Repetitive Transcranial Magnetic Stimulation for Alcohol Craving in Alcohol Use Disorders: A Meta-analysis.

AIMS: We aimed to evaluate the immediate and up to 3 months' effect of multiple-session repetitive transcranial magnetic stimulation (rTMS) on alcohol craving in AUD.

METHODS

We performed a systematic review and random effects meta-analysis. We included randomized controlled trials with at least 10 sessions of rTMS and postintervention alcohol craving assessment. We evaluated the immediate and up to 3 months' effects of active rTMS versus sham stimulation.

RESULTS

Twelve studies met inclusion criteria, including 475 participants across both treatment and control groups. rTMS reduced alcohol craving over sham stimulation immediately post-treatment (SMD = -0.79, 95% CI: -1.53 to -0.04, P = 0.04, I2 = 93%). Concerning a maintenance effect, our meta-analysis revealed a medium effect for active rTMS in reduction of alcohol craving at 3-month follow-up (SMD = -0.44, 95% CI: -0.77 to 0.11, P < 0.01, I2 = 38%). Our subgroup analysis revealed that rTMS targeting the medial prefrontal cortex (SMD = -2.12, 95% CI: -4.34 to 0.09, P = 0.06, I2 = 94%) may be more effective than stimulating the right dorsolateral prefrontal cortex (SMD = -1.04, 95% CI: -2.56 to 0.48, P = 0.18, I2 = 96%) or left dorsolateral prefrontal cortex (SMD = -0.27, 95% CI: -0.60 to 0.05, P = 0.10, I2 = 0%) immediately after treatment.

CONCLUSION

A minimum of 10 sessions of rTMS reduced alcohol craving immediately after treatment; this effect seems to be sustained over a 3-month period. We provide limited evidence of superiority for rTMS targeting the medial prefrontal cortex.