Dissociable Effects of Theta-Burst Repeated Transcranial Magnetic Stimulation to the Inferior Frontal Gyrus on Inhibitory Control in Nicotine Addiction

Abstract

Nicotine addiction, like other substance use disorders (SUD's), is associated with deficits in prefrontal mediated inhibitory control. The strength of inhibitory control task-based functional connectivity (tbFC) between the right inferior frontal gyrus (r.IFG) and thalamus (corticothalamic circuit) mediates the association between successful inhibition and smoking relapse vulnerability. However, the potential efficacy of theta burst stimulation (TBS) to the r.IFG, a treatment known to alter clinical symptoms among neuropsychiatric patients, has not been reported in a SUD population. This study utilized fMRI guided neuronavigation to examine the effects of TBS on inhibitory control among nicotine dependent individuals. Participants (N=12) were scanned while performing an inhibitory control task known to elicit inhibition-related activity in the r.IFG. Using a randomized, counterbalanced cross-over design, participants then received TBS over two visits: excitatory (iTBS) on one visit and inhibitory (cTBS) TBS on the other visit. The effects of each TBS condition on subsequent inhibitory control task performance were examined. A significant condition x time interaction was identified on trials requiring inhibitory control (F (1,10) = 7.27, p = .022, D = 1.63). iTBS improved inhibitory control, whereas cTBS impaired inhibitory control. Brain stimulation did not influence performance in control conditions including novelty detection and response execution. This is the first study to demonstrate that non-invasive neural stimulation using iTBS to the r.IFG enhances baseline inhibitory control among individuals with a SUD. Further research is needed to directly examine the potential parametric effects of TBS on corticothalamic tbFC in individuals with a SUD.

Endogenous theta stimulation during meditation predicts reduced opioid dosing following treatment with Mindfulness-Oriented Recovery Enhancement

“…In humans with addictive behaviors, exogenous theta stimulation may be therapeutic. For example, among people with nicotine addiction, excitatory theta burst stimulation to the right inferior frontal gyrus of the PFC significantly increased inhibitory control [ 44 ]—a neurocognitive mechanism shown to predict decreased smoking relapse vulnerability [ 45 ]. In parallel, increased frontal theta and FMT power indicate heightened PFC activation [ 16 , 20 , 23 ], and meditation training increases mPFC and inferior frontal gyrus activation while reducing cigarette smoking [ 46 ].…”

Associations Between Smoking Abstinence, Inhibitory Control, and Smoking Behavior: An fMRI Study

“…These findings may have applicability to therapies for enhancing IC and ameliorating relapse vulnerability. For example, non-invasive neural stimulation, specifically theta-burst transcranial magnetic stimulation (TMS) to the rIFG, has recently been shown to influence IC among sated smokers ( 70 ). Future studies may also explore whether TMS can improve IC in abstinent smokers and impact its relationship with resisting smoking.…”

Reducing craving and consumption in individuals with drug addiction, obesity or overeating through neuromodulation intervention: a systematic review and meta‐analysis of its follow‐up effects

“…Fourth, although iTBS is the fastest growing stimulation type in clinical applications, none of the studies conducted so far met our screening criteria (e.g. [75][76][77][78][79][80]). Fifth, we used P values to assess the maintenance effect of neuromodulation on abstinence.…”