Yang HR, Li ZY, Zhu H, Wu H, Xie C, Wang XQ, Huang CS, Geng WJ. Mapping the current trends and hotspots of transcranial magnetic stimulation-based addiction treatment from 2001-2023: A bibliometric analysis. World J Meta-Anal 2025; 13(1): 104644 [DOI: 10.13105/wjma.v13.i1.104644]
Corresponding Author of This Article
Wu-Jun Geng, MD, PhD, Associate Professor, Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou Medical University, No. 999 Jinshi Road, Yongzhong Street, Longwan District, Wenzhou 325000, Zhejiang Province, China. gengwujun@ojlab.ac.cn
Research Domain of This Article
Psychiatry
Article-Type of This Article
Scientometrics
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hao-Ran Yang, School of Educational Sciences, Chongqing Normal University, Chongqing 400030, China
Zheng-Yu Li, Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Hao Zhu, Hong Wu, Chang-Shun Huang, Department of Anesthesiology, The First Affiliated Hospital of Ningbo University, Ningbo 315010, Zhejiang Province, China
Chen Xie, Xin-Qiang Wang, Department of Anesthesiology, The First People's Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
Wu-Jun Geng, Oujiang Laboratory (Zhejiang Laboratory for Regenerative Medicine, Vision and Brain Health), Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Wu-Jun Geng, Department of Pain, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Co-corresponding authors: Chang-Shun Huang and Wu-Jun Geng.
Author contributions: Yang HR and Li ZY screened articles and wrote original manuscript, conducted CiteSpace and VOSviewer analysis; Yang HR, Li ZY, Zhu H, Wu H, Xie C, Wang XQ, Huang CS, and Geng WJ revised and critically edited the manuscript; Wang XQ, Huang CS, and Geng WJ put forward the concept of this study and designed this study; all authors contributed to this article and approved the submitted version.
Supported by National Natural Science Foundation of China, No. 81973620; and Wenzhou Municipal Science and Technology Bureau, No. Y20220091.
Conflict-of-interest statement: The authors declare no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wu-Jun Geng, MD, PhD, Associate Professor, Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou Medical University, No. 999 Jinshi Road, Yongzhong Street, Longwan District, Wenzhou 325000, Zhejiang Province, China. gengwujun@ojlab.ac.cn
Received: December 28, 2024 Revised: January 26, 2025 Accepted: February 12, 2025 Published online: March 18, 2025 Processing time: 77 Days and 20.1 Hours
Abstract
BACKGROUND
The prevalence of addiction makes it a significant public health issue. Recently, transcranial magnetic stimulation (TMS) has garnered significant attention as a promising treatment for addiction.
AIM
To analyze development trends and research hotspots in TMS-based addiction treatment using a bibliometric approach.
METHODS
Articles on TMS-based addiction treatment from 2001 to 2023 were sourced from the Science Citation Index Expanded in the Web of Science Core Collection. CiteSpace software, VOSviewer, the "bibliometrix" R software package, and the bibliometric online analysis platform were used to analyze the current publication trends and hotspots.
RESULTS
Total 190 articles on TMS-based addiction treatment were identified, with clinical studies being the most prevalent. The United States led in both publication volume and international collaborations. Medical University of South Carolina and Zangen A were the most productive institution and author, respectively. Neurobiology, alcohol use disorder, and repetitive TMS were the most recent research hotspots.
CONCLUSION
Future research should focus on the neurobiological mechanisms underlying TMS-based addiction treatment. This study offers comprehensive insights and recommendations for advancing research on TMS-based addiction treatment.
Core Tip: This study presents the inaugural bibliometric analysis of research on addiction treatment using transcranial magnetic stimulation (TMS). From 2001 to 2023, the United States led in both output volume and international collaborations. Medical University of South Carolina and Zangen A were the most productive institution and author, respectively. Neurobiology, alcohol use disorder, and repetitive TMS were the most recent research hotspots.
Citation: Yang HR, Li ZY, Zhu H, Wu H, Xie C, Wang XQ, Huang CS, Geng WJ. Mapping the current trends and hotspots of transcranial magnetic stimulation-based addiction treatment from 2001-2023: A bibliometric analysis. World J Meta-Anal 2025; 13(1): 104644
Addiction is a periodic or chronic toxic state that arises from the continuous use of certain substances. Despite understanding the serious harm of addictive substances, individuals cannot control their use and continue to seek out these substances[1]. According to the 2018 National Survey on Drug Use and Health in America[2], approximately 20.3 million individuals aged 12 or older were reported to suffer from substance use disorders. Despite the availability of therapeutic interventions, relapse rates are high, and addiction is inadequately addressed[3]. Consequently, improved treatment strategies can benefit individuals with addiction globally. Transcranial magnetic stimulation (TMS) is a non-invasive, relatively simple treatment with fewer side effects, making it a significant alternative for addiction[4,5].
TMS stimulates brain activity using a fast and time-varying magnetic field[6]. It can target the prefrontal cortex (PFC) and activate underlying cortical regions[7]. Recently, many studies have found that TMS can be used to effectively treat different types of addiction, such as addiction to nicotine[8,9], alcohol[10], cocaine[11], heroin[12,13], and methamphetamine[14]. TMS is used to treat addiction due to dorsolateral PFC dysfunction in these disorders. Normal function of the dorsolateral PFC is essential for top-down inhibitory control mechanisms and reward mechanisms[15]. Nevertheless, the neurobiological mechanisms of TMS in the treatment of addiction have not been fully elucidated, and the optimal stimulation parameters remain undetermined. Although the high worldwide prevalence of addiction has led to a growing interest in TMS-based treatment of addiction among researchers, few articles have summarized current advances in this field and predicted future research hotspots.
Bibliometric analysis is an in-depth econometric examination of publications within a particular field over a specified timeframe. It includes parameters like article count, author count, country or region, journal, reference, and keyword. It presents a detailed overview of the chosen research area, enabling researchers to gain an in-depth and comprehensive understanding of the latest research trends and potential future hotspots[16-20]. However, there is currently a lack of bibliometric articles analyzing publication characteristics, research trends, and hotspots related to TMS-based treatment of addiction. This bibliometric study analyzed research trends and key areas in TMS-based addiction treatment from 2001 to 2023. In this study, we provided a panoramic overview of the field and identified future research trends and potential hotspots.
MATERIALS AND METHODS
Sources of data and search methodologies
The study utilizes data from publications dated January 1, 2001, to December 31, 2023, sourced from the Web of Science Core Collection (WoSCC) on January 20, 2024. To prevent bias in database updates, we conducted data extraction and downloads within a single day. We conducted a literature search using the strategy: TS = [(Transcranial Magnetic Stimulation) OR (Theta burst stimulation) OR (TMS) OR (TBS)] AND [TS = (addiction) OR (addictive behavior) OR (substance use disorder) OR (substance-related disorders) OR (habituation) OR (dependence) OR (dependency) OR (craving) OR (alcoholism)] AND [DT = (Article)] AND [LA = (English)]. The selection was limited to the Science Citation Index-Expanded (SCI-E). The exclusion criteria included: (1) Studies unrelated to TMS-based addiction treatment; (2) Non-scientific articles, including proceedings, book chapters, reviews, corrections, editorials, letters, news items, meeting abstracts, and retracted publications; (3) Publications not in English; and (4) Duplicate publications. To ensure the accuracy of the bibliometric analysis, researchers Yang HR and Li ZY verified all publications obtained through the search strategy, examining their titles, abstracts, and publication years. Then, raw data were downloaded from WoSCC as text files containing full records. Figure 1 provides a schematic representation of the detailed screening workflow.
Figure 1 Flowchart describing the inclusion and exclusion criteria used in the present study on transcranial magnetic stimulation-based treatment of addiction.
DT: Document type; TBS: Theta-burst stimulation; TMS: Transcranial magnetic stimulation; TS: Topic search.
Bibliometric analysis
We used the Web of Science to characterize all publications on TMS-based treatment of addiction, analyze the search results, and extract histograms depicting publication trends. Data from WoSCC were converted to TXT format and imported into VOSviewer 1.6.19 and CiteSpace V6.1R6 for analysis. Furthermore, data were analyzed using the "bibliometrix" R software package and the bibliometric online analysis platform.
The annual publication count was obtained from WoSCC, and the publication counts for the top 10 countries/regions and the top 10 most cited journals were sourced from the bibliometric online analysis platform. A word cloud of the top 100 high-frequency keywords was created using the "bibliometrix" R package. Furthermore, the analysis of collaborations between countries/regions was conducted using VOSviewer software, a tool that facilitates the construction of visual bibliometric maps[21]. CiteSpace, a widely recognized bibliometric visualization tool[22], was used to analyze various data, help understand the recent status of research related to TMS-based treatment of addiction, and predict potential hotspots in this field. The data encompassed institutional and author collaborations, reference co-citation analysis, and keywords exhibiting significant citation bursts.
RESULTS
Quantity and trend analysis of published papers
One hundred-ninety articles meeting our inclusion criteria were retrieved from the SCI-E of WoSCC. The total number of articles published per year is displayed at the top of the bar (Figure 2A). Research on TMS-based treatment of addiction was categorized into two periods based on the number of publications. From 2001 to 2014, publications gradually increased, whereas from 2015 to 2023, there was a notable surge in publication numbers. The number of publications in 2022 exceeded that in 2001 by more than 14 times, indicating a significant rise in global interest in research on TMS-based treatment of addiction. Additionally, we assessed the number of clinical research and basic research papers and observed that the majority of the publications were in the realm of clinical research (Figure 2B). Using Microsoft Excel 2021, we formulated a growth trend model represented by the equation: F(x) = 0.0547x² - 218.9x + 219163 (R² = 0.8513). This model predicted the publication of approximately 43 articles in 2030 (Supplementary Figure 1).
Figure 2 Analysis of the quantity and research trends on transcranial magnetic stimulation-based treatment of addiction from 2001 to 2023.
A: The annual number of papers on transcranial magnetic stimulation (TMS)-based treatment of addiction published from 2001 to 2023 was obtained from Web of Science data; B: The proportion of basic and clinical research articles on TMS-based treatment of addiction published from 2001 to 2023; C: Analysis of publication numbers and growth trends for the leading 10 countries/regions in TMS-based addiction treatment, sourced from a bibliometric online platform; D: A bar graph illustrating the total citations from 190 retrieved articles across all countries. This figure displays the top 10 countries ranked by total citation count. Each bar corresponds to a country, with its length directly proportional to the total citation count.
Using the bibliometric online analysis platform, we identified the leading country/region researching TMS-based addiction treatment from 2001 to 2023 and quantified the publication counts across various countries/regions. Figure 2C illustrates a bar chart showing the top 10 countries with the most published papers from 2001 to 2023. Throughout this period, the United States has maintained its prominent position in studying TMS-based treatment of addiction, with China overtaking the United States in annual publications from 2020 to 2022.
We analyzed the overall citation count for articles published from each country/region and presented the top 10 countries/regions (Figure 2D). The United States and Canada ranked first and second with 1923 and 1718 total citations for all relevant papers published, respectively. By calculating the average number of citations per article (total number of citations/total number of articles) for each country/region, we determined the top 10 countries/regions based on this metric (Table 1). Switzerland, Canada, and Israel ranked as the top three countries with the highest average citations, recording 280.0, 156.2, and 80.1 citations, respectively.
Table 1 The top 10 countries with the highest total citations for research on transcranial magnetic stimulation-based addiction treatment, published between 2001 and 2023 (ranked by average citations).
Rank
Country
Number of publications
Total number of citations
Average number of citations
1
Switzerland
1
280
280.0
2
Canada
10
1718
156.2
3
Israel
8
641
80.1
4
Germany
5
341
68.2
5
India
4
234
58.5
6
England
6
335
55.8
7
United States
43
1923
44.7
8
Belgium
10
388
38.8
9
Italy
29
638
22.0
10
China
40
539
13.5
Analysis of collaborating countries/regions and institutions
From 2001 to 2023, 190 articles on TMS-based treatment of addiction were published in 27 countries and regions. The VOSviewer software was applied to explore the collaborative status among these countries or regions. Figure 3A illustrates international academic collaborations in TMS-based addiction treatment research, with circles representing countries/regions and lines indicating collaborative links. Circle size represents the number of articles published by each country/region, while line thickness reflects the collaboration intensity between them. The findings indicated that the United States was the leading nation in international collaboration. The United States collaborated most frequently with Italy, followed by China.
Figure 3 Map of national/regional and institutional cooperation networks in studying transcranial magnetic stimulation-based treatment of addiction.
A: Collaborations among 27 countries/regions in studying transcranial magnetic stimulation (TMS)-based treatment of addiction; B: Collaborative network map illustrating institutions engaged in researching TMS-based addiction treatments. The circles represent different countries/regions and institutions. Circle size denotes the number of published articles, while link thickness reflects the level of collaboration.
Data in the TXT format was entered into the CiteSpace software to understand the collaboration status among academic institutions. In total, 229 research institutions participated in studying TMS-based treatment of addiction. Figure 3B visualizes the top 10 most productive institutions, with each concentric circle's size indicating the number of published articles and the thickness of connecting lines representing the extent of inter-institutional collaboration. There were 10 productive institutions with more than 8 publications. The Medical University of South Carolina in the United States published the highest number of articles (n = 20). Five of the top ten most productive institutions were based in the United States, highlighting the country's significant academic influence in this research area.
Analysis of co-authorship networks and core author distribution
By analyzing the characteristics of author collaboration networks in a specific field, we can identify the core authors and the extent of collaboration among them[23]. Here, 411 authors were involved in 190 identified articles related to TMS-based treatment of addiction from 2001 to 2023. Figure 4 depicts author collaboration. We identified the top 10 authors based on their publication count. Node and font sizes are directly proportional to publication counts, while line thickness indicates the strength of author collaboration. The visualization map provides intuitive information about the collaboration between different authors, helping researchers identify potential partners. Zangen A, affiliated with the Medical University of South Carolina, authored the highest number of articles (n = 12). The author collaboration network map showed strong collaboration between these prolific authors and other authors.
Figure 4 Collaborative network of authors in the field of transcranial magnetic stimulation-based treatment of addiction.
This figure displays the top 10 authors with more than five publications. Circles symbolize authors, with links denoting collaborative relationships. There is a positive correlation between font size and the number of published papers.
Journal analysis
The online analysis platform of bibliometrics was used to analyze the influence of journals. The top 10 most cited journals are shown in Table 2, with articles published by Biological psychiatry being the most cited (769 citations), followed by articles published by Drug and alcohol dependence (675 citations), European neuropsychopharmacology (378 citations), Frontiers in psychiatry (288 citations), Brain stimulation (237 citations), Neuropsychopharmacology (218 citations), Frontiers in neuroscience (143 citations), Addiction biology (98 citations), Addiction (69 citations), and Alcoholism-clinical and experimental research (56 citations). The publishers of these journals were mainly from the United States (4 of 10). European Neuropsychopharmacology articles had the highest average citations per article, with 126 citations.
Table 2 The top 10 most cited journals in the field of transcranial magnetic stimulation-based treatment of addiction, published from 2001 to 2023 (sorted by total number of citations).
Rank
Journal title
Frequency
Total citations
Average citation per paper
Impact factor (2023)
Country
JCR
1
Biological Psychiatry
7
769
109.86
9.6
United States
Q1
2
Drug and Alcohol Dependence
14
675
48.21
3.9
Switzerland
Q1
3
European Neuropsychopharmacology
3
378
126.00
6.1
United States
Q1
4
Frontiers in Psychiatry
5
288
57.60
3.2
Netherlands
Q2
5
Brain Stimulation
20
237
11.85
7.6
Switzerland
Q1
6
Neuropsychopharmacology
6
218
36.33
6.6
United States
Q1
7
Frontiers in Neuroscience
4
143
35.75
3.2
England
Q2
8
Addiction Biology
6
98
16.33
3.1
Switzerland
Q2
9
Addiction
6
69
11.50
5.2
England
Q1
10
Alcoholism-Clinical and Experimental Research
3
57
19.00
3.0
United States
Q2
Examination of co-citation patterns and network clustering
Literature co-citation identifies articles frequently cited together by multiple authors. Each node symbolizes a reference, with connecting lines indicating that these articles were co-cited by the same article among the 190 articles (Figure 5A). There is a positive correlation between node size and citation frequency. Thicker connecting lines between nodes imply a higher co-citation intensity. Red nodes signify documents frequently cited in recent years, whereas purple nodes represent those cited in earlier years. Citations serve as a key measure of an article's influence within a specific research field. Table 3 indicates the top 10 most cited references from 190 articles. In 2017, a review published in Nature Reviews Neuroscience by Diana et al[24] Ranked first with 32 citations, the paper reviews TMS mechanisms and proposes that repetitive TMS (rTMS) is pioneering new approaches in addiction treatment. The second-ranked and third-ranked publications were published in European Neuropsychopharmacology and Neuroscience and Biobehavioral Reviews. They were cited 28 times and 24 times, respectively. The first study indicated the potential therapeutic role of rTMS-mediated PFC stimulation in reducing cocaine use[11], while the second offered guidelines for best practices in researching transcranial electrical and magnetic treatments for substance use disorders[25].
Figure 5 Reference co-citation network analysis of publications on transcranial magnetic stimulation for addiction treatment, spanning 2001 to 2023.
A: CiteSpace co-citation map of 6607 references related to transcranial magnetic stimulation (TMS)-based treatment of addiction. Each node symbolizes a reference. Node size correlates positively with citation frequency, while links between nodes indicate shared references within the same article. Nodes with a deeper red hue indicate papers with high citation frequency in recent years, whereas nodes with a deeper purple hue signify references cited more frequently in earlier years. The top 10 most cited publications are listed with their first author and year of publication; B: The 25 most influential references with significant citation bursts related to TMS-based addiction treatment, spanning publications from 2001 to 2023. The blue bars indicate the period in which the reference has been published, and the red bars represent bursts of citation frequency.
Table 3 The top 10 highly-cited references among 190 retrieved articles on transcranial magnetic stimulation-based treatment of addiction, published from 2001 to 2023 (sorted by citation frequency).
Rank
Title
First author
Journal
Year
Cited frequency
DOI
1
Rehabilitating the addicted brain with transcranial magnetic stimulation
Diana M
Nature Reviews Neuroscience
2017
32
10.1038/nrn.2017.113
2
Transcranial magnetic stimulation of dorsolateral prefrontal cortex reduces cocaine use: A pilot study
Terraneo A
European Neuropsychopharmacology
2016
28
10.1016/j.euroneuro.2015.11.011
3
Transcranial electrical and magnetic stimulation (tES and TMS) for addiction medicine: A consensus paper on the present state of the science and the road ahead
Ekhtiari H
Neuroscience and Biobehavioral Reviews
2019
24
10.1016/j.neubiorev.2019.06.007
4
Smoking cessation induced by deep repetitive transcranial magnetic stimulation of the prefrontal and insular cortices: A prospective, randomized controlled trial
Dinur-Klein L
Biological Psychiatry
2014
19
10.1016/j.biopsych.2014.05.020
5
High frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex for methamphetamine use disorders: A randomised clinical trial
Su H
Drug and Alcohol Dependence
2017
19
10.1016/j.drugalcdep.2017.01.037
6
10-Hz Repetitive Transcranial Magnetic Stimulation of the Left Dorsolateral Prefrontal Cortex Reduces Heroin Cue Craving in Long-Term Addicts
Shen Y
Biological Psychiatry
2016
18
10.1016/j.biopsych.2016.02.006
7
Effects of repetitive transcranial magnetic stimulation (rTMS) on craving and substance consumption in patients with substance dependence: A systematic review and meta-analysis
Zhang JJQ
Addiction
2019
17
10.1111/add.14753
8
Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex reduces nicotine cue craving
Li XB
Biological Psychiatry
2013
17
10.1016/j.biopsych.2013.01.003
9
Transcranial magnetic stimulation in the treatment of substance addiction
Gorelick DA
Annals of the New York Academy of Sciences
2014
16
10.1111/nyas.12479
10
Efficacy of repetitive transcranial magnetic stimulation in alcohol dependence: A sham-controlled study
Mishra BR
Addiction
2010
15
10.1111/j.1360-0443.2009. 02777.x
The reference citation burst refers to a rapid increase in citation frequency, which usually reflects the emergence or transformation of a research field. In addition, the higher burst strength of the reference shows greater significance in the field. CiteSpace was used to generate the top 25 references exhibiting the strongest citation bursts (Figure 5B). The blue line indicates the time frame from 2001 to 2023, and the red line indicates the period over which the burst references were maintained. Among the burst references in recent years, the most recent and most cited study was a review, published by Nature reviews neuroscience in 2017. The burst began in 2019 and continued until the end of 2023. In this review, the authors described the fundamentals of TMS and its putative mechanisms of action and discussed the pros and cons of TMS. They argued that neural plasticity and connectivity changes may underlie some of the long-term effects of TMS[24].
CiteSpace was used to conduct a co-citation cluster mapping of the references in the 190 articles, based on their keywords. The co-citation cluster analysis showed the most popular terms in studying TMS-based treatment of addiction (Figure 6A), by hierarchical cluster labels was as follows: (1) Dopamine (DA) hypothesis; (2) Gambling disorder; (3) Low frequency; (4) Cigarette craving; (5) DA release; (6) Alcohol-dependent patient; (7) Relapse; (8) Nicotine dependence; (9) Caudate nucleus; and (10) Considering motor excitability. A summary of these clusters is presented in Table 4. The silhouette value of > 0.5 indicated that the clustering results were credible.
Figure 6 Analysis of the clustered network of publications in on transcranial magnetic stimulation for addiction treatment, covering the period from 2001 to 2023.
A: A CiteSpace visual analysis of the co-cited literature clustering network. This figure displays the ten largest citation clusters; B: Timeline visualization of co-cited references concerning transcranial magnetic stimulation-based addiction treatment. Clusters are depicted by horizontal lines, with smaller label numbers indicating larger clusters. Node size represents co-citation frequency, while links denote co-citation relationships. Node and line colors indicate the citing years.
Table 4 A summary of 10 clusters of references in publications about transcranial magnetic stimulation-based treatment of addiction.
Keyword-based analysis of research trends and burst detection
Figure 6B shows a timeline view to clearly depict the changes in research hotspots related to TMS-based treatment of addiction from 2001 to 2023. Each circle denotes a significant cited paper within a particular cluster. The size of the cited tree ring on the timeline represents the citation frequency. Large nodes were frequently cited or were explosively cited in a specific period. The co-cited literature clustering with the keyword “gambling disorder” occurred from around 2010 to 2018. Recent hotspots are “dopamine hypothesis” and “nicotine dependence”, which emerged in 2013 and have continued ever since.
The word cloud (Figure 7A) represents the top 100 high-frequency keywords in studying TMS-based treatment of addiction. There is a positive correlation between font size and usage frequency. After excluding the keywords with minor practical significance, the following keywords with high frequency were included: (1) Dorsolateral PFC; (2) Addiction, rtms; (3) Drug-addiction; and (4) PFC. Keyword burst detection is a method for swiftly identifying research hotspots. Figure 7B shows the top 15 strongest keywords for the 2001-2023 keyword bursts. The green line represents the period from 2001 to 2023, while the red line indicates the duration associated with the burst keyword among the confirmed keyword bursts, the most recent keywords were “rtms” (4.85), “neurobiology” (2.48), “alcohol use disorder (AUD)” (2.8), and “repetitive transcranial magnetic stimulation” (2.54).
Figure 7 Analysis of keywords and burst detection of publications on transcranial magnetic stimulation-based treatment of addiction, published from 2001 to 2023.
A: Word cloud illustrating the 100 most frequent keywords from research on transcranial magnetic stimulation-based addiction treatment; B: The 15 keywords with the most significant citation bursts, arranged by the year they began. Keywords marked in red bars indicate a sudden increase in using frequency during the corresponding period, and the blue color represents a relatively unpopular period.
DISCUSSION
This study provides the first comprehensive overview of articles published in the field of TMS-based treatment of addiction from 2001 to 2023. Our analysis indicates a significant rise in the number of articles published in this field over the past nine years. The United States, the Medical University of South Carolina, and researcher Zangen A were identified as the leading contributors in this area through bibliometric and visual analysis. Keyword burst detection indicated that neurobiology, AUD, and rtms are current research hotspots. This bibliometric analysis can help researchers interested in TMS-based treatment of addiction understand the latest research trends and hotspots.
From 2001 to 2023, the United States and China were major contributors to research on TMS-based treatment of addiction. The United States consistently leads in publication volume, citation count, and international collaboration. Half of the top ten research organizations and researchers with the most publications were based in the United States. Four of the ten most active academic journals in the field were from the United States, with the most cited journal coming from the United States. All of these findings show the absolute academic influence and dominance of the United States in this field. China started publishing research papers in this field in 2016 and exceeded the United States in annual publication numbers by 2020. In 2023, China ranked second in the number of published papers, following the United States, but was fifth in total citations, significantly trailing the United States, which held the first position. This suggests that the academic impact of China in this area still requires enhancement, particularly in producing high-quality publications.
With the process of globalization, there has been a significant trend toward increased international collaboration. This has led to the production of high-quality publications on public health issues. The United States 's closest collaboration is with Italy, followed by China. Research institutions with the most publications predominantly originated from the United States, China, and Canada. In the face of the global burden of addiction, research in this area requires more collaboration among countries and institutions.
The sharp rise in publications over the past nine years indicates heightened interest in TMS-based addiction treatment. Recently, several clinical studies have found that rTMS can reduce craving levels[26] and improve cognitive functions, such as attention, memory, and decision-making, in substance-addicted patients[27], suggesting that TMS is effective in treating addiction. Preclinical and clinical studies suggested that rTMS induces adaptation in specific subcortical neural circuits of the frontal regions of the brain, thereby leading to substantial behavioral changes[27-29]. Basic experiments are more conducive to exploring the neural mechanisms underlying TMS-based treatment of addiction[30-32]. However, they are limited by the absence of TMS devices suitable for small animals.
Zangen A was the leading author in TMS-based addiction treatment research, with George MS and Hanlon CA each contributing 11 articles. Zangen A from Ben Gurion University (Israel) studies electrophysiological and behavioral alterations induced by deep rTMS in depression, addiction, and attention deficit hyperactivity disorder[5,10,33]. Hanlon CA and George MS are affiliated with the Medical University of South Carolina, United States. Using functional and structural brain imaging techniques, along with TMS, they investigated cortico-striatal connectivity in substance-dependent populations[5]. Recent research employed functional magnetic resonance imaging to examine the impact of 10 rTMS sessions on cortical activity and neural networks in smokers seeking treatment. They demonstrated that diminished drive-reward and executive control functional connectivity correlate with the smoking cessation effects of rTMS[15].
Using a timeline view of changes in research fields, we found that the latest research trends in the field of TMS-based treatment of addiction included the DA hypothesis and nicotine dependence, as shown by the red nodes in Figure 6B. The DA hypothesis cluster started to appear in 2013 and remained a hot research topic until recent years. Dopaminergic activity is reduced in rodent models and in people with addiction. Brain stimulation has been shown to "boost" DA signaling in human brain, thereby providing a path for restoring neural homeostasis[34]. In addition, rTMS of frontal brain regions selectively stimulates DA release from the hippocampus[35], positioning DA as a key candidate neurotransmitter directly and selectively modulated by rTMS. Moreover, high-frequency rTMS also increases DA levels in the nucleus accumbens, anterior cingulate cortex, and PFC[24]. The nicotine dependence cluster was closely linked to the DA hypothesis cluster (Figure 6B), indicating that research on TMS-based treatment of patients with tobacco addiction has received much attention in recent years[15,36,37].
Keyword bursts are considered indicators of important research hotspots or emerging trends. The top 15 most cited keyword bursts are listed in Figure 7B. The time period of the listed keyword bursts was scattered but completely covered the 2001-2023 period, indicating that major research interests have evolved over time. Among the four most recent keywords, the outburst of "rtms", also “repetitive transcranial magnetic stimulation”, began in 2020 and ranked first, with an intensity of 4.85. Studies related to this keyword focused on the safety and efficacy of rTMS, a new neuroelectrophysiological technique developed based on TMS for treating addiction[4]. Second, the burst of "neurobiology" originated from studies targeting the neurobiological mechanisms associated with addiction. They showed adaptive changes in neuronal circuits involved in reward and fear processing due to chronic substance use and abuse[38]. In addition to acute effects, TMS can induce long-term plasticity, which alleviates addiction. The frequency and pattern of the TMS pulse sequence determine whether the long-term plasticity effects of TMS are facilitatory or suppressive[39-42]. Most clinical trials on rTMS employ relatively strong intensities (approximately 100%-120% of the motor threshold); however, relatively weak rTMS intensities, which do not induce pyramidal cell action potentials, can also modulate cortical excitability. This modulatory effect may be due to the altered synaptic strengths between interneurons and pyramidal cells[43]. The third keyword burst was "AUD". As the most prevalent form of addiction, AUD brings a serious burden to individuals and society[44]. The neural mechanism of AUD has always been a hot spot in treating addiction[45], and investigating the neurobiological mechanism of TMS-based treatment of AUD[10]. To sum up, these keywords suggest that the neurobiological mechanisms of TMS-based treatment of addiction, such as AUD, nicotine dependence, and drug addiction, will continue to be research hotspots in the future. This finding can help better understand the disease-specific pathophysiology of addiction and select optimal cortical and network-level targets for TMS.
Our study has limitations. First, only data retrieved from WoSCC contained the complete information needed for co-citation analysis by CiteSpace. Consequently, data were exclusively sourced from the WoSCC SCI-E database, omitting records from other significant search engines such as PubMed, EMBASE, and Ovid. This choice might have resulted in an incomplete literature sample on TMS-based treatment of addiction published from 2001 to 2023. Secondly, we chose papers published in English, as it is the dominant language in contemporary academic journals. Consequently, articles published in languages other than English were excluded. Furthermore, despite the increasing number of articles related to TMS-based treatment of addiction, the total number of articles remains relatively small. Hence, our analysis results may be somewhat biased due to reliance on existing literature. Future studies should overcome these limitations.
CONCLUSION
This study presents the inaugural bibliometric and visual analysis of publications on TMS-based addiction treatment. The number of papers in this field has rapidly increased since 2015, with the United States and China being the primary contributors. The neurobiological mechanisms of TMS-based treatment of addiction are expected to remain a prominent research direction in the future. The current study offers valuable insights to explore the therapeutic parameters and neurobiological mechanisms involved in TMS-based treatment of addiction.
ACKNOWLEDGEMENTS
We thank the databases that provide access to the data. We also would like to thank the bibliometric analysis softwares for help in analyzing the results.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Medicine, research and experimental
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade C
Novelty: Grade C
Creativity or Innovation: Grade C
Scientific Significance: Grade C
P-Reviewer: Chai R S-Editor: Luo ML L-Editor: A P-Editor: Zhang XD
Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, United States Department of Health and Human Services.
Results from the 2018 National Survey on Drug Use and Health: Graphics from the Key Findings Report. Available from: https://mamh-web.files.svdcdn.com/production/files/NSDUHffrBriefingSlides2018.pdf.
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