Transcranial Magnetic Stimulation Used to Both Measure Cortical Excitability and Explore Methamphetamine Cue Craving

Study Overview
=================
Brief Summary
-----------------
Specific Primary Aims include: Aim # 1. The investigators explore the feasibility of using the TMS to investigate the cortical excitability and to inhibit meth cue craving in meth dependent population. The investigators anticipate that meth elevates cortical excitability measured by motor threshold, causes changes of cortical silent period, and RC. The investigators also anticipate that paired pulse measures (short-interval intracortical inhibition, short-interval intracortical facilitation and long-interval intracortical inhibition) will be different from healthy control, which are more directly linked to glutamatergic cortical facilitation and GABAergic inhibition, respectively. Aim # 2. Given the change of the cortical excitability in meth users, the investigators will use inhibiting TMS (1 Hz) over medial prefrontal cortex to study whether TMS can be used to reduce cue craving. The investigators hypothesize that repetitive TMS reduce meth cue craving in meth dependent population compared with sham rTMS.

Official Title
-----------------
Transcranial Magnetic Stimulation Used to Both Measure Cortical Excitability and Explore Methamphetamine Cue Craving

Conditions
-----------------
Methamphetamine Dependence

Intervention / Treatment
-----------------
* Device: Transcranial Magnetic Stimulation
* Device: Sham Transcranial Magnetic Stimulation


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Be volunteers who are dependent on meth and not currently seeking treatment. They must not have received substance abuse treatment within the previous 30 days. Be male or female of any race or ethnic group, between the ages of 18 and 50 years. Meet DSM IV criteria for meth dependence as determined by the MINI International Neuropsychiatric Interview (MINI). Currently be using meth by smoked, oral, or intravenous routes of administration, used meth for a minimum of 2 years and a minimum of an average of 3 times a week in the 30 days prior to screening. Be in stable mental and physical health. If female, test non-pregnant and use adequate birth control. All female subjects will have urine pregnancy tests in all three phases of the study. Be capable of providing written informed consent to participate in this study. Be able to comply with protocol requirements and be likely to complete all study procedures. Live within a 50 mile radius of our research program, have reliable transportation, and have a stable residence for at least the 30 days prior to starting the study. Be willing to abstain from alcohol, marijuana and CNS acting prescription and OTC medications for the 2 week screening and hospitalization phases. Have a positive urine for meth within 72 hours of admission to the hospital phase of the study and have at least one other positive urine for meth during the screening phase. Be right-handed. Exclusion Criteria: Have current dependence, defined by DSM IV criteria, on any psychoactive substances other than meth, nicotine, or caffeine. Have a history and/or test positive for significant hepatic, renal, endocrine, cardiac, or inflammatory diseases, as well as stroke, seizures, migraine, serious head trauma, or other neurological disorders that might interfere with stability during the study or the acquisition of accurate fMRI scans. If female, have intentions to become pregnant during the study. Have been required by the courts to obtain treatment for meth or some other substance dependence. Be seeking treatment for meth or other substance dependence. Have a medical history or condition considered by the investigators to place the subject at increased risk (implanted ferrous materials or devices) or to decrease the likelihood of study completion. Be anticipating elective surgery or hospitalization within 8 weeks of signing the informed consent agreement. Be on medications in the last 30 days that may alter CNS function or alter fMRI results. Examples of such medications include but are not limited to the following: psychotropics, CNS active anti-hypertensives, steroids, anticonvulsants, antihistamines and CNS OTCs. Have a life time history of major Axis I disorders such as: BPAD, Schizophrenia, PTSD, or Dementia, or have a current history of Major Depression or suicide attempt within 12 months Have a self report of >21 standard alcohol drinks per week in any week in the 30 days prior to screening or a Carbohydrate Deficient Transferrin >3.0%. Be unwilling to use a patch and cease smoking cigarettes for the eight days in the hospital.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Transcranial Magnetic Stimulation<br>Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation technology that can focally stimulate the brain of an awake individual. The brain stimulation techniques could theoretically improve the efficacy of smoking cessation. | Device: Transcranial Magnetic Stimulation<br>* Active TMS:1 Hz, 100% motor threshold TMS for 15 minutes, total 900 pulses. Electrical stimulation instead.<br>* Other names: Magstim Rapid;|
| Placebo Comparator: Sham Transcranial Magnetic Stimulation<br>Sham-TMS procedures: After rTMS determination, participants were fitted with two electrodes on the scalp just below the hairline. Electrodes will be connected to an Epix VT Transcutaneous Electrical nerve stimulation device. | Device: Sham Transcranial Magnetic Stimulation<br>* The electrical current of the sham system is titrated to a level matching participants' ratings of active TMS. The sham-TMS scalp discomfort will be matched to that of active TMS.<br>* Other names: Epix VT Transcutaneous Electrical Nerve Stimulation Device;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cue Craving Rating | The subject is asked to rate craving with 0 mm being  no craving at all and 100 mm representing the most craving I have ever had. | Change from Baseline in Craving rating 10 minutes after TMS | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Baseline of Resting Motor Threshold | Resting motor threshold (RMT); on a scale of 0-100 with 100 being most power given to enact a motor response | Baseline to 10 minutes after TMS | 
| Change in Cortical Silent Period | Cortical Silent Period is measured in seconds | Baseline and 10 minutes after TMS | 
| Change Recruitment Curve (RC) Slope | Recruitment Curve (RC) Slope, measured at angle of slope | Baseline and 10 minutes after TMS | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
methamphetamine, craving, TMS, cortical excitability, prefrontal cortex