Non-invasive Brain Stimulation for Gambling Disorder: A Systematic Review

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Abstract

Background: Gambling disorder (GD) is the most common behavioral addiction and shares pathophysiological and clinical features with substance use disorders (SUDs). Effective therapeutic interventions for GD are lacking. Non-invasive brain stimulation (NIBS) may represent a promising treatment option for GD.

Objective: This systematic review aimed to provide a comprehensive and structured overview of studies applying NIBS techniques to GD and problem gambling.

Methods: A literature search using Pubmed, Web of Science, and Science Direct was conducted from databases inception to December 19, 2019, for studies assessing the effects of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (t-DCS) on subjects with GD or problem gambling. Studies using NIBS techniques on healthy subjects and those without therapeutic goals but only aiming to assess basic neurophysiology measures were excluded.

Results: A total of 269 articles were title and abstract screened, 13 full texts were assessed, and 11 were included, of which six were controlled and five were uncontrolled. Most studies showed a reduction of gambling behavior, craving for gambling, and gambling-related symptoms. NIBS effects on psychiatric symptoms were less consistent. A decrease of the behavioral activation related to gambling was also reported. Some studies reported modulation of behavioral measures (i.e., impulsivity, cognitive and attentional control, decision making, cognitive flexibility). Studies were not consistent in terms of NIBS protocol, site of stimulation, clinical and surrogate outcome measures, and duration of treatment and follow-up. Sample size was small in most studies.

Conclusions: The clinical and methodological heterogeneity of the included studies prevented us from drawing any firm conclusion on the efficacy of NIBS interventions for GD. Further methodologically sound, robust, and well-powered studies are needed.

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Problem gambling worldwide: An update and systematic review of empirical research (2000–2015)

Filipa Calado, Mark D. Griffiths (2016)

Problem gambling has been identified as an emergent public health issue, and there is a need to identify gambling trends and to regularly update worldwide gambling prevalence rates. This paper aims to review recent research on adult gambling and problem gambling (since 2000) and then, in the context of a growing liberalization of the gambling market in the European Union, intends to provide a more detailed analysis of adult gambling behavior across European countries. A systematic literature search was carried out using academic databases, Internet, and governmental websites. Following this search and utilizing exclusion criteria, 69 studies on adult gambling prevalence were identified. These studies demonstrated that there are wide variations in past-year problem gambling rates across different countries in the world (0.12–5.8%) and in Europe (0.12–3.4%). However, it is difficult to directly compare studies due to different methodological procedures, instruments, cut-offs, and time frames. Despite the variability among instruments, some consistent results with regard to demographics were found. The findings highlight the need for continuous monitoring of problem gambling prevalence rates in order to examine the influence of cultural context on gambling patterns, assess the effectiveness of policies on gambling-related harms, and establish priorities for future research.

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Modulating parameters of excitability during and after transcranial direct current stimulation of the human motor cortex.

Michael Nitsche, Antje Seeber, Kai Frommann … (2005)

Weak transcranial direct current stimulation (tDCS) of the human motor cortex results in excitability shifts which occur during and after stimulation. These excitability shifts are polarity-specific with anodal tDCS enhancing excitability, and cathodal reducing it. To explore the origin of this excitability modulation in more detail, we measured the input-output curve and motor thresholds as global parameters of cortico-spinal excitability, and determined intracortical inhibition and facilitation, as well as facilitatory indirect wave (I-wave) interactions. Measurements were performed during short-term tDCS, which elicits no after-effects, and during other tDCS protocols which do elicit short- and long-lasting after-effects. Resting and active motor thresholds remained stable during and after tDCS. The slope of the input-output curve was increased by anodal tDCS and decreased by cathodal tDCS. Anodal tDCS of the primary motor cortex reduced intracortical inhibition and enhanced facilitation after tDCS but not during tDCS. Cathodal tDCS reduced facilitation during, and additionally increased inhibition after its administration. During tDCS, I-wave facilitation was not influenced but, for the after-effects, anodal tDCS increased I-wave facilitation, while cathodal tDCS had only minor effects. These results suggest that the effect of tDCS on cortico-spinal excitability during a short period of stimulation (which does not induce after-effects) primarily depends on subthreshold resting membrane potential changes, which are able to modulate the input-output curve, but not motor thresholds. In contrast, the after-effects of tDCS are due to shifts in intracortical inhibition and facilitation, and at least partly also to facilitatory I-wave interaction, which is controlled by synaptic activity.

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Study and modulation of human cortical excitability with transcranial magnetic stimulation.

Peter A. Leone, C Canete, Jose Tormos … (1998)

Transcranial magnetic stimulation (TMS) can be applied in different paradigms to obtain a measure of various aspects of cortical excitability. These different TMS paradigms provide information about different neurotransmitter systems, enhance our understanding about the pathophysiology of neuropsychiatric conditions, and in the future may be helpful as a guide for pharmacological interventions. In addition, repetitive TMS (rTMS) modulates cortical excitability beyond the duration of the rTMS trains themselves. Depending on rTMS parameters, a lasting inhibition or facilitation of cortical excitability can be induced. These effects can be demonstrated neurophysiologically or by combining rTMS with neuroimaging techniques. The effects do not remain limited to the cortical area directly targeted by rTMS, but affect a wider neural network transynaptically. Modulation of cortical excitability by rTMS may in the future be useful not only as a research tool but also as a therapeutic intervention in neurology, psychiatry, and neurorehabilitation.

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Contributors

Chiara Zucchella: URI : http://loop.frontiersin.org/people/650046/overview

Elisa Mantovani: URI : http://loop.frontiersin.org/people/595167/overview

Angela Federico: URI : http://loop.frontiersin.org/people/564169/overview

Fabio Lugoboni: URI : http://loop.frontiersin.org/people/645076/overview

Stefano Tamburin: URI : http://loop.frontiersin.org/people/156050/overview

Journal

Journal ID (nlm-ta): Front Neurosci

Journal ID (iso-abbrev): Front Neurosci

Journal ID (publisher-id): Front. Neurosci.

Title: Frontiers in Neuroscience

Publisher: Frontiers Media S.A.

ISSN (Print): 1662-4548

ISSN (Electronic): 1662-453X

Publication date (Electronic): 18 August 2020

Publication date Collection: 2020

Volume: 14

Electronic Location Identifier: 729

Affiliations

[1] ¹Neurology Unit, Department of Neurosciences, Verona University Hospital , Verona, Italy

[2] ²Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona , Verona, Italy

[3] ³Addiction Medicine Unit, Department of Medicine, Verona University Hospital , Verona, Italy

Author notes

Edited by: Liana Fattore, National Research Council (CNR), Italy

Reviewed by: Karen Moxon, University of California, Davis, United States; Suelen Lucio Boschen, Mayo Clinic, United States

*Correspondence: Fabio Lugoboni fabio.lugoboni@ 123456aovr.veneto.it

Stefano Tamburin stefano.tamburin@ 123456univr.it

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

†These authors have contributed equally to this work

‡ORCID: Stefano Tamburin orcid.org/0000-0002-1561-2187

Article

DOI: 10.3389/fnins.2020.00729

PMC ID: 7461832

SO-VID: 95276c28-be9f-48ef-aa0c-9389d027dc57

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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) and the copyright owner(s) 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

Date received : 20 February 2020

Date accepted : 18 June 2020

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Figures: 1, Tables: 2, Equations: 0, References: 78, Pages: 11, Words: 8334

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Most cited references 55

Problem gambling worldwide: An update and systematic review of empirical research (2000–2015)

Modulating parameters of excitability during and after transcranial direct current stimulation of the human motor cortex.

Study and modulation of human cortical excitability with transcranial magnetic stimulation.

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