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. 2024 Jul 8;14(1):280.
doi: 10.1038/s41398-024-03000-z.

Modulation of dlPFC function and decision-making capacity by repetitive transcranial magnetic stimulation in methamphetamine use disorder

Qingming Liu  1   2   3 , Huimin Cui  4   5 , Jiali Li  4   5 , Ying Shen  6 , Lei Zhang  7 , Hui Zheng  8   9
Affiliations

Modulation of dlPFC function and decision-making capacity by repetitive transcranial magnetic stimulation in methamphetamine use disorder

Qingming Liu et al. Transl Psychiatry. .

Abstract

This study explores the impact of repetitive transcranial magnetic stimulation (rTMS) on decision-making capabilities in individuals with methamphetamine use disorder (MUD), alongside potential underlying psychological mechanisms. Employing the Iowa Gambling Task (IGT) and computational modeling techniques, we assessed the decision-making processes of 50 male MUD participants (24 underwent rTMS treatment, 26 received no treatment) and 39 healthy controls (HC). We compared pre- and post-rTMS treatment alterations in the left dorsolateral prefrontal cortex (dlPFC). Results revealed inferior performance in the IGT among the MUD group, characterized by aberrant model parameters in the Value-Plus-Perseverance (VPP) model, including heightened learning rate, outcome sensitivity, and reinforcement learning weight, alongside diminished response consistency and loss aversion. RTMS treatment demonstrated efficacy in reducing craving scores, enhancing decision-making abilities, and partially restoring normalcy to certain model parameters in the MUD cohort. Nonetheless, no linear relationship between changes in model parameters and craving was observed. These findings lend support to the somatic marker hypothesis, implicating the dlPFC in the decision-making deficits observed in MUD, with rTMS potentially ameliorating these deficits by modulating the function of these brain regions. This study not only offers novel insights and methodologies for MUD rehabilitation but also underscores the necessity for further research to corroborate and refine these findings. Trial Registration www.chictr.org.cn Identifier: No. ChiCTR17013610.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Flowchart of this study.
A total of 60 patients with methamphetamine use disorder (MUD) and 44 healthy controls were recruited, as originally planned, of which 30 received the 10-HZ rTMS intervention (MUD-t) and the other 30 served as blank controls (MUD-n). However, because of quality control, 4 of them left the facility without completing the intervention due to criminal offenses, and another 6 MUD patients and 5 HC failed the quality control of the IGT task not to be included in the data analysis (more details show in the Methods section), and finally a total of 24 completed the intervention and 26 served as blank controls.
Fig. 2
Fig. 2. Treatment effects in the MUD group.
The paired sample t-test and repeated-variance test showed improvement in the MUD group. a A line graph shows a significant reduction in craving in the MUD treatment (MUD-t) group (n = 24), but no such change in the MUD blank (MUD-n) group (n = 26). Each line represents a subject’s pre- and post-treatment measurements. Post data for four MUD patients were missing from the data analysis due to arrests prior to post-testing and some patients have the same pre- and post-thirst scores, so the lines will overlap. b Line and scatter plots illustrate a more advantageous selection in Iowa Gambling Task for the MUD-t group after rTMS treatment. Dark red lines represent pre-rTMS patients, while dark blue indicates post-rTMS patients. The proportion of beneficial deck selection increases as the experimental blocking progresses (***p < 0.001, **p < 0.01, *p < 0.05, ## means that the main effect of block is significant, specifically p < 0.01).
Fig. 3
Fig. 3. Abnormal VPP parameters in the MUD group.
Gardner–Altman plots were used to show the difference between two groups (MUD (n = 50) vs. HC (n = 39)). Red solid dots represent the parameters for each individual in the MUD group (jitter), while black solid dots represent the parameter scores for the healthy control group. The funnel-shaped gray range on the right indicates the difference between the two groups, with the large black dot showing the mean of the difference, and the short black vertical line representing the 95% confidence interval of the difference. A confidence interval that does not cross zero signifies a statistically significant difference between the two groups. This suggests that the MUD group had significantly higher values for parameters A and alpha, and significantly lower values for parameters cons, lambda, and ω.
Fig. 4
Fig. 4. rTMS treatment improves abnormal VPP parameters in the MUD group.
Pre- and post-intervention difference in the MUD treatment (MUD-t) group (n = 24) were showing by Gardner–Altman plots. Black solid lines represent the parameters for pre- and post-rTMS measurements in the MUD-t group. The funnel-shaped gray range on the right signifies the difference between the two time points, with the large black dot indicating the mean of the difference, and a short black vertical line representing the 95% confidence interval of the difference. A confidence interval that does not cross zero indicates a statistically significant difference between the two groups. This suggests that rTMS significantly decreased parameters A, alpha, and ω, and significantly increased parameters cons, lambda, and K.
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