Deep TMS of the insula using the H-coil modulates dopamine release: a crossover [11C] PHNO-PET pilot trial in healthy humans

Malik, Saima Shakil; Jacobs, Mark F.; Cho, Sang Soo; Boileau, Isabelle; Blumberger, Daniel M.; Heilig, Markus; Wilson, Alan A.; Daskalakis, Zafiris J.; Strafella, Antonio P.; Zangen, Abraham; Foll, Bernard Le

doi:10.1007/s11682-017-9800-1

Cited by 42 publications

(29 citation statements)

References 86 publications

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“…Given the crucial role of the insula in incentive motivational processes (Naqvi and Bechara, 2010; Naqvi et al, 2014) and in the contextual control over cocaine-seeking (Arguello et al, 2017) and cue-induced reinstatement (Cosme et al, 2015), modulating the function of both the prefrontal and insular cortices could result in a novel therapeutic strategy to be extended to cocaine addicts. In partial support to this hypothesis, deep rTMS of the insular cortex was recently reported to significantly modulate dopamine release in healthy subjects (Malik et al, 2018).…”

Section: Introductionmentioning

confidence: 88%

Intermittent Theta Burst Stimulation of the Prefrontal Cortex in Cocaine Use Disorder: A Pilot Study

et al. 2019

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Transcranial Magnetic Stimulation (TMS) is earning a role in the therapeutic arsenal of cocaine use disorder (CUD). A widespread and still growing number of studies have reported beneficial use of repeated TMS (rTMS) in reduction of craving, intake and cue-induced craving in cocaine addicts. In spite of these encouraging findings, many issues are still unresolved such as brain area to be stimulated, laterality of the effects, coil geometry and stimulation protocols/parameters. Intermittent theta burst stimulation (iTBS) is a more tolerable protocol administered at lower intensities and shorter intervals than conventional rTMS protocols. Yet, its effects on cocaine craving and length of abstinence in comparison with standard high frequency (10–15 Hz) protocols have never been evaluated so far. In the present paper, we describe the effect of the bilateral iTBS of the prefrontal cortex (PFC) in a population ( n = 25) of treatment-seeking cocaine addicts, in an outpatient setting, and compare them with 15 Hz stimulation of the same brain area ( n = 22). The results indicate that iTBS produces effects on cocaine consumption and cocaine craving virtually superimposable to the 15 Hz rTMS group. Both treatments had low numbers of dropouts and similar side-effects, safety and tolerability profiles. While larger studies are warranted to confirm these observations, iTBS appears to be a valid approach to be considered in treatment-seeking cocaine addicts, especially in light of its brief duration (3 min) vs. 15 Hz stimulation (15 min). The use of iTBS would allow increasing the number of patients treated per day with current rTMS devices, thus reducing patient discomfort and hopefully reducing drop-out rates without compromising clinical effectiveness.

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Section: Introductionmentioning

confidence: 88%

Intermittent Theta Burst Stimulation of the Prefrontal Cortex in Cocaine Use Disorder: A Pilot Study

et al. 2019

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“…There has been one study investigating the changes in dopamine levels following bilateral insula rTMS, but it was done on healthy participants. Low-frequency rTMS (1 Hz) was found to significantly decrease dopamine levels in the substantia nigra, sensorimotor striatum, and associative striatum (Malik et al, 2018).…”

Section: Clinical Evidence For the Insulamentioning

confidence: 99%

The Insula: A Brain Stimulation Target for the Treatment of Addiction

et al. 2019

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Substance use disorders (SUDs) are a growing public health concern with only a limited number of approved treatments. However, even approved treatments are subject to limited efficacy with high long-term relapse rates. Current treatment approaches are typically a combination of pharmacotherapies and behavioral counselling. Growing evidence and technological advances suggest the potential of brain stimulation techniques for the treatment of SUDs. There are three main brain stimulation techniques that are outlined in this review: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS). The insula, a region of the cerebral cortex, is known to be involved in critical aspects underlying SUDs, such as interoception, decision making, anxiety, pain perception, cognition, mood, threat recognition, and conscious urges. This review focuses on both the preclinical and clinical evidence demonstrating the role of the insula in addiction, thereby demonstrating its promise as a target for brain stimulation. Future research should evaluate the optimal parameters for brain stimulation of the insula, through the use of relevant biomarkers and clinical outcomes for SUDs.

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“… 69 , 75 Recently, Malik et al tested the capacity of the H-coil to modulate DA release in eight healthy subjects, finding that low-frequency rTMS (1 Hz) significantly decreased DA levels in the substantia nigra and sensorimotor and associative striata. 76 This novel coil seems to have more chance of obtaining consistent and prolonged effects, presumably due to its ability to stimulate subcortical brain regions that are involved in the development of addiction’s neuropathology. However, since cortical thickness is contained within 2 cm from the skin surface, targeting fifth-layer cortical pyramidal neurons (efferent) may suffice to modulate subcortical circuitries involved in taking and relapse.…”

Section: Tms Physiologymentioning

confidence: 99%

Transcranial magnetic stimulation for the treatment of cocaine addiction: evidence to date

Bolloni¹,

Badas²,

Corona³

et al. 2018

SAR

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There is a common consensus in considering substance-use disorders (SUDs) a devastating chronic illness with social and psychological impact. Despite significant progress in understanding the neurobiology of SUDs, therapeutic advances have proceeded at a slower pace, in particular for cocaine-use disorder (CUD). Transcranial magnetic stimulation (TMS) is gaining support as a safe and cost-effective tool in the treatment of SUDs. In this review, we consider human studies that have investigated the efficacy of TMS in achieving therapeutic benefits in treating CUD. All studies conducted to date that have evaluated the therapeutic effect of TMS in CUD are included. We focus on the protocol of stimulation applied, emphasizing the neurophysiological effects of coils employed related to outcomes. Moreover, we examine the subjective and objective measurements used to assess the therapeutic effects along the timeline considered. The revision of scientific literatures underscores the therapeutic potential of TMS in treating CUD. However, the variability in stimulation protocols applied and the lack of methodological control do not allow us to draw firm conclusions, and further studies are warranted to examine the interaction between TMS patterns of stimulation relative to clinical outcomes in depth.

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Deep TMS of the insula using the H-coil modulates dopamine release: a crossover [11C] PHNO-PET pilot trial in healthy humans

Abstract: NCT02212405.

Cited by 42 publications

References 86 publications

Intermittent Theta Burst Stimulation of the Prefrontal Cortex in Cocaine Use Disorder: A Pilot Study

Intermittent Theta Burst Stimulation of the Prefrontal Cortex in Cocaine Use Disorder: A Pilot Study

The Insula: A Brain Stimulation Target for the Treatment of Addiction

Transcranial magnetic stimulation for the treatment of cocaine addiction: evidence to date

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