Transcranial Direct Current Stimulation (tDCS)/Transcranial Alternating Current Stimulation (tACS)Short CommunicationBilateral Transcranial Direct Current Stimulation Over Dorsolateral Prefrontal Cortex Changes the Drug-cued Reactivity in the Anterior Cingulate Cortex of Crack-cocaine Addicts
Introduction
It has been suggested that prefrontal dysfunction, particularly dysfunction of cognitive control, may be related to the loss of control over drug use that can lead to addiction [1]. Thus, treatment aiming to improve cognitive control over drug intake is clinically useful. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that induces polarity-dependent alterations of cortical excitability [2], [3], [4], [5], [6], [7], [8]. It can modulate the function of deeper cortical areas, such as the anterior cingulate cortex (ACC) [9], [10], [11], [12], which seems to be involved in drug-related attention bias [1]. Considering this evidence, we hypothesize that tDCS over the dorsolateral prefrontal cortex (DLPFC), a prefrontal area primarily involved in cognitive control, will extend its modulation of the ACC in the addicted brain, thereby changing drug-related cue processing. In this study, we examine the N2 component (200–350 ms) of ACC activity during visual presentation of drug-related cues after a single exposure of bilateral (left cathodal/right anodal) tDCS over the DLPFC.
Section snippets
Subjects
Thirteen crack-cocaine addicted subjects, as defined by the DSM-IV, were recruited for this trial. The mean age of the participants was 30 ± 7 (SD) years, and the mean time of drug abstinence was 16 ± 23 (SD) days. Treatment and data collection were conducted according to the Declaration of Helsinki. This report is part of the results from the study registered in the ClinicalTrials.gov Protocol Registration System under identifier NCT01337297.
EEG recording
Electrophysiological recordings were obtained
Results
The sham (n = 6) and tDCS (n = 7) groups were matched regarding socio-demographic characteristics and pattern of drug use (data not shown). Changes in the N2 component of the ACC activity (mean current density ± SD) were recorded during neutral or crack-related cue presentations (Fig. 1). The ACC activity during the N2 segment was similar for neutral images before and after brain stimulation or sham stimulation. However, the ACC activity was increased (P < 0.0001) during exposure to
Discussion
Here, we observe increased ACC activity in the sham group and decreased activity in the tDCS group during visualization of crack-related cues but not neutral cues. Our stimulation protocol involves left cathodal/right anodal stimulation. It is well-established that cathodal tDCS decreases cortical excitability [5], [6], [7], [8]. This could suggest that the left cathode but not the right anode over the (left) DLPFC is related to the reduced activity in the ACC during crack-related image
Acknowledgments
We thank Dr. Janine Moscon for help recruiting patients for this trial.
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2021, Progress in Neuro-Psychopharmacology and Biological PsychiatryCitation Excerpt :Individuals with substance use disorder revealed hyperactivation in ACC that may increase cue-related attentional bias resulting in substance use disorder (Adinoff, 2004; Blanco et al., 2001; De Biasi and Dani, 2011). These abnormal activation patterns in ACC may be linked with hyperactivation of prefrontal cortex (PFC) (Daglish and Nutt, 2003; Garavan et al., 2000; Goldstein et al., 2007), and further suppressing left DLPFC activation was effective for attenuating excessive ACC activations in individuals with drug use disorder (Conti and Nakamura, 2014). Presumably, increasing interhemispheric inhibition from right DLPFC using anodal tDCS combined with cathodal tDCS on left DLPFC may effectively reduce excessive left DLPFC activation contributing to functional improvements in ACC.
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2020, Biological PsychiatryCitation Excerpt :Enhanced ACC activity has been associated with chronic pain and depression, whereas decreased ACC gray matter volume coincides with these two conditions as well as with heroin dependence (73–78). Notably, clinical trials suggest that interrupting abnormal ACC signaling by DBS or transcranial direct current stimulation has promise for the management of neuropathic pain, treatment-resistant depression, and cue-evoked cocaine cravings (79–81). Nuclei of the amygdala help to regulate emotional stress and pain perception (82--84).
Financial disclosures: CLC received a student scholarship from a governmental institution (CAPES). The authors report no conflicts of interest regarding the content of this manuscript.