Effect of rTMS in Pathological Gamblers

Patients included in this study will have:

• An anatomical brain MRI (30 minutes).
• Two 20 minute sessions of rTMS (placebo and active) of the left DLPFC, at the frequency of 10 Hz.
• Visual Analogue Scale measuring their desire to gamble before and after a gambling video and test measuring their gambling behavior during the last 7 days (PG-YBOCS).
• Cognitive tests, to be carried out on a computer before and immediately after rTMS sessions.
• Recording heart rate variability (HRV) to measure the autonomic nervous system (ANS) activity

As it is a pilot study, the investigators don't have sufficient data to calculate statistical power and number of participants. The investigators based on previous studies evaluating one rTMS session on craving in SUD and used a crossover design to generate greater power.

Inclusion criteria

• Patients with a diagnosis of pathological gambling (DSM IV criteria)
• First-time consultants.
• Without psychotropic treatment or treatment with a stable and unchanged for over a month.

Exclusion criteria

• Presence of ferromagnetic material or devices implanted neurostimulation in close contact with the coil
• Pregnant women and patients with hearing disorders
• Personal history of epilepsy (untreated or poorly balanced)
• Focal brain injury, whatever its origin (vascular, traumatic, tumor or infectious)
• History of head trauma with loss of consciousness,
• Administration of drugs or substances lowering the seizure threshold
• Sleep deprivation, jet lag, or drug withdrawal.
• Participants with a problem of uncorrected visual acuity.
• Other current addiction (except tobacco, for reasons of feasibility).
• Current Psychiatric comorbidity
• Treatment psychotropic introduced or changed for less than a month.
• Subjects with atrial fibrillation, with a pacemaker and / or receiving antiarrhythmic drugs