CNS & Neurological Disorders - Drug Targets   Send Orders for Reprints to reprints@benthamscience.net 310 CNS & Neurological Disorders - Drug Targets, 2021, 20, 310-311 LETTER TO THE EDITOR Emergence of Sexual Dreams and Emission Following Deep Transcranial Magnetic Stimulation over the Medial Prefrontal and Cingulate Cortices Ying Shen 1,# , Xinyu Cao 2,# , Ning-Ning Zeng 3,# , Yingjie Wang 4,# , Hangbin Zhang 3 , Abraham Zangen 5 and Ti-Fei Yuan 3,6,* 1 Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; 2 Addic- tion Rehabilitation Department, Da Lian Shan Institute of Addiction Rehabilitation, Nanjing, China; 3 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; 4 Social Work Department, Nanjing University of Finance and Economics, Nanjing, Chi- na; 5 Department of Life Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; 6 Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China ARTICLE HISTORY Received: April 19, 2020 Revised: September 01, 2020 Accepted: September 15, 2020 DOI: 10.2174/1871527319666201209111620 Abstract: In a pilot study involving methamphetamine dependents receiving deep Transcranial Magnetic Stimulation (dTMS) targeting the medial prefrontal and cingulate cortices with H7 coil (Brainsway, Israel), we assessed clinical outcomes from patients receiving 20 sessions of dTMS treatments over 4 weeks (5 days on, 2 days off). Although the primary outcome was the behavioral changes related to addiction, we encountered a phenomenon of robust increases in sexual dreams and emission in a patient recruited for this study, which may inform alterations in cortical excitabil- ity following dTMS treatment. TO THE EDITOR Chronic methamphetamine use affects synaptic plastici- ty. Transcranial Magnetic Stimulation (TMS) intervention can modulate cortical plasticity and improve episodic memo- ry correspondingly. In a pilot study, we assessed the clinical outcomes of methamphetamine-dependent patients receiving 20 sessions of deep TMS (dTMS) treatments over 4 weeks (5 days on, 2 days off). The dTMS treatment targeted the me- dial prefrontal and cingulate cortices with H7 coil (Brain- sway, Israel). In one patient, we observed robust increases in sexual dreams and emissions. This suggests that cortical exc- itability may be altered by the dTMS treatment. The study was approved by the Ethics Committee of Research at Shanghai Mental Health Center and Nanjing Medical Univer- sity. All subjects or their representative family members sub- mitted their written informed consent for participating in the study. The subject was 33 years old (married, 9 years of educa- tion), male, healthy, and worked as a chef before admission to the addiction rehabilitation center. The subject reported a history of methamphetamine abuse for 8 years. The subject had his first sexual emission at 14 years old and married at 29 years old. The subject reported no emissions during his * Address correspondence to this author at the Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; E-mail ytf0707@126.com # These authors contributed equally to this work. marriage. However, since his admission to the addiction re- habilitation center in March 2019, he reported an average of 4 sexual dreams accompanying emission per month (Table 1). Table 1. Demographic information and dTMS treatment. Methamphetamine Abuse 0.1 Gram/per Use, 5 Times Per Month Smoking 3 cigarettes per day Symptom Checklist-90 129 Beck-depression inventory 18 Beck-anxiety inventory 25 Barratt impulsiveness scale 86 OLSON marriage quality scale 39 dTMS treatment with H7 coil 10 Hz, 100% rMT of lower extremity,3s on and 17s off, 16.7 minutes per session, 1500 pulses, 5 sessions per week for 4 weeks. This subject received the following dTMS protocol. 20 treatment sessions were administrated over 4 weeks (5 days on, 2 days off). In each treatment session, the dTMS parame- ters were 10Hz, 100% rMT of lower extremity,3s on and 17s off for 16.7 minutes, and 1500 pulses. The H-coils were positioned over the motor cortex of the lower extremity to determine the individual subject’s resting motor threshold, which was then used to establish the treatment stimulation in- tensity. The subject was asked to sit in a comfortable chair and to keep quiet and awake. The study followed a dou- 1-/21 $65.00+.00 © 2021 Bentham Science Publishers