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, I2 = 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, I2 = 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, I2 = 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, I2 = 96%) or left dorsolateral prefrontal cortex (SMD = -0.27, 95% CI: -0.60 to 0.05, P = 0.10, I2 = 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.
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