High Frequency rTMS Over l-DLPFC in Gambling Disorder

NCT ID: NCT03733808

Last Updated: 2020-02-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

36 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-12-11

Study Completion Date

2022-08-31

Brief Summary

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Gambling disorder (GD), currently considered a behavioral addiction, show substantial similarities with substance use disorders (SUDs) in terms of neurobiology and symptomatology. In particular, alterations in prefrontal control circuit may underlie vulnerability to gambling- and drug-related cues and diminished cognitive control over craving, and negative emotions. Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) could represent a novel approach to remodel these brain circuits.

The aim of this study is to evaluate High frequency (HF) rTMS over the left DLPFC as an efficacious treatment for reduction of gambling urges and behavior in a randomized double-blind placebo-controlled design in which 36 GD patients will receive active or sham rTMS for 12 weeks.

Detailed Description

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Gambling disorder (GD) is a progressive and recurrent maladaptive pattern of gambling behavior, leading to impaired functioning.

GD has been recategorized from an impulse control disorder to an addiction-related disorder in the fifth edition of Diagnostic and Statistical Manual of Mental (DSM-5) reflecting the growing evidence of the substantially overlapping between the neurobiology of GD and substance use disorders (SUDs). Both GD and SUDs are characterized by malfunction in reward, stress and cognitive-control circuits, which underlie manifestations such as compulsive gambling or compulsive drug consumption, craving, altered reward sensitivity, impaired self-control and decision-making processes. Particularly, similar alterations in cortico-limbic-striatal and prefrontal control circuits have been shown associated to the emergence of drug cravings and gambling urges. Hence, craving might be seen as a core component across addictions. Indeed, identifying and targeting the neurocircuit alterations underlying craving, may allow to treat this feature across different addictions with similar strategies.

In this regard, High frequency (HF) repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (l-DLPFC), is a promising approach for modulating brain circuits underlying cue-induced craving. Since alterations in these circuits have been shown to underlie the emergence of gambling urges, HF rTMS may represent a potential treatment also for GD patients.

Thus, the main goals of this clinical trial are to 1) assess whether HF rTMS over l-DLPFC reduces urges to gamble and problem behaviors gambling related; 2) investigate whether rTMS induces hemodynamics changes in DLPFC activity in response to specific tasks that elicit such areas as visual stimuli associated with gambling; 3) assess whether rTMS induces improvements in decision making processes of GD patients; and 4) evaluate the effects of HF rTMS over l-DLPFC on resting functional connectivity, focusing mainly in connectivity changes of cortical and subcortical regions involved in this disorder.

Conditions

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Gambling Disorder

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Double blind, randomized, sham-controlled with a 1:1 allocation into 2 parallel arms
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Active rTMS treatment

Active High frequency rTMS will be administered with a Magventure MagPro Stimulator R30 using a butterfly coil. The stimulation protocol parameters will be set as follow: frequency of 15 Hz, of 100% of resting motor threshold (rMT), 40 trains, 60 pulses per train, 15 s intertrain-interval, 2400 pulses per session.

Group Type ACTIVE_COMPARATOR

Repetitive Transcranial Magnetic Stimulation

Intervention Type DEVICE

Non-invasive brain stimulation technique

Sham rTMS treatment

Sham rTMS will be administered with a Magventure MagPro Stimulator R30 using a butterfly sham coil. The same procedures of active High frequency rTMS will be used.

Group Type SHAM_COMPARATOR

Repetitive Transcranial Magnetic Stimulation

Intervention Type DEVICE

Non-invasive brain stimulation technique

Interventions

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Repetitive Transcranial Magnetic Stimulation

Non-invasive brain stimulation technique

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Age 18-65;
* Current DSM-5 diagnosis of Gambling Disorder;
* Right-handed;

Exclusion Criteria

* Current DSM-5 diagnosis of Schizophrenia Spectrum and other Psychotic Disorders;
* Current DSM-5 diagnosis of Bipolar and related Disorders;
* Use in the past 4 weeks of any medication with known pro-convulsant action; or current regular use of any psychotropic medications (benzodiazepines, antipsychotic medications, tricyclic antidepressants, anti-epileptics, mood stabilizers);
* Any history of any clinically significant neurological disorder, including organic brain disease, epilepsy, stroke, brain lesions, multiple sclerosis, previous neurosurgery, or personal history of head trauma that resulted in loss of consciousness for \> 5 minutes and retrograde amnesia for \> 30 minutes;
* Any personal history of seizures other than febrile childhood seizures;
* Presence of iron magnetic objects in the body contraindicated for treatments with rTMS and for participation in MRI sessions (pacemakers or other electrical devices implants, brain stimulators, some types of dental implants, aneurysm clips, metal implants, permanent eyeliner, fragments of projectile);
* Inability to remain lying on the back for up to 2 hours in the MRI plant;
* Current DSM-5 diagnosis of any Substance Use disorder with the exception of Tobacco Use Disorder and Mild Alcohol Use Disorder;
* Positive drug urine test to one or more classes of substances of abuse;
* For female subjects: pregnancy or breastfeeding in progress;
* Judicial provision that includes a cure in progress or if the subject is already engaged in a cure for gambling disorder;
* Any psychiatric, medical or social condition whether or not listed above, due to which, in the judgment of the PI and after any consults if indicated, participation in the study is not in the best interest of the patient;
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Casa di Cura Park Villa Napoleon

UNKNOWN

Sponsor Role collaborator

University of Padova

OTHER

Sponsor Role collaborator

Istituto Italiano di Tecnologia

OTHER

Sponsor Role collaborator

Fondazione Novella Fronda

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Franco Garonna, MD

Role: PRINCIPAL_INVESTIGATOR

Casa di Cura Park Villa Napoleon

Stefano Cardullo, PhD

Role: STUDY_CHAIR

Fondazione Novella Fronda

Locations

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Casa di Cura Park Villa Napoleon

Preganziol, Treviso, Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Graziella Madeo, MD, PhD

Role: CONTACT

0039 3920170804

Luis J Gómez Pérez, MSc

Role: CONTACT

0039 3286086304

Facility Contacts

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Franco Garonna, MD

Role: primary

0039 3358007663

Other Identifiers

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rTM20NG4MBLDSD

Identifier Type: -

Identifier Source: org_study_id

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