Effects of Frontopolar TMS in Alcohol Craving
Investigation of Frontopolar Transcranial Magnetic Stimulation on Correlates of Craving in Alcohol Addiction
Goethe University
34 participants
May 16, 2025
INTERVENTIONAL
Conditions
Summary
The goal of this interventional study is to learn if continuous theta burst stimulation (cTBS) applied over the left frontopolar cortex can reduce psychological, physiological, and neurobiological markers of alcohol craving in patients with alcohol dependence (AD). The main questions it aims to answer are: * Does cTBS over the left frontopolar cortex reduce psychological and physiological measures of alcohol craving in individuals with AD? * Are baseline structural and functional brain connectivity patterns associated with individual differences in cTBS-induced changes in craving? The participants will: * Receive cTBS over the left frontopolar cortex using an accelerated protocol comprising 15 TMS-sessions on five consecutive days * Undergo psychological and physiological assessments of alcohol craving before and after the TMS intervention * Complete magnetic resonance imaging (MRI) sessions to assess baseline brain structural and functional connectivity This study aims to advance the understanding of the neurophysiological mechanisms underlying craving in AD and the identification of potential biomarkers for predicting psychological and physiological craving reductions.
Eligibility
Inclusion Criteria4
- adults aged 18-65
- ICD-10 diagnosis of alcohol dependence
- Ability to give consent
- Sinus rhythm in ECG
Exclusion Criteria4
- Current psychotic symptoms in patients with psychotic disorders (F20, F23, F10.5)
- Contraindication against TMS or MRI
- Severe neurological disorders such as epilepsy, stroke, neuroinflammatory disorders (e.g., multiple sclerosis). A history of seizures only in the context of alcohol withdrawal does not represent a contraindication, unless the seizure happened in the last 3 weeks before study inclusion.
- Acute withdrawal symptoms (CIWA-Ar \> 5)
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Interventions
Patients will receive cTBS, a five-minute protocol with inhibitory effects over the left frontal pole, using an accelerated design comprising three sessions daily for five consecutive days (15 sessions total). Stimulation will be delivered using a Magventure TMS device routinely used in clinical practice at the Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Frankfurt. TMS is generally well tolerated, with mild headache or scalp discomfort as common side effects. Localization will be based on individual MRI data: after cortical parcellation with FreeSurfer 7.4.1, the left frontal pole centroid will be extracted. Coil placement will be neuronavigated using the Localite Neuronavigator. Stimulation will be applied at 110% resting motor threshold (rMT; 3-pulse bursts at 50 Hz, 5 Hz interburst; 1800 pulses/train; 60 s intertrain). Intensity may be gradually increased until 110% rMT is reached.
Locations(2)
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NCT07064590