Trial Outcomes & Findings for Bilateral Prefrontal Modulation in Alcoholism (NCT NCT02091284)

NCT ID: NCT02091284

Last Updated: 2019-08-08

Results Overview

Five items from the original obsessive compulsive drinking scale, which are believed to reliably assess craving in a narrow sense were used. Questions of this brief scale allow quantification of thoughts and feelings (obsessions), and behavioral intentions, and are answered on a scale ranging from 0 to 4, resulting in a total score between 0 and 20. Higher scores reflect more severe craving. These items were applied at the beginning, during and at the end of the treatment with sham-tDCS or tDCS.

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

49 participants

Primary outcome timeframe

Five applications: first week before tDCS treatment (baseline), second, third and fourth weeks, during the treatment, and in the fifth week, after the end of the tDCS treatment.

Results posted on

2019-08-08

Participant Flow

AUD patients of both genders were successively recruited between June of 2015 and January of 2018 from three specialized clinics for drug dependence treatment, one public and two privates, from the State of Espírito Santo, Brazil.

Participant milestones

Participant milestones
Measure
Real tDCS
Ten sessions (every other day) of bilateral transcranial Direct Current Stimulation (tDCS: 2 milliamperes, 3 x 7 cm2, during 20 minutes) over dorsolateral Prefrontal Cortex (cathodal left / anodal right). transcranial Direct Current Stimulation: Direct currents were transferred via a pair of carbonated-silicone electrodes (35 cm2) with a thick layer of high conductive gel for EEG underneath them. The electric current will be delivered by an electric stimulator. To stimulate the left DLPFC, the cathode electrode was placed over F3 according to the 10-20 international system while the anode was placed over the contralateral F4 region. The currents flowed continuously for 20 minutes with an intensity of 2 milliamperes.
Sham-tDCS
Ten sessions (every other day) of placebo control (sham procedure) of transcranial Direct Current Stimulation (sham-tDCS) during 20 minutes with electrodes placed over the dorsolateral Prefrontal Cortex (cathodal left / anodal right). Current was delivered for 20 seconds and was turned off for the rest of the stimulation period. In this way, subjects experienced the initial itching sensation at the beginning of stimulation, but received no current for the rest of the session.
Overall Study
STARTED
26
23
Overall Study
COMPLETED
23
22
Overall Study
NOT COMPLETED
3
1

Reasons for withdrawal

Reasons for withdrawal
Measure
Real tDCS
Ten sessions (every other day) of bilateral transcranial Direct Current Stimulation (tDCS: 2 milliamperes, 3 x 7 cm2, during 20 minutes) over dorsolateral Prefrontal Cortex (cathodal left / anodal right). transcranial Direct Current Stimulation: Direct currents were transferred via a pair of carbonated-silicone electrodes (35 cm2) with a thick layer of high conductive gel for EEG underneath them. The electric current will be delivered by an electric stimulator. To stimulate the left DLPFC, the cathode electrode was placed over F3 according to the 10-20 international system while the anode was placed over the contralateral F4 region. The currents flowed continuously for 20 minutes with an intensity of 2 milliamperes.
Sham-tDCS
Ten sessions (every other day) of placebo control (sham procedure) of transcranial Direct Current Stimulation (sham-tDCS) during 20 minutes with electrodes placed over the dorsolateral Prefrontal Cortex (cathodal left / anodal right). Current was delivered for 20 seconds and was turned off for the rest of the stimulation period. In this way, subjects experienced the initial itching sensation at the beginning of stimulation, but received no current for the rest of the session.
Overall Study
Withdrawal by Subject
2
1
Overall Study
unreliable data
1
0

Baseline Characteristics

Bilateral Prefrontal Modulation in Alcoholism

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Real tDCS
n=23 Participants
Ten sessions (every other day) of bilateral transcranial Direct Current Stimulation (tDCS: 2 milliamperes, 3 x 7 cm2, during 20 minutes) over dorsolateral Prefrontal Cortex (cathodal left / anodal right). transcranial Direct Current Stimulation: Direct currents were transferred via a pair of carbonated-silicone electrodes (35 cm2) with a thick layer of high conductive gel for EEG underneath them. The electric current will be delivered by an electric stimulator. To stimulate the left DLPFC, the cathode electrode was placed over F3 according to the 10-20 international system while the anode was placed over the contralateral F4 region. The currents flowed continuously for 20 minutes with an intensity of 2 milliamperes.
Sham-tDCS
n=22 Participants
Ten sessions (every other day) of placebo control (sham procedure) of transcranial Direct Current Stimulation (sham-tDCS) during 20 minutes with electrodes placed over the dorsolateral Prefrontal Cortex (cathodal left / anodal right). Current was delivered for 20 seconds and was turned off for the rest of the stimulation period. In this way, subjects experienced the initial itching sensation at the beginning of stimulation, but received no current for the rest of the session.
Total
n=45 Participants
Total of all reporting groups
Age, Continuous
46.3 years
STANDARD_DEVIATION 12.0 • n=5 Participants
43.5 years
STANDARD_DEVIATION 10.2 • n=7 Participants
44.9 years
STANDARD_DEVIATION 11.1 • n=5 Participants
Sex: Female, Male
Female
5 Participants
n=5 Participants
3 Participants
n=7 Participants
8 Participants
n=5 Participants
Sex: Female, Male
Male
18 Participants
n=5 Participants
19 Participants
n=7 Participants
37 Participants
n=5 Participants
Race/Ethnicity, Customized
Race · White
11 Participants
n=5 Participants
12 Participants
n=7 Participants
23 Participants
n=5 Participants
Race/Ethnicity, Customized
Race · Brown
8 Participants
n=5 Participants
6 Participants
n=7 Participants
14 Participants
n=5 Participants
Race/Ethnicity, Customized
Race · Black
4 Participants
n=5 Participants
4 Participants
n=7 Participants
8 Participants
n=5 Participants
Years of education
Up to 5
13 Participants
n=5 Participants
9 Participants
n=7 Participants
22 Participants
n=5 Participants
Years of education
Between 6 to 9
1 Participants
n=5 Participants
4 Participants
n=7 Participants
5 Participants
n=5 Participants
Years of education
Between 10 to 13
5 Participants
n=5 Participants
5 Participants
n=7 Participants
10 Participants
n=5 Participants
Years of education
Above 13
3 Participants
n=5 Participants
4 Participants
n=7 Participants
7 Participants
n=5 Participants
Years of education
Not reported
1 Participants
n=5 Participants
0 Participants
n=7 Participants
1 Participants
n=5 Participants
Employment situation
Formal job
2 Participants
n=5 Participants
6 Participants
n=7 Participants
8 Participants
n=5 Participants
Employment situation
Informal job
2 Participants
n=5 Participants
0 Participants
n=7 Participants
2 Participants
n=5 Participants
Employment situation
Unemployed
11 Participants
n=5 Participants
10 Participants
n=7 Participants
21 Participants
n=5 Participants
Employment situation
Freelance
2 Participants
n=5 Participants
2 Participants
n=7 Participants
4 Participants
n=5 Participants
Employment situation
Disease benefit
3 Participants
n=5 Participants
0 Participants
n=7 Participants
3 Participants
n=5 Participants
Employment situation
Not reported
1 Participants
n=5 Participants
2 Participants
n=7 Participants
3 Participants
n=5 Participants
Employment situation
Retired
2 Participants
n=5 Participants
2 Participants
n=7 Participants
4 Participants
n=5 Participants
Marital state
Single
15 Participants
n=5 Participants
7 Participants
n=7 Participants
22 Participants
n=5 Participants
Marital state
Married or common-law
7 Participants
n=5 Participants
7 Participants
n=7 Participants
14 Participants
n=5 Participants
Marital state
Divorced
0 Participants
n=5 Participants
6 Participants
n=7 Participants
6 Participants
n=5 Participants
Marital state
Widow
1 Participants
n=5 Participants
1 Participants
n=7 Participants
2 Participants
n=5 Participants
Marital state
Not reported
0 Participants
n=5 Participants
1 Participants
n=7 Participants
1 Participants
n=5 Participants
Tobacco use
Yes
12 Participants
n=5 Participants
11 Participants
n=7 Participants
23 Participants
n=5 Participants
Tobacco use
No
11 Participants
n=5 Participants
11 Participants
n=7 Participants
22 Participants
n=5 Participants
Age at onset of alcohol use
15.5 years
STANDARD_DEVIATION 5.4 • n=5 Participants
16.9 years
STANDARD_DEVIATION 6.0 • n=7 Participants
16.2 years
STANDARD_DEVIATION 5.7 • n=5 Participants
Amount of alcohol used (drinks/day)
20.3 drinks/day
STANDARD_DEVIATION 13.4 • n=5 Participants
15.5 drinks/day
STANDARD_DEVIATION 15.0 • n=7 Participants
17.9 drinks/day
STANDARD_DEVIATION 14.3 • n=5 Participants
Days of abstinence before study
33.0 days
STANDARD_DEVIATION 12.4 • n=5 Participants
32.9 days
STANDARD_DEVIATION 12.5 • n=7 Participants
33.0 days
STANDARD_DEVIATION 12.7 • n=5 Participants

PRIMARY outcome

Timeframe: Five applications: first week before tDCS treatment (baseline), second, third and fourth weeks, during the treatment, and in the fifth week, after the end of the tDCS treatment.

Five items from the original obsessive compulsive drinking scale, which are believed to reliably assess craving in a narrow sense were used. Questions of this brief scale allow quantification of thoughts and feelings (obsessions), and behavioral intentions, and are answered on a scale ranging from 0 to 4, resulting in a total score between 0 and 20. Higher scores reflect more severe craving. These items were applied at the beginning, during and at the end of the treatment with sham-tDCS or tDCS.

Outcome measures

Outcome measures
Measure
Real tDCS
n=23 Participants
Ten sessions (every other day) of bilateral transcranial Direct Current Stimulation (tDCS: 2 milliamperes, 3 x 7 cm2, during 20 minutes) over dorsolateral Prefrontal Cortex (cathodal left / anodal right). transcranial Direct Current Stimulation: Direct currents were transferred via a pair of carbonated-silicone electrodes (35 cm2) with a thick layer of high conductive gel for EEG underneath them. The electric current will be delivered by an electric stimulator. To stimulate the left DLPFC, the cathode electrode was placed over F3 according to the 10-20 international system while the anode was placed over the contralateral F4 region. The currents flowed continuously for 20 minutes with an intensity of 2 milliamperes.
Sham-tDCS
n=22 Participants
Ten sessions (every other day) of placebo control (sham procedure) of transcranial Direct Current Stimulation (sham-tDCS) during 20 minutes with electrodes placed over the dorsolateral Prefrontal Cortex (cathodal left / anodal right). Current was delivered for 20 seconds and was turned off for the rest of the stimulation period. In this way, subjects experienced the initial itching sensation at the beginning of stimulation, but received no current for the rest of the session.
Craving
Initial scores (1st week)
5.522 scores
Standard Deviation 4.44
3.818 scores
Standard Deviation 4.468
Craving
During treatment (2nd week)
4.391 scores
Standard Deviation 3.751
4.136 scores
Standard Deviation 4.549
Craving
During treatment (3rd week)
3.348 scores
Standard Deviation 3.485
3.545 scores
Standard Deviation 3.961
Craving
During treatment (4th week)
1.739 scores
Standard Deviation 2.544
3.273 scores
Standard Deviation 4.322
Craving
Final scores (5th week)
1.565 scores
Standard Deviation 2.409
2.455 scores
Standard Deviation 3.674

OTHER_PRE_SPECIFIED outcome

Timeframe: Before tDCS treatment (initial) and after the end of the tDCS treatment (final)

The FAB was used to explore six different domains of executive function. Each of these items is scored from 0 (zero) to a maximum of 3. Thus, the maximum score, meaning better scores, of FAB is 18. A single well trained examiner administered this assessment.

Outcome measures

Outcome measures
Measure
Real tDCS
n=23 Participants
Ten sessions (every other day) of bilateral transcranial Direct Current Stimulation (tDCS: 2 milliamperes, 3 x 7 cm2, during 20 minutes) over dorsolateral Prefrontal Cortex (cathodal left / anodal right). transcranial Direct Current Stimulation: Direct currents were transferred via a pair of carbonated-silicone electrodes (35 cm2) with a thick layer of high conductive gel for EEG underneath them. The electric current will be delivered by an electric stimulator. To stimulate the left DLPFC, the cathode electrode was placed over F3 according to the 10-20 international system while the anode was placed over the contralateral F4 region. The currents flowed continuously for 20 minutes with an intensity of 2 milliamperes.
Sham-tDCS
n=22 Participants
Ten sessions (every other day) of placebo control (sham procedure) of transcranial Direct Current Stimulation (sham-tDCS) during 20 minutes with electrodes placed over the dorsolateral Prefrontal Cortex (cathodal left / anodal right). Current was delivered for 20 seconds and was turned off for the rest of the stimulation period. In this way, subjects experienced the initial itching sensation at the beginning of stimulation, but received no current for the rest of the session.
Changes in Frontal Assessment Battery (FAB) Scores
initial
12.48 scores
Standard Deviation 4.19
11.14 scores
Standard Deviation 2.95
Changes in Frontal Assessment Battery (FAB) Scores
final
13.26 scores
Standard Deviation 4.41
13.32 scores
Standard Deviation 3.59

OTHER_PRE_SPECIFIED outcome

Timeframe: Before tDCS treatment (initial) and after the end of the tDCS treatment (final)

An adapted version of the MMSE in Portuguese was used. This version included an 11-item examination that examined five areas of cognitive function: orientation, registration, attention and calculation, recall, and language. The maximum score, meaning better scores, that could be achieved was 30, while a mean score between 23 and 26 or between 26 and 29 would be expected according to the age and educational level of the alcoholics.

Outcome measures

Outcome measures
Measure
Real tDCS
n=23 Participants
Ten sessions (every other day) of bilateral transcranial Direct Current Stimulation (tDCS: 2 milliamperes, 3 x 7 cm2, during 20 minutes) over dorsolateral Prefrontal Cortex (cathodal left / anodal right). transcranial Direct Current Stimulation: Direct currents were transferred via a pair of carbonated-silicone electrodes (35 cm2) with a thick layer of high conductive gel for EEG underneath them. The electric current will be delivered by an electric stimulator. To stimulate the left DLPFC, the cathode electrode was placed over F3 according to the 10-20 international system while the anode was placed over the contralateral F4 region. The currents flowed continuously for 20 minutes with an intensity of 2 milliamperes.
Sham-tDCS
n=22 Participants
Ten sessions (every other day) of placebo control (sham procedure) of transcranial Direct Current Stimulation (sham-tDCS) during 20 minutes with electrodes placed over the dorsolateral Prefrontal Cortex (cathodal left / anodal right). Current was delivered for 20 seconds and was turned off for the rest of the stimulation period. In this way, subjects experienced the initial itching sensation at the beginning of stimulation, but received no current for the rest of the session.
Changes in Mini-Mental Status Examination (MMSE)
initial
23.13 scores
Standard Deviation 8.67
24.91 scores
Standard Deviation 5.82
Changes in Mini-Mental Status Examination (MMSE)
final
23.87 scores
Standard Deviation 8.42
24.64 scores
Standard Deviation 5.9

OTHER_PRE_SPECIFIED outcome

Timeframe: Before tDCS treatment (initial) and after the end of the tDCS treatment (final)

A structured multiple-choice questionnaire was used to assess the severity of depression symptoms. This instrument assesses the severity of symptoms observed in depression, such as low mood, insomnia, agitation, anxiety and weight loss (Hamilton, 1960). Each question has between 3 and 5 possible answers that increase in severity. In the original scale, the first 17 questions contribute to the total score, while questions 18 to 21 provide additional information about depression (e.g., diurnal variation, paranoid symptoms), but are not included in the total score of the scale. Scores of 0-7 are considered as being normal, 8-16 suggest mild depression, 17-23 moderate depression and scores over 24 are indicative of severe depression; the maximum score is 52.

Outcome measures

Outcome measures
Measure
Real tDCS
n=23 Participants
Ten sessions (every other day) of bilateral transcranial Direct Current Stimulation (tDCS: 2 milliamperes, 3 x 7 cm2, during 20 minutes) over dorsolateral Prefrontal Cortex (cathodal left / anodal right). transcranial Direct Current Stimulation: Direct currents were transferred via a pair of carbonated-silicone electrodes (35 cm2) with a thick layer of high conductive gel for EEG underneath them. The electric current will be delivered by an electric stimulator. To stimulate the left DLPFC, the cathode electrode was placed over F3 according to the 10-20 international system while the anode was placed over the contralateral F4 region. The currents flowed continuously for 20 minutes with an intensity of 2 milliamperes.
Sham-tDCS
n=22 Participants
Ten sessions (every other day) of placebo control (sham procedure) of transcranial Direct Current Stimulation (sham-tDCS) during 20 minutes with electrodes placed over the dorsolateral Prefrontal Cortex (cathodal left / anodal right). Current was delivered for 20 seconds and was turned off for the rest of the stimulation period. In this way, subjects experienced the initial itching sensation at the beginning of stimulation, but received no current for the rest of the session.
Changes in Hamilton Depression Rating Scale (HAM-D)
initial
2.95 scores
Standard Deviation 2.1
3.0 scores
Standard Deviation 1.75
Changes in Hamilton Depression Rating Scale (HAM-D)
final
2.17 scores
Standard Deviation 1.88
2.73 scores
Standard Deviation 2.25

OTHER_PRE_SPECIFIED outcome

Timeframe: Before tDCS treatment (initial) and after the end of the tDCS treatment (final)

A structured multiple-choice questionnaire designed to assess the severity of anxiety symptoms was employed. The scale consists of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (e.g., mental agitation and psychological distress) and somatic anxiety (e.g., physical complaints related to anxiety). The higher the scores, higher the severity. Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0-56, where below 17 indicates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe.

Outcome measures

Outcome measures
Measure
Real tDCS
n=23 Participants
Ten sessions (every other day) of bilateral transcranial Direct Current Stimulation (tDCS: 2 milliamperes, 3 x 7 cm2, during 20 minutes) over dorsolateral Prefrontal Cortex (cathodal left / anodal right). transcranial Direct Current Stimulation: Direct currents were transferred via a pair of carbonated-silicone electrodes (35 cm2) with a thick layer of high conductive gel for EEG underneath them. The electric current will be delivered by an electric stimulator. To stimulate the left DLPFC, the cathode electrode was placed over F3 according to the 10-20 international system while the anode was placed over the contralateral F4 region. The currents flowed continuously for 20 minutes with an intensity of 2 milliamperes.
Sham-tDCS
n=22 Participants
Ten sessions (every other day) of placebo control (sham procedure) of transcranial Direct Current Stimulation (sham-tDCS) during 20 minutes with electrodes placed over the dorsolateral Prefrontal Cortex (cathodal left / anodal right). Current was delivered for 20 seconds and was turned off for the rest of the stimulation period. In this way, subjects experienced the initial itching sensation at the beginning of stimulation, but received no current for the rest of the session.
Changes in Hamilton Anxiety Rating Scale (HAM-A)
initial
4.26 scores
Standard Deviation 5.9
3.77 scores
Standard Deviation 3.93
Changes in Hamilton Anxiety Rating Scale (HAM-A)
final
3.87 scores
Standard Deviation 7.51
3.91 scores
Standard Deviation 6.36

OTHER_PRE_SPECIFIED outcome

Timeframe: Before tDCS treatment (initial) and after the end of the tDCS treatment (final)

Population: ERP data was not possible in the total sample of each group because of technical difficulties.

Electrophysiological recording was obtained through a 32-channel system placed on the scalp according to the International 10/20 EEG system. A cue-reactivity paradigm was adapted following standard cue-reactivity paradigms well established for pictures and videos. During picture presentation the subjects were asked to press a button whenever the drug-related pictures were presented, and to withhold the response when the neutral pictures were presented (50% of the time). The percent change of ventral medial Prefrontal Cortex current density was analyzed.

Outcome measures

Outcome measures
Measure
Real tDCS
n=10 Participants
Ten sessions (every other day) of bilateral transcranial Direct Current Stimulation (tDCS: 2 milliamperes, 3 x 7 cm2, during 20 minutes) over dorsolateral Prefrontal Cortex (cathodal left / anodal right). transcranial Direct Current Stimulation: Direct currents were transferred via a pair of carbonated-silicone electrodes (35 cm2) with a thick layer of high conductive gel for EEG underneath them. The electric current will be delivered by an electric stimulator. To stimulate the left DLPFC, the cathode electrode was placed over F3 according to the 10-20 international system while the anode was placed over the contralateral F4 region. The currents flowed continuously for 20 minutes with an intensity of 2 milliamperes.
Sham-tDCS
n=8 Participants
Ten sessions (every other day) of placebo control (sham procedure) of transcranial Direct Current Stimulation (sham-tDCS) during 20 minutes with electrodes placed over the dorsolateral Prefrontal Cortex (cathodal left / anodal right). Current was delivered for 20 seconds and was turned off for the rest of the stimulation period. In this way, subjects experienced the initial itching sensation at the beginning of stimulation, but received no current for the rest of the session.
Changes in Event-Related Potentials (ERPs)
-30.34 percent change
Standard Deviation 28.68
125.7 percent change
Standard Deviation 141.6

OTHER_PRE_SPECIFIED outcome

Timeframe: Before tDCS treatment (initial) and after the end of the tDCS treatment (final)

Population: These data was not collected correctly.

An abbreviated instrument of cross-culturally valid assessment of quality of life of the World Health Organization (WHOQOL-BREF) with 26 questions translated to Portuguese was applied at the beginning and at the end of the five-week treatment. This instrument yields four domains (physical health, psychological, social relationships and environment) and two individually scored items regarding overall perception of quality of life (Q1, i.e., first question) and health (Q2, i.e., second question). The four domain scores are scaled in a way that higher scores stand for higher quality of life. These scores were transformed to be comparable with the scores used in the WHOQOL-100.

Outcome measures

Outcome data not reported

Adverse Events

Real tDCS

Serious events: 0 serious events
Other events: 16 other events
Deaths: 0 deaths

Sham-tDCS

Serious events: 0 serious events
Other events: 13 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Real tDCS
n=23 participants at risk
Ten sessions (every other day) of bilateral transcranial Direct Current Stimulation (tDCS: 2 milliamperes, 3 x 7 cm2, during 20 minutes) over dorsolateral Prefrontal Cortex (cathodal left / anodal right). transcranial Direct Current Stimulation: Direct currents were transferred via a pair of carbonated-silicone electrodes (35 cm2) with a thick layer of high conductive gel for EEG underneath them. The electric current will be delivered by an electric stimulator. To stimulate the left DLPFC, the cathode electrode was placed over F3 according to the 10-20 international system while the anode was placed over the contralateral F4 region. The currents flowed continuously for 20 minutes with an intensity of 2 milliamperes.
Sham-tDCS
n=22 participants at risk
Ten sessions (every other day) of placebo control (sham procedure) of transcranial Direct Current Stimulation (sham-tDCS) during 20 minutes with electrodes placed over the dorsolateral Prefrontal Cortex (cathodal left / anodal right). Current was delivered for 20 seconds and was turned off for the rest of the stimulation period. In this way, subjects experienced the initial itching sensation at the beginning of stimulation, but received no current for the rest of the session.
Skin and subcutaneous tissue disorders
Tingling in the scalp
69.6%
16/23 • Number of events 16 • Adverse events were examined once at the end of each tDCS application. Therefore, over 10 tDCS applications, with a total of 10 examinations.
We asked subjects about the following adverse effects: headache, neck and scalp pain, tingling, itching, skin redness, burning sensation of the scalp, sleepiness, acute mood changes, trouble concentrating, and others after treatment.
59.1%
13/22 • Number of events 13 • Adverse events were examined once at the end of each tDCS application. Therefore, over 10 tDCS applications, with a total of 10 examinations.
We asked subjects about the following adverse effects: headache, neck and scalp pain, tingling, itching, skin redness, burning sensation of the scalp, sleepiness, acute mood changes, trouble concentrating, and others after treatment.

Additional Information

Dr. Ester Miyuki Nakamura-Palacios

Federal University of Espírito Santo

Phone: +55 27 3335-7337

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place