at least 6th grade of primary equivalent to fifth grade of elementary school.
Alcohol users with an AUDIT ≥ 20 puntos.
Abstinence from alcohol consumption from 8 weeks to 5 years with CIWA-Ar scale scores ≤ 9 points.
No disabling neuropsychiatric conditions i.e. Schizophrenia.
No substance use disorders except alcohol and nicotine.
BrAC Breath Alcohol = 0.00 mg/dl in each of the assessments.
No traces of alcohol consumption using urine test strips.
No contraindications for TMS therapy.
Individuals with symptoms of severe agitation or who are unable to cooperate in the study.
History of epilepsy.
Sudden onset of stroke focal neurological findings such as hemiparesis sensory loss visual field deficits and lack of coordination.
Seizures or gait disturbances.
History of severe psychiatric disorders.
Alterations in a conventional electroencephalogram.
Pacemakers or intracranial metallic objects.
At the subject's request.
The presence of adverse incidents that deteriorate the subject's health and would limit continuation of rTMS treatment.
Exacerbation of cognitive or behavioral symptoms during treatment.
Sites
Universidad Nacional Autónoma de México Campus Juriquilla