Insula responses to drug cues are correlated with cravings, and lesions in this area reduce nicotine seeking. Here, we investigated the potential efficacy of repetitive transcranial magnetic stimulation (rTMS) targeting the insula in alcohol addiction. Treatment-seeking alcohol-dependent patients (Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition; N = 56) participated in this double-blind, sham-controlled, randomized trial. Participants received 10 Hz rTMS or sham using an H8 coil, 5 days a week for 3 weeks. Stimulation targeted insular cortex and overlaying regions bilaterally, while excluding anterior prefrontal areas. Craving and self-reported as well as biomarker-based drinking measures were collected at baseline, during treatment, and through 12 weeks. Resting-state magnetic resonance imaging (rsMRI) data were collected before and after treatment. Task-based MRI was used to probe brain correlates of reward processing, affective responses, and alcohol following completion of treatment. A marked overall decrease in craving and drinking measures was observed during treatment, but did not differ between rTMS or sham stimulation. Both groups equally increased their alcohol use following completion of treatment and through the 12-week follow-up. Analysis using seeds in the insula identified differences in resting-state connectivity between active and sham groups at completion of treatment, potentially indicating an ability of treatment to modify insula function. However, while each task robustly replicated brain responses established in the literature, no effects of rTMS were found. Collectively, this study does not support efficacy of rTMS targeting the insula in alcohol addiction.

胰岛素对药物提示的反应与渴望有关，该区域的病变减少了对尼古丁的寻求。在这里，我们调查了针对酒精成瘾的岛内重复经颅磁刺激（rTMS）的潜在功效。寻求治疗的酒精依赖型患者（《精神障碍诊断和统计手册》，第四版；N = 56）参加了该双盲，假对照，随机试验。参与者每周5天使用H8线圈接收10 Hz rTMS或假信号，持续3周。刺激的目标是双侧岛上皮层和覆盖区域，同时不包括前额叶前区域。在基线，治疗期间和整个12周内收集了渴望和自我报告的饮酒以及基于生物标志物的饮酒措施。在治疗前后收集静息磁共振成像（rsMRI）数据。基于任务的MRI用于在完成治疗后探查奖励过程，情感反应和酒精的大脑相关性。在治疗期间观察到渴望和饮水措施的总体下降，但在rTMS或假刺激之间没有差异。两组均在完成治疗后和12周的随访中平均增加了饮酒量。使用绝缘岛中的种子进行的分析确定了治疗完成后活跃组和假生命组之间在静息状态连接性方面的差异，这可能表明治疗具有改变绝缘岛功能的能力。但是，尽管每个任务都可以可靠地复制文献中确定的大脑反应，但并未发现rTMS的作用。总体而言，该研究不支持针对烟瘾的针对岛突的rTMS的功效。尽管每个任务都可以强有力地复制文献中确定的大脑反应，但未发现rTMS的作用。总体而言，该研究不支持针对烟瘾的针对岛突的rTMS的功效。尽管每个任务都可以强有力地复制文献中确定的大脑反应，但未发现rTMS的作用。总体而言，该研究不支持针对烟瘾的针对岛突的rTMS的功效。