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Potential TMS biomarkers for GABAB receptor engagement in alcohol use disorder: A systematic review of existing evidence
Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
Univ Parma, Italy.
Univ Parma, Italy.
Univ Parma, Italy.
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2025 (English)In: ALCOHOL-CLINICAL AND EXPERIMENTAL RESEARCH, ISSN 2993-7175, Vol. 49, no 12, p. 2633-2648Article, review/survey (Refereed) Published
Abstract [en]

Alcohol use disorder (AUD) is a major global health issue, with current treatments often limited in efficacy and patient acceptance. The gamma-aminobutyric acid (GABA) system, particularly GABAB receptors (GABABR), is crucial in the pathophysiology of AUD. This review aimed to evaluate the potential of transcranial magnetic stimulation (TMS) as a tool for identifying neurophysiological biomarkers of GABABR engagement in AUD. Two independent systematic literature reviews were conducted using MEDLINE, PsychINFO, and EMBASE databases to evaluate: (1) the neurophysiological effects of GABABR pharmacological manipulation, and (2) the neurophysiological alterations linked to alcohol consumption and addiction. Studies included human subjects and assessed cortical excitability using TMS-EMG or TMS-EEG. Data on study design, sample characteristics, TMS protocols, and neurophysiological outcomes were extracted and analyzed. The final analysis included 13 studies evaluating the effects of GABABR agonism (mainly baclofen administration) and 16 studies on acute and chronic alcohol consumption. The GABABR agonism studies were primarily randomized, placebo-controlled experimental medicine studies in healthy controls. Results showed that GABABR agonism enhanced long-interval intracortical inhibition (LICI) and increased post-TMS N100 amplitude, indicating the sensitivity of these parameters to GABABR manipulation. The alcohol consumption studies were mostly case-control or within-subject designs, with fewer randomized controlled trials. Acute and chronic alcohol consumption was found to alter LICI, N100 amplitude, and the cortical silent period (CSP). However, no alcohol-induced changes were observed in short-interval intracortical inhibition (SICI), which depends on GABAAR activation. Despite limitations, this review indicates GABABR functioning to be measurable and different in AUD compared to healthy controls. Overall, the reviewed literature supports the hypothesis that GABABR is involved in the neurotransmission imbalances induced by both acute and chronic alcohol intake, with potential regional differences that warrant further investigation. Standardized protocols and larger studies are needed to validate these findings and their clinical relevance.

Place, publisher, year, edition, pages
WILEY , 2025. Vol. 49, no 12, p. 2633-2648
Keywords [en]
alcohol use disorder; baclofen; cortical inhibition; gamma-aminobutyric acid; transcranial magnetic stimulation
National Category
Drug Abuse and Addiction
Identifiers
URN: urn:nbn:se:liu:diva-219062DOI: 10.1111/acer.70180ISI: 001594144500001PubMedID: 41094747Scopus ID: 2-s2.0-105018810896OAI: oai:DiVA.org:liu-219062DiVA, id: diva2:2009517
Note

Funding Agencies|Swedish Research Council

Available from: 2025-10-28 Created: 2025-10-28 Last updated: 2026-04-21Bibliographically approved

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Montemitro, ChiaraHeilig, Markus

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Center for Social and Affective NeuroscienceFaculty of Medicine and Health SciencesPsykiatriska kliniken i LinköpingCenter for Medical Image Science and Visualization (CMIV)
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