Transcranial magnetic stimulation of the dorsal lateral prefrontal cortex inhibits medial orbitofrontal activity in smokers

Abstract

Background and Objective Several studies have shown that repetitive transcranial magnetic stimulation (rTMS), applied to the dorsolateral prefrontal cortex (DLPFC), can reduce cue-elicited craving in smokers. Currently the mechanism of this effect is unknown. We used functional magnetic resonance imaging (fMRI) to explore the effect of a single treatment of rTMS on cortical and sub-cortical neural activity in non-treatment seeking nicotine dependent participants. Methods We conducted a randomized, counterbalanced, crossover trial in which participants attended two experimental visits separated by at least 1 week. On the first visit, participants received either active, or sham rTMS (10 Hz, 5 seconds-on, 10 seconds-off, 100% motor threshold, 3000 pulses) over the left DLPFC, and on the second visit they received the opposite condition (active or sham). Cue craving fMRI scans were completed before and after each rTMS session. Results 11 non-treatment seeking nicotine dependent cigarette smokers were enrolled in the study [6 female, average age 39.7±13.2, average cigarettes per day 17.3±5.9]. Active rTMS decreased activity in the contralateral medial orbitofrontal cortex (mOFC) and ipsilateral nucleus accumbens (NAc) compared to sham rTMS. Conclusions This preliminary data suggests that one session of rTMS applied to the DLPFC decreases brain activity in the NAc and mOFC in smokers. Scientific Significance rTMS may exert its anti-craving effect by decreasing activity in the NAc and mOFC in smokers. Despite a small sample size, these findings warrant future rTMS/fMRI studies in addictions.

Elevated ad libitum alcohol consumption following continuous theta burst stimulation to the left-dorsolateral prefrontal cortex is partially mediated by changes in craving

“…This preregistered study (osf.io/hjy4n) applied a randomised mixed design to transiently inhibit the neural structures associated with AB, inhibitory control, and craving (DLPFC, mOFC) to illuminate how these processes interact and drive consumption. In accordance with previous findings (McNeill et al, 2018), it was hypothesised that stimulation to the DLPFC will impair inhibitory control, while stimulation of the mOFC would significantly reduce AB for alcohol-related cues in a manner akin to observations in smokers (Li et al, 2017). As previously indicated (Adams et al, 2013;Monk et al, 2017), it was expected that inhibitory control impairments will, in turn, increase alcohol-related AB.…”

Reduced frontostriatal functional connectivity and associations with severity of Internet gaming disorder

“…For example, rTMS of the medial prefrontal cortex (mPFC) decreases ventral striatal activation in individuals with cocaine‐use problems 54 . rTMS of the left dorsolateral PFC (dlPFC) decreases activation in the NAcc 55 and alters correlation between the left dlPFC and the salience network in healthy individuals 56 . Continuous theta burst stimulation of the left ventromedial PFC (vmPFC) can decrease the FC between the vmPFC and striatum during cue reactivity in individuals with cocaine‐use and alcohol‐use problems 57 .…”

Two weeks of image-guided left dorsolateral prefrontal cortex repetitive transcranial magnetic stimulation improves smoking cessation: A double-blind, sham-controlled, randomized clinical trial

“…[7,8] In earlier work, we found that a single 15-min session of rTMS over the left DLPFC (LDLPFC) immediately reduced cue-induced craving compared to sham stimulation in smokers [9]. Subsequently, the results of cueinduced functional MRI showed that one session of LDLPFC rTMS decreased brain activity in both the medial orbitofrontal cortex (mOFC) and nucleus accumbens [10]. Notably, activity in these brain regions has been reported to be increased in cigarette smokers [11,12].…”