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      Gambling disorder and bilateral transcranial direct current stimulation: A case report

      case-report

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          Abstract

          Introduction

          Gambling disorder (GD) is a major public health concern with currently no validated and efficacious treatments approved. In this single case study, we report the short- and long-term effect of bilateral transcranial direct current stimulation (tDCS) of dorsolateral prefrontal cortex (DLPFC) on craving and impulse control in a subject with GD.

          Methods

          The patient is a 26-year-old Caucasian male with an 8-year history of GD as well as alcohol and cocaine misuse. Treatment consisted of twice-a-day stimulation for 10 days. According to the literature, both the left (to control craving) and the right (to control emotional impulses) DLPFC were stimulated. Patients subsequently received tDCS once a week for 3 months and then once every 2 weeks for another 3 months.

          Results

          After 10 days of treatment, the subject reported improved psychiatric symptoms (depression, anxiety, and impulsivity), as well as reduced gambling craving symptom severity. After 3 and 6 months of treatment, the clinical picture further improved.

          Discussion

          This is the first report of tDCS effectiveness in a single case study of GD. Therapeutic effects, both on the addictive behavior and on psychiatric comorbid symptomatology, were lasting and continued over 6 months of tDCS maintenance treatment. Future case–control studies are required to test the efficacy of this tool in patients with GD.

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          Most cited references27

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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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            Using the international 10-20 EEG system for positioning of transcranial magnetic stimulation.

            Carlos Schönfeldt-Lecuona, Peyman Satrapi, Uwe Herwig (2002)
            The International 10-20 system for EEG electrode placement is increasingly applied for the positioning of transcranial magnetic stimulation (TMS) in cognitive neuroscience and in psychiatric treatment studies. The crucial issue in TMS studies remains the reliable positioning of the coil above the skull for targeting a desired cortex region. In order to asses the precision of the 10-20 system for this purpose, we tested its projections onto the underlying cortex by using neuronavigation. In 21 subjects, the 10-20 positions F3, F4, T3, TP3, and P3, as determined by a 10-20 positioning cap, were targeted stereotactically. The corresponding individual anatomical sites were identified in the Talairach atlas. The main targeted regions were: for F3 Brodmann areas (BA) 8/9 within the dorsolateral prefrontal cortex, for T3 BA 22/42 on the superior temporal gyrus, for TP3 BA 40/39 in thearea of the supramarginal and angular gyrus, and for P3 BA 7/40 on the inferior parietal lobe. However, in about 10% of the measurements adjacent and possibly functionally distinct BAs were reached. The ranges were mainly below 20 mm. Using the 10-20 system for TMS positioning is applicable at low cost and may reach desired cortex regions reliably on a larger scale level. For finer grained positioning, possible interindividual differences, and therefore the application of neuroimaging based methods, are to be considered.
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              An efficient and accurate new method for locating the F3 position for prefrontal TMS applications.

              William Beam, Jeffrey J Borckardt, Scott Reeves … (2009)
              The International 10-20 system is a method for standardized placement of electroencephalogram (EEG) electrodes. The 10-20 system correlates external skull locations with the underlying cortical areas. This system accounts for variability in patient skull size by using certain percentages of the circumference and distances between four basic anatomical landmarks. This 10-20 system has recently been used in transcranial magnetic stimulation (TMS) research for locating specific cortical areas. In the treatment of depression (and some types of pain), the desired placement of the TMS coil is often above the left dorsalateral prefrontal cortex (DLPFC) which corresponds to the F3 location given by the 10-20 system. However, for an administrator with little experience with the 10-20 system, the numerous measurements and calculations can be excessively time-consuming. Additionally, with more measurements comes more opportunity for human error. For this reason we have developed a new, simpler and faster way to find the F3 position using only three skull measurements. In this paper, we describe and illustrate the application of the new F3 location system, provide the formulas used in the calculation of the F3 position, and summarize data from 10 healthy adults. After using both the International 10-20 system and this new method, it appears that the new method is sufficiently accurate; however, future investigations may be warranted to conduct more in dept analyses of the method's utility and potential limitations. This system requires less time and training to find the optimal position for prefrontal coil placement and it saves considerable time compared to the 10-20 EEG system.
              Article 0 comments Cited 143 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (pmc): jba
                Journal ID (publisher-id): JBA
                Title: Journal of Behavioral Addictions
                Abbreviated Title: J Behav Addict
                Publisher: Akadémiai Kiadó (Budapest )
                ISSN (Print): 2062-5871
                ISSN (Electronic): 2063-5303
                Publication date (Electronic, epub): 21 September 2018
                Publication date (Print, ppub): September 2018
                Volume: 7
                Issue: 3
                Pages: 834-837
                Affiliations
                [ 1 ]Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University , Chieti, Italy
                [ 2 ]Department of Pharmacy, Pharmacology, Clinical Science, University of Hertfordshire , Herts, UK
                [ 3 ] SRP “Villa Maria Pia” , Rome, Italy
                [ 4 ]Institute of Psychiatry and Psychology, Fondazione Policlinico Universitario “A.Gemelli”, Università Cattolica del Sacro Cuore , Rome, Italy
                Author notes
                [* ]Corresponding author: Matteo Lupi, MD; Department of Neuroscience and Imaging, University “G. d’Annunzio”, Via dei Vestini 33, 66100, Chieti, Italy; Phone: +39 3385302482; Fax: +39 08713555887; E-mail: matteo826@ 123456yahoo.it
                Article
                DOI: 10.1556/2006.7.2018.85
                PMC ID: 6426396
                PubMed ID: 30264605
                SO-VID: e54315c0-1b62-4a4d-bc31-badb619eefc6
                Copyright © © 2018 The Author(s)
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                History
                Date received : 14 October 2017
                Date revision received : 16 February 2018
                Date: 05 August 2018
                Date accepted : 06 August 2018
                Page count
                Figures: 0, Tables: 1, Equations: 0, References: 25, Pages: 4
                Funding
                Funding sources: This manuscript was entirely funded by the authors, and no pharmaceutical companies were informed of or involved in the review.
                Categories
                Subject: CASE REPORT

                ScienceOpen disciplines: Evolutionary Biology,Medicine,Psychology,Educational research & Statistics,Social & Behavioral Sciences
                Keywords: gambling disorder,dorsolateral prefrontal cortex,transcranical direct current stimulation
                Data availability:
                ScienceOpen disciplines: Evolutionary Biology, Medicine, Psychology, Educational research & Statistics, Social & Behavioral Sciences
                Keywords: gambling disorder, dorsolateral prefrontal cortex, transcranical direct current stimulation

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