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      Transcranial direct current stimulation (tDCS) in behavioral and food addiction: a systematic review of efficacy, technical, and methodological issues

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          Abstract

          Objectives: Behavioral addictions (BA) are complex disorders for which pharmacological and psychotherapeutic treatments have shown their limits. Non-invasive brain stimulation, among which transcranial direct current stimulation (tDCS), has opened up new perspectives in addiction treatment. The purpose of this work is to conduct a critical and systematic review of tDCS efficacy, and of technical and methodological considerations in the field of BA.

          Methods: A bibliographic search has been conducted on the Medline and ScienceDirect databases until December 2014, based on the following selection criteria: clinical studies on tDCS and BA (namely eating disorders, compulsive buying, Internet addiction, pathological gambling, sexual addiction, sports addiction, video games addiction). Study selection, data analysis, and reporting were conducted according to the PRISMA guidelines.

          Results: Out of 402 potential articles, seven studies were selected. So far focusing essentially on abnormal eating, these studies suggest that tDCS (right prefrontal anode/left prefrontal cathode) reduces food craving induced by visual stimuli.

          Conclusions: Despite methodological and technical differences between studies, the results are promising. So far, only few studies of tDCS in BA have been conducted. New research is recommended on the use of tDCS in BA, other than eating disorders.

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          Most cited references70

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          Diminishing risk-taking behavior by modulating activity in the prefrontal cortex: a direct current stimulation study.

          Studies have shown increased risk taking in healthy individuals after low-frequency repetitive transcranial magnetic stimulation, known to transiently suppress cortical excitability, over the right dorsolateral prefrontal cortex (DLPFC). It appears, therefore, plausible that differential modulation of DLPFC activity, increasing the right while decreasing the left, might lead to decreased risk taking, which could hold clinical relevance as excessively risky decision making is observed in clinical populations leading to deleterious consequences. The goal of the present study was to investigate whether risk-taking behaviors could be decreased using concurrent anodal transcranial direct current stimulation (tDCS) of the right DLPFC, which allows upregulation of brain activity, with cathodal tDCS of the left DLPCF, which downregulates activity. Thirty-six healthy volunteers performed the risk task while they received either anodal over the right with cathodal over the left DLPFC, anodal over the left with cathodal over the right DLPFC, or sham stimulation. We hypothesized that right anodal/left cathodal would decrease risk-taking behavior compared with left anodal/right cathodal or sham stimulation. As predicted, during right anodal/left cathodal stimulation over the DLPFC, participants chose more often the safe prospect compared with the other groups. Moreover, these participants appeared to be insensitive to the reward associated with the prospects. These findings support the notion that the interhemispheric balance of activity across the DLPFCs is critical in decision-making behaviors. Most importantly, the observed suppression of risky behaviors suggests that populations with boundless risk-taking behaviors leading to negative real-life consequences, such as individuals with addiction, might benefit from such neuromodulation-based approaches.
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            Sex differences and the impact of steroid hormones on the developing human brain.

            Little is known about the hormonal effects of puberty on the anatomy of the developing human brain. In a voxel-based morphometry study, sex-related differences in gray matter (GM) volume were examined in 46 subjects aged 8-15 years. Males had larger GM volumes in the left amygdala, whereas females had larger right striatal and bilateral hippocampal GM volumes than males. Sexually dimorphic areas were related to Tanner stages (TS) of pubertal development and to circulating level of steroid hormones in a subsample of 30 subjects. Regardless of sex, amygdala and hippocampal volumes varied as a function of TS and were associated with circulating testosterone (TEST) levels. By contrast, striatal GM volumes were unrelated to pubertal development and circulating steroid hormones. Whole-brain regression analyses revealed positive associations between circulating estrogen levels and parahippocampal GM volumes as well as between TEST levels and diencephalic brain structures. In addition, a negative association was found between circulating TEST and left parietal GM volumes. These data suggest that GM development in certain brain regions is associated with sexual maturation and that pubertal hormones might have organizational effects on the developing human brain.
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              Effects of non-invasive neurostimulation on craving: a meta-analysis.

              This meta-analysis was conducted to evaluate the available evidence regarding the effects of non-invasive neurostimulation of the dorsolateral prefrontal cortex (DLPFC), on craving in substance dependence and craving for high palatable food. Non-invasive neurostimulation techniques were restricted to repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS). A total of 17 eligible studies were identified. Random effects analysis revealed a pooled standardized effect size (Hedge's g) of 0.476 (CI: 0.316-0.636), indicating a medium effect size favouring active non-invasive neurostimulation over sham stimulation in the reduction of craving (z=5.832, p<0.001). No significant differences were found between rTMS and tDCS, between the various substances of abuse and between substances of abuse and food, or between left and right DLPFC stimulation. In conclusion, this meta-analysis provides the first clear evidence that non-invasive neurostimulation of the DLPFC decreases craving levels in substance dependence. Copyright © 2013 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Journal
                Front Neurosci
                Front Neurosci
                Front. Neurosci.
                Frontiers in Neuroscience
                Frontiers Media S.A.
                1662-4548
                1662-453X
                09 October 2015
                2015
                : 9
                : 349
                Affiliations
                [1] 1Addictology and Liaison Psychiatry Department, Nantes University Hospital Nantes, France
                [2] 2Clinical Investigation Unit 18-BALANCED “BehaviorAL AddictioNs and ComplEx Mood Disorders”, University Hospital of Nantes Nantes, France
                [3] 3Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain
                [4] 4Department of Psychiatry and Addictology, University Hospital of Dijon Dijon, France
                [5] 5Behavioral Addictions Program, NANT New Addictions New Treatments, Addiction Division, Department of Mental Health and Psychiatry, University Hospital of Geneva Geneva, Switzerland
                [6] 6CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos III Barcelona, Spain
                [7] 7CIBER Salud Mental, Instituto de Salud Carlos III Barcelona, Spain
                [8] 8EA 4275 “Biostatistics, Clinical Research and Subjective Measures in Health Sciences”, University of Nantes Nantes, France
                Author notes

                Edited by: Antonio Oliviero, Hospital Nacional de Parapléjicos, Spain

                Reviewed by: Andre R. Brunoni, Universidade de São Paulo, Brazil; Laura Mordillo-Mateos, Hospital Nacional de Parapléjicos, Spain

                *Correspondence: Anne Sauvaget, Cappa Jacques Prevert, Addictology and Liaison-Psychiatry Department, Hôtel Dieu 3éme Nord, 1 Place Alexis-Ricordeau, 44000 Nantes, France anne.sauvaget@ 123456chu-nantes.fr

                This article was submitted to Neurodegeneration, a section of the journal Frontiers in Neuroscience

                Article
                10.3389/fnins.2015.00349
                4598576
                26500478
                44546a3b-83a7-4de2-84b7-28773c4e397d
                Copyright © 2015 Sauvaget, Trojak, Bulteau, Jiménez-Murcia, Fernández-Aranda, Wolz, Menchón, Achab, Vanelle and Grall-Bronnec.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 24 July 2015
                : 14 September 2015
                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 89, Pages: 14, Words: 9569
                Categories
                Psychiatry
                Review

                Neurosciences
                transcranial direct current stimulation,neuromodulation,behavioral addiction,craving,eating disorders,food craving,non-invasive brain stimulation

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