Currently there are few evidence based treatments for Cannabis Use Disorder (CUD), and those that are available have limited efficacy [1]. Cannabis craving is a commonly described behavioral construct in CUD [2], and may have clinical relevance. An expanding evidence base suggests that repetitive transcranial magnetic stimulation (rTMS) applied to the dorsolateral prefrontal cortex (DLPFC) decreases craving across a variety of different substance use disorders and may have treatment efficacy [3]. We recently reported that it was both safe and feasible to deliver a single session of rTMS to non-treatment seeking participants with CUD [4]; however, to date, no trial has attempted to apply a multi-session course of rTMS to individuals with CUD interested in reducing use. We sought to determine the feasibility of delivering such a course in this population and to determine a preliminary effect size to inform future research. We did so by performing an open-label pilot safety and tolerability trial, applying 20-sessions of rTMS over two weeks to participants with CUD who were interested in reducing use. Participants were then followed for four-weeks to determine if there was a potential treatment effect. The protocol was approved by the Medical University of South Carolina’s institutional review board, and registered with clinicaltrials.gov (NCT03538288). Participants were recruited from the community, and underwent a standardized evaluation [5e8]. Participants were included if they heavily used cannabis (>20 days/month), met DSM-5 criteria for moderate CUD, had a desire to reduce use, and were aged 18e60. Participants were excluded if they were pregnant/breastfeeding; met moderate use disorder of any other substance besides tobacco; required treatment for another psychiatric condition; were taking central nervous system active medications; or had any contraindications to receiving rTMS. Enrolling participants who met inclusion/exclusion criteria were scheduled to have 10 treatment visits (each consecutive weekday for two weeks), where twenty sessions of rTMS were delivered. Stimulation was delivered at the EEG coordinate for F3

中文翻译：

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系列案例探讨二十次重复经颅磁刺激 (rTMS) 对大麻使用和渴望的影响


目前，针对大麻使用障碍 (CUD) 的基于证据的治疗方法很少，而且现有的治疗方法疗效有限 [1]。对大麻的渴望是 CUD 中常见的行为结构 [2]，并且可能具有临床相关性。不断扩大的证据基础表明，应用于背外侧前额叶皮层 (DLPFC) 的重复经颅磁刺激 (rTMS) 可减少对各种不同物质使用障碍的渴望，并可能具有治疗功效 [3]。我们最近报告说，向未寻求治疗的 CUD 参与者提供单次 rTMS 既安全又可行 [4]；然而，迄今为止，还没有试验尝试将多疗程的 rTMS 应用于有兴趣减少使用的 CUD 患者。我们试图确定在这一人群中提供此类课程的可行性，并确定初步效果大小，为未来的研究提供信息。为此，我们进行了一项开放标签试点安全性和耐受性试验，在两周内对有兴趣减少使用的 CUD 参与者应用 20 次 rTMS。然后对参与者进行为期四个星期的跟踪以确定是否有潜在的治疗效果。该方案得到了南卡罗来纳医科大学机构审查委员会的批准，并在 ClinicalTrials.gov 注册（NCT03538288）。参与者是从社区招募的，并接受标准化评估[5e8]。如果参与者大量使用大麻（>20 天/月）、符合 DSM-5 中度 CUD 标准、希望减少使用且年龄在 18-60 岁，则被纳入研究范围。 如果参与者怀孕/哺乳，则被排除在外；除烟草外，患有任何其他物质的中度使用障碍；需要治疗另一种精神疾病；正在服用中枢神经系统活性药物；或有接受 rTMS 的任何禁忌症。符合纳入/排除标准的入组参与者计划进行 10 次治疗就诊（每周连续工作日，持续两周），其中进行 20 次 rTMS 治疗。在 EEG 坐标处为 F3 提供刺激