Optimizing brain functional-structural architecture with cTBS to reduce relapse in alcohol use disorder: a randomized controlled trial.
Zhou-Kang Wu, Jing-Nan Zhao, Ning-Ning Zeng et al.
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In 30 seconds
This randomized, double-blind, sham-controlled trial evaluated right dorsolateral prefrontal cortex continuous theta-burst stimulation (cTBS) in 50 adults with alcohol use disorder. Participants received active or sham stimulation over 2 weeks, with relapse monitored for 1 year. Active cTBS was associated with a lower risk of relapse than sham (hazard ratio = 0.426, 95% CI [0.189, 0.964], p = 0.041). Imaging analyses also linked stimulation to an abstinence-associated prefrontal-subcortical pattern and reduced frontoparietal-to-subcortical network control energy, which mediated changes in alcohol-use severity.
Key findings
- Active cTBS was associated with lower 1-year relapse risk than sham (hazard ratio = 0.426, 95% CI [0.189, 0.964], p = 0.041).
- An abstinence-associated prefrontal-subcortical pattern was enhanced with cTBS (p = 0.042).
- Frontoparietal-to-subcortical control energy decreased with cTBS (p = 0.003) and mediated changes in AUDIT-assessed severity (95% CI [-0.302, -0.014]).
- Control-energy changes correlated with neuroplasticity-related gene expression (p < 0.001, FDR corrected) and mapped to murine infralimbic and prelimbic areas.
Why it matters
The trial connects a clinical outcome—relapse—with measurable changes in brain network regulation, offering a potential framework for studying how neuromodulation may affect alcohol-use severity. The findings are relevant to development of network-informed approaches, while the proposed neural and gene-expression links remain mechanistic evidence rather than established clinical markers.
What to keep in mind
The trial included 50 patients at a single hospital, and the abstract does not report the number of relapses or provide further detail on follow-up completeness.