Neurostimulation in alcohol dependence: The effect of repetitive transcranial magnetic stimulation on cognitive functioning and craving

The main objective of this thesis is to assess whether there are behavioural and neural differences related to (1) emotion regulation and (2) cognitive flexibility between alcohol dependent patients and healthy controls, and if rTMS can (3) improve emotion regulation, (4) change related brain function and (5) reduce craving. Finally, we assess (6) differences in pre-frontal resting state networks and (7) the effects of rTMS on these resting state networks. In order to evaluate and answer these points several studies are presented. These questions were assessed by using a wide variety of techniques, including meta-analysis, analysis of emotion regulation and cognitive flexibility task performance, neurostimulation (rTMS) and various neuroimaging techniques (including functional MRI, resting state fMRI and DTI analysis). For these studies a total of 40 alcohol dependent patients and over 50 healthy controls were recruited. The results of these studies show (1) emotion regulation difficulties in alcohol dependent patients compared to heathy controls based on an emotion regulation task; (2) that these difficulties are related to increased, presumably inefficient, task-related brain activation in alcohol dependent patients; (3) evidence that a single session of high-frequency rTMS increases emotion regulation abilities in alcohol dependent patients and healthy controls compared to sham stimulation; (4) that in alcohol dependent patients improvement in emotion regulation is accompanied by a decrease in prefrontal brain activity; (5) that rTMS reduces craving levels and finally (7) that rTMS increases resting state network connectivity which may be related to reduced relapse rates. Although this study only incorporated a single session of rTMS, these results are highly promising for the treatment of alcohol dependence and should therefore be investigated further with a randomized clinical trial