Introduction

Despite intense neuroscience research on the neurobiological underpinnings of Gambling Disorder (GD) and gambling-related decision-making, effective treatments targeting these dysfunctions are still lacking. Non Invasive Brain Stimulation (NIBS) techniques, such as transcranial Direct Current Stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS), selectively modulate activity of brain circuits and have the potential to reverse alterations sustaining GD symptoms. Therefore, the aim of this systematic review was to determine the impact of different NIBS interventions on gambling-related decision processes.

Methods

We conducted a comprehensive and translational search in three online databases (MEDLINE via PubMed, Scopus, Web of Science), in accordance with the PRISMA guidelines. We included studies applying neuromodulation (TMS, tDCS) techniques in GD patients or assessing gambling-related decision-making in healthy subjects. In addition, we explored the potential impact of NIBS in drug-induced GD (e.g., Parkinson's Disease).

Results

Twenty-seven studies have been included. We summarized results to detect the impact of different targets and stimulation/inhibition protocols in terms of gambling-related decision-making. The majority of both tDCS and TMS studies targeted the dorsolateral prefrontal cortex. Although heterogeneous in protocols and parameters, results from tDCS and TMS studies converge in indicating that the stimulation (instead of inhibition) of prefrontal regions could be beneficial to contrast dysfunctional gambling-related decision processes.

Conclusion

NIBS interventions show promise to be further tested in controlled clinical settings for the treatment of behavioral addictions. Further studies are also necessary to investigate connectivity changes and laterality issues (unilateral versus bilateral; left versus right) of NIBS application in GD.

中文翻译：

---

非侵入性大脑刺激的目标和方法来调节与赌博相关的决定：系统综述

介绍

尽管对赌博疾病（GD）和赌博相关决策的神经生物学基础进行了深入的神经科学研究，但仍缺乏针对这些功能障碍的有效治疗方法。非侵入性脑刺激（NIBS）技术，例如经颅直流电刺激（tDCS）和经颅磁刺激（TMS），可以选择性调节脑回路的活动，并具有逆转维持GD症状的改变的潜力。因此，本系统综述的目的是确定不同的NIBS干预对与赌博相关的决策过程的影响。

方法

根据PRISMA指南，我们在三个在线数据库（MEDLINE通过PubMed，Scopus，Web of Science）中进行了全面的翻译搜索。我们纳入了在GD患者中应用神经调节（TMS，tDCS）技术或评估健康受试者中与赌博相关的决策的研究。此外，我们探讨了NIBS对药物诱导的GD（例如帕金森氏病）的潜在影响。

结果

已纳入二十七项研究。我们总结了结果，以检测与赌博相关的决策方面不同目标和刺激/抑制方案的影响。tDCS和TMS的大多数研究都针对背外侧前额叶皮层。尽管协议和参数各不相同，但tDCS和TMS研究的结果融合在一起，表明前额叶区域的刺激（而非抑制作用）可能有利于对比与赌博相关的功能障碍的决策过程。

结论

NIBS干预措施显示有望在可控制的临床环境中进一步测试行为成瘾的治疗。还需要进一步研究来研究GD中NIBS应用的连通性变化和侧向性问题（单侧与双侧；左与右）。