"Targeted magnetic pulses to the brain were shown to reduce craving and substance use in cocaineaddicted patients. The results of this pilot study published in the peerreviewed journal European Neuropsychopharmacology suggest that this may become an effective medical treatment for patients with cocaine addiction although a larger trial is needed to confirm the initial findings.  Cocaine use is widespread in the Western World. Last year . million young Europeans aged  to  used cocaine and the US National Institute on Drug Abuse estimates that . million Americans suffer from cocaine addiction. There is no effective drug treatment for cocaine addiction with behavioural therapies being the main element of any treatment regime. Now a group of researchers working in Italy and the USA have shown in a preliminary clinical study that cocaine use can be reduced by treatment with rTMS repetitive Transcranial Magnetic Stimulation.  As author Dr Antonello Bonci Scientific Director National Institute on Drug Abuse and Adjunct Professor John Hopkins University Baltimore said  Despite the fact that more than  million people worldwide suffer from cocaine use disorders there are no effective neurobiological treatments for patients with this devastating condition.  The practical work was conducted by team of scientists led by Dr Luigi Gallimberti from the University of Padova Medical School Italy who enrolled  patients who were seeking treatment for cocaine addiction at the hospital clinic. The participating patients were randomized to receive either rTMS or standard symptomrelieving medications.  The experimental group received one rTMS session per day for five days and then once a week for the following three weeks for a total of  TMS sessions over  days. Those in the control group received pharmacological treatment for symptoms associated with cocaine addiction such as depression anxiety and sleep problems. The study indicated the safety of rTMS in patients with cocaine addiction. There was significantly less craving and there were a significantly higher number of cocainefree urine drug tests in the rTMS compared to the control group. In addition   patients in the experimental group showed no relapse to cocaine use whereas only   patients in the control group showed a similar positive result the results are adjusted for patients who dropped out of the trial.  Dr Bonci said rTMS is a noninvasive and very safe therapeutic approach which is used with other mental health and neurological conditions such as depression and neuropathic pain. Our study suggests that rTMS may also represent a new treatment for patients with cocaine use disorder.  At the end of the first  days of the experiment the experimental group was given the option of continuing the treatment whereas those in the control group were given the possibility of receiving the same rTMS treatment as the experimental group for  days. Results further confirmed the beneficial effects of rTMS in helping patients to maintain abstinence from cocaine.  Dr. Bonci continued We consider this study promising but preliminary. We need to replicate the work in a bigger group of patients using shamTMS as the control condition. As far as we know this work represents the first clinical report indicating that rTMS treatment results in significant reduction in cocaine use. It is also important to emphasize that in this study patients were seeking treatment for their cocaine addiction in a hospital setting the group studied albeit small was a real world sample. We have continued to follow patients from the trial and the improvement seems to be sustained over time up to  months although we dont have any hard data on that yet. It is important that this is taken forward to a larger trial.  We decided to target an area of the brain involved in decision making the dorsolateral prefrontal cortex DL PFC. This was because previous animal studies from our lab had shown that compulsive cocaineseeking was associated with hypoactivity in the prelimbic cortex which is a brain area that shares similar behavioural roles to the DL PFC. Importantly we had found that increasing the activity in the prelimbic cortex could significantly reduce cocaine selfadministration.  Commenting European Neuropsychopharmacology editor Dr Andreas MeyerLindenberg Mannheim said  This study represents a creative approach to a disorder that is notoriously difficult to treat in the real world. These pilot data also show that biological treatments nowadays reach far beyond medications and that new neuroscience methods may be used for targeted changes in brain regions relevant for complex mental disorders."