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Efficacy of Continuous Theta Burst Stimulation to the Pre-supplementary Motor Area in Gambling Disorder: a Randomized Double-Blind Controlled Trial

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Abstract

Gambling disorder (GD) is a condition constituting a public health concern due to its impactful detrimental consequences for affected individuals and its very high social costs. Given the lack of FDA-approved treatments, novel non-pharmacological interventions are warranted. In this double-blind randomized controlled trial, we aimed to investigate the effects of continuous Theta Burst Stimulation (cTBS) in patients with GD. Twenty-nine patients with a diagnosis of GD were included and randomly assigned to active or sham condition. In the active condition, participants received 10 sessions of cTBS over pre-SMA bilaterally. Patients were evaluated at baseline and at the end of treatment with the Pathological Gambling version of the Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS) as primary outcome measure, and with the following secondary measures: Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D), Gambling Urges Scale (GUS), Barratt Impulsiveness Scale (BIS-11), Sheehan Disability Scale (SDS), Fagerstrom Test for Nicotine Dependence (FTND). A two-way repeated measures ANOVA revealed a significant “group” × “time” interaction for PG-YBOCS and GUS measures. Within group comparisons revealed that PG-YBOCS scores (p<.001) and GUS scores (p<.001) improved significantly in the group receiving the active stimulation, and positively correlated with a reduction of gambling-related disability, as measured with the SDS. This study shows that cTBS could be an effective treatment for GD, since it reduces one of its main dimensions: craving. Trial registration: ClinicalTrials.gov Identifier: NCT03669315

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Acknowledgements

All authors would like to thank Gregory Gasic for his valuable suggestions.

Funding

This research was supported in part by the Institute of Health (NIH) grants R01 MH112748 (to NM), R01 MH111917 (to NM), R21 DA042271 (to NM, JC and SP) and K24 MH116366 (to NM).

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Correspondence to Stefano Pallanti.

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The study was approved by the regional ethics committee (ref. 11992), under the venue of the Universitary hospital (Comitato Etico Area Vasta Centro, Florence, Italy),

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Pallanti, S., Camprodon, J.A., Di Ponzio, M. et al. Efficacy of Continuous Theta Burst Stimulation to the Pre-supplementary Motor Area in Gambling Disorder: a Randomized Double-Blind Controlled Trial. Int J Ment Health Addiction (2023). https://doi.org/10.1007/s11469-023-01120-z

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