# No Effects of rTMS on Performance Monitoring and Attentional Bias in Patients With Alcohol Use Disorder: A Pilot Study

## TL;DR

This study found no significant effects of rTMS on brain activity related to attention and performance in patients with alcohol use disorder.

## Contribution

The study is a pilot investigation into the neuropsychological effects of rTMS on ERP markers in recently detoxified AUD patients.

## Key findings

- rTMS had no significant effect on ERPs like N100, N200, and P300 in AUD patients.
- Bayesian analysis suggested a possible effect on frontal N100 amplitude.
- The study highlights the need for further exploration of ERP markers in rTMS treatment for AUD.

## Abstract

Repetitive transcranial magnetic stimulation (rTMS) presents a promising approach for treating patients with alcohol use disorder (AUD). However, its neuropsychological working mechanisms are to be elucidated. Therefore, we investigated the effect of rTMS treatment on event‐related potentials (ERPs) evoked by a flanker task and a passive picture task using electro‐encephalography, in 30 recently detoxified patients. Participants were randomly assigned to receive either 10 sessions of rTMS or sham rTMS. Measurements were made at baseline, and after 5 and 10 treatments. The results revealed no significant effect of rTMS on any of the assessed ERPs (N100, N200, and P300). These findings suggest that high‐frequency rTMS applied over the right dlPFC, in addition to treatment as usual (TAU), does not impact performance monitoring or attentional bias in recently detoxified patients with AUD. Bayesian analyses did suggest a potential effect of rTMS on N100 amplitude at frontal electrode FZ. These preliminary findings warrant further study of the effects of rTMS on ERP outcomes in AUD patients, and exploration of ERPs related to performance monitoring and attentional bias as potential neuropsychological markers for the clinical effects of rTMS. However, other neuropsychological markers, like brain network connectivity, should also be explored.

Registered in a trial Register (ClinicalTrials.gov Identifier: NCT01973127)f.

We tested whether high‐frequency rTMS over right dlPFC modulates ERP markers of performance monitoring and attentional bias in 30 recently detoxified AUD patients in a randomized sham‐controlled design, assessing N100, N200, and P300 during a flanker and passive picture tasks at baseline, mid‐treatment, and post‐treatment. No significant group‐by‐time effects were observed, indicating no robust modulation of targeted ERPs. Bayesian evidence suggested a possible effect on frontal N100, supporting further exploration of neurophysiological markers of rTMS response in AUD.