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Release carefully makes case for magnetic stimulation for cocaine addiction

Magnetic stimulation of the brain may help patients with cocaine addiction

Our Review Summary

brainThis release reports the findings from a small pilot study asking whether rTMS (repetitive transcranial magnetic stimulation) to certain parts of the brain in cocaine users can limit their use and affect their cravings for the drug. The results showed a decrease in both use and cravings for cocaine among the experimental group, as compared to a control group which only received medicinal drugs to address the effects of cocaine. The release did not address costs or the availability of rTMS treatments; otherwise it was a good, readable overview of an intriguing study.

 

Why This Matters

While cocaine abuse is widespread in the developed world, there are no proven therapies for this addiction. Some pharmacologic approaches appear to be helpful but they are still under investigation. Medicines given to such patients are intended to affect the symptoms but not the underlying disease.  If a non-invasive method such as rTMS proved effective in reducing cocaine use and if it were readily available, it would bring significant improvement to those users willing to take advantage of it.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

While the release clearly labels this work as preliminary, the overall inference of the news is that this is a potential successful treatment for cocaine addiction. But there is no mention at all of the potential cost of using this new approach.The FDA approved rTMS for major depression in December 2008. A 2013 article in Scientific American said a typical rTMS therapy session cost $300. In this study, patient volunteers underwent eight sessions which would have totaled $2,400 if paying out of pocket.

The costs of the drugs used to treat persons in the control group are well-known so at least those costs could be compared to that of the magnetic stimulation treatments to give readers an idea of whether the two approaches were financially comparable.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The release does an adequate job of pointing to improvements in both a reduction of drug cravings and an apparent reduction in cocaine use, based on regular urine tests. In addition, the release points to a greater relapse rate among those in the control group versus those who received the brain stimulation — using absolute numbers to describe the differences.

The study is promising and exciting, but the findings are only a suggestion and not a conclusion. We think the news release makes the distinction clear.

Does the news release adequately explain/quantify the harms of the intervention?

Satisfactory

The release states that the magnetic stimulation treatment is safe and non-invasive and is already in use to treat patients with depression and neuropathic pain.

Does the news release seem to grasp the quality of the evidence?

Satisfactory

This release does a good job of positioning the findings early as preliminary and stating that replication will be required among a much larger group of patients. It also points out that future larger studies should include a sham group as a control, rather than a group receiving pharmacological interventions.  Moreover, it points out that participants were all patients who sought out treatment in a hospital setting, meaning that they were perhaps more motivated toward ceasing drug abuse than other users.

Does the news release commit disease-mongering?

Satisfactory

This release does not promote disease mongering.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

The release fails to point out the funding sources for this work, or to address any possible information on potential conflicts of interest, even though that information is readily available in the research paper.

The published study states that funding was provided by several public and private sources in Italy and the National Institute on Alcohol Abuse (US), and that the study authors had no financial or potential conflicts of interest.

Does the news release compare the new approach with existing alternatives?

Satisfactory

The release states, “There is no effective drug treatment for cocaine addiction, with behavioural therapies being the main element of any treatment regime.” The medicinal drugs used on members of the control group were intended to treat accompanying symptoms brought on by cocaine use. In addition, addiction specialists have found that some drugs do offer some small benefits clinically, but they are not FDA approved for cocaine addiction treatment.

Does the news release establish the availability of the treatment/test/product/procedure?

Not Satisfactory

While the release does state that this particular form of brain stimulation is being used to treat some other conditions, there is no suggestion that the treatment is readily available in most hospital or out-patient facilities, information which would help readers gauge the practicality of seeking such treatments.

Does the news release establish the true novelty of the approach?

Satisfactory

The release states that, “As far as we know, this work represents the first clinical report indicating that rTMS treatment results in significant reduction in cocaine use.” That pretty clearly states the novel nature of the work, especially given the fact that there are no other effective treatments for cocaine addiction.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Satisfactory

This release does not seem to use any language that appears unjustifiable.

Total Score: 7 of 10 Satisfactory

Comments (2)

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James Fugedy

December 9, 2015 at 5:27 pm

Another neuromodulation procedure, transcranial direct current stimulation (tDCS) provides similar benefit to rTMS, but tDCS is safer, easier to do and can be self-administered with appropriate training and supervision. The lifetime cost of tDCS is less than the cost of 2 weeks of rTMS.

Concerning tDCS compared to rTMS:
Transcranial Brain Stimulation Techniques For Major Depression: Should We Extend TMS Lessons to tDCS? (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192830/)

Transcranial direct current stimulation (tDCS) for depression
NICE interventional procedure guidance [IPG530] Published date: August 2015 (https://www.nice.org.uk/guidance/ipg530)

Transcranial direct current stimulation for depression: 3-week, randomised, sham-controlled trial (figure 2 shows a 10% reduction of depression scores per week of tDCS)

(https://www.researchgate.net/profile/Veronica_Galvez/publication/51981465_Transcranial_direct_current_stimulation_for_depression_3-week_randomised_sham-controlled_trial/links/09e415087fa29739ef000000.pdf)

tDCS is safer than rTMS: the most significant adverse effect of rTMS is seizure:

https://www.researchgate.net/profile/Andrea_Antal/publication/6377248_Safety_aspects_of_transcranial_direct_current_stimulation_concerning_healthy_subjects_and_patients/links/0fcfd50a34830ccb05000000.pdf

7 seizures reported due to rTMS prior to 1996: Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5–7, 1996 (http://www1.icts.uci.edu/neuroimaging/Wassermann_rTMS_Safety1998.pdf)

The only reported case of seizure associated with tDCS (and it was most likely due to medication changes, not tDCS): http://eeg.sagepub.com/content/46/2/169.extract

tDCS, ease of use, as demonstrated by DIY:

Early adopters of the magical thinking cap: a study on do-it-yourself (DIY) transcranial direct current stimulation (tDCS) user community (http://jlb.oxfordjournals.org/content/early/2015/06/01/jlb.lsv017.full.pdf+html)

Self-administration of tDCS:

Evaluation of a home-based transcranial direct current stimulation (tDCS) treatment device for chronic pain: study protocol for a randomised controlled trial (http://www.trialsjournal.com/content/pdf/s13063-015-0710-5.pdf)

Evaluation of a home-based transcranial direct current stimulation (tDCS) treatment device for chronic pain: study protocol for a randomised controlled trial.
(http://www.ncbi.nlm.nih.gov/pubmed/25902771)

Cost of tDCS vs rTMS:

$4,000 for 2 weeks of rTMS (http://khn.org/news/magnetic-pulse-treatment-depression/)

The cost of the tDCS home-use program at the Brain Stimulation Clinic in Atlanta is $3,000 which is the lifetime cost.

Reply

Tom Parkhill

December 14, 2015 at 7:47 am

Just a couple of notes on this – I’m the press officer who issued the release. The press release did contain funding info, which was in ‘notes for editors’, which is available to journalists. I did not mention costs, as this is obviously a new and fairly experimental intervention, therefore routine costs (assuming the technique is validated) would be difficult to establish and certainly would not be comparable to the costs in the study. Same for availability, I had assumed that as a pilot study, a reader would guess that it is not generally available. However, I accept that I did not make these explicit points. Thanks for the review, which I appreciate.

Reply