Transcranial magnetic stimulation of dorsomedial prefrontal cortex for cocaine use disorder: A pilot study

Cocaine use disorder (CUD) is a difficult-to-treat condition with no FDA-approved medications. Recent work has turned to brain stimulation methods to help rectify hypofrontality and dopamine reward system changes often observed in individuals with CUD. Preliminary studies using transcranial magnetic stimulation (TMS) have demonstrated promising results, but there is room for optimization of the stimulation site, stimulation pattern, and identification of relevant biomarkers of TMS effects. The current pilot study aimed to test the feasibility, safety, and preliminary effects of a double-blind, sham-controlled, cross-over, acute design using intermittent theta burst stimulation to dorsomedial prefrontal cortex (dmPFC) on electroencephalogram (EEG) as intermediate outcome assessment in CUD patients. This small pilot enrolled five individuals with moderate-to-severe CUD for feasibility and proof-of-concept. Participants completed safety, psychometric, and EEG measures before and after receiving two sessions of active or sham TMS to dmPFC on two separate days. All five participants completed all the study tasks and found the TMS to be tolerable. The side effects were minimal and consistent with an acute TMS design. Visible changes were observed in the electrical activity of the brain during a monetary guessing task, while minimal changes in psychometric measures were observed. These results indicate the feasibility and safety of the current approach and suggest that dmPFC is a viable target for treating CUD. Future work should expand upon these findings in a randomized controlled clinical trial.