ACCELERATED COURSE OF INTERMITTENT THETA BURST FOR METHAMPHETAMINE USE DISORDER: FEASIBILITY AND EEG-DERIVED FUNCTIONAL CONNECTIVITY CORRELATES OF TREATMENT RESPONSE

Background

Intermittent theta burst stimulation (iTBS) has been shown to reduce craving in individuals with methamphetamine use disorder (MUD). Low retention rates, due in part to housing and transportation challenges, is a common barrier which may be overcome using accelerated iTBS protocols. Concurrent electroencephalograhy (EEG) offers the potential to measure brain network-level effects of iTBS in MUD. Here, we evaluated the feasibility of an accelerated iTBS protocol in MUD and explored EEG-derived connectivity changes with iTBS.

Methods

Participants received 50 sessions of open-label iTBS of left dorsolateral prefrontal cortex (L-DLPFC) over a three-week-period (NCT06424184). Resting state EEG (eyesclosed) was recorded before and after the first iTBS session. EEG-derived power envelope source space connectivity was computed using the Schaefer 100-parcel atlas for default mode (DMN), visual (VIS), somatomotor (SMN), dorsal attention (DAN), salience (SN), limbic (LN), and frontoparietal (FPN) networks. Craving was assessed using a visual analog scale (VAS) before treatment and self-rated ability to control use (11-point Likert scale, 0= no ability and 10=complete ability) was assessed after first treatment each day. Depression severity was assessed with the 16-item Quick Inventory of Depressive Symptomatology SelfReport version.

Results

Of the 14 participants [4 females/ 10 males; mean (standard deviation, SD) age: 44.5 (8.6)], 12 completed at least 45 sessions . After three weeks of accelerated iTBS, there was significant reduction in craving [est. (95% CI): -18.79 (-34.20, -3.37)] and QIDS-SR [est. (95% CI): -3.36 (-4.74, -1.97)] and significant improvement in self-rated ability to control methamphetamine use [est. (95% CI): 1.36 (0.28, 2.43)]. A single iTBS session was associated with increased DMN-FPN connectivity (FDR-adjusted p < 0.05). Greater SMN connectivity with LN (rspearman = 0.71, p=0.015), SN (rspearman = 0.72, p=0.012) and DMN (rspearman = 0.69, p=0.018) after the first session was associated with higher selfreported ability to control use.

Conclusions

These findings suggest accelerated protocols enable delivery of therapeutic doses of iTBS to individuals with MUD. iTBS targeting L-DLPFC may increase DMN-FPN connectivity, reduce craving and improve ability to control methamphetamine use.

References

Su H, Chen T, Jiang H, et al. Intermittent theta burst transcranial magnetic stimulation for methamphetamine addiction: A randomized clinical trial. Eur Neuropsychopharmacol. 2020;31:158–161. Li Y, Yang B, Ma J, et al. Assessment of rTMS treatment effects for methamphetamine addiction based on EEG functional connectivity. Cogn Neurodyn. 2024;18(5):2373–2386.