Repetitive Transcranial Magnetic Stimulation for Alcohol Craving in Alcohol Use Disorders: A Meta-analysis.

AIMS: We aimed to evaluate the immediate and up to 3 months' effect of multiple-session repetitive transcranial magnetic stimulation (rTMS) on alcohol craving in AUD. METHODS: We performed a systematic review and random effects meta-analysis. We included randomized controlled trials with at least 10 sessions of rTMS and postintervention alcohol craving assessment. We evaluated the immediate and up to 3 months' effects of active rTMS versus sham stimulation. RESULTS: Twelve studies met inclusion criteria, including 475 participants across both treatment and control groups. rTMS reduced alcohol craving over sham stimulation immediately post-treatment (SMD = −0.79, 95% CI: −1.53 to −0.04, P = 0.04, I ² = 93%). Concerning a maintenance effect, our meta-analysis revealed a medium effect for active rTMS in reduction of alcohol craving at 3-month follow-up (SMD = −0.44, 95% CI: −0.77 to 0.11, P < 0.01, I ² = 38%). Our subgroup analysis revealed that rTMS targeting the medial prefrontal cortex (SMD = −2.12, 95% CI: −4.34 to 0.09, P = 0.06, I ² = 94%) may be more effective than stimulating the right dorsolateral prefrontal cortex (SMD = −1.04, 95% CI: −2.56 to 0.48, P = 0.18, I ² = 96%) or left dorsolateral prefrontal cortex (SMD = −0.27, 95% CI: −0.60 to 0.05, P = 0.10, I ² = 0%) immediately after treatment. CONCLUSION: A minimum of 10 sessions of rTMS reduced alcohol craving immediately after treatment; this effect seems to be sustained over a 3-month period. We provide limited evidence of superiority for rTMS targeting the medial prefrontal cortex.