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

Abstract

Background: Previous studies have found that repetitive transcranial magnetic stimulation (rTMS) to the left dorsal lateral prefrontal cortex (LDLPFC) transiently reduces smoking craving, decreases cigarette consumption, and increases abstinence rates. Objective: We investigated whether 10 daily MRI-guided rTMS sessions over two weeks to the LDLPFC paired with craving cues could reduce cigarette consumption and induce smoking cessation. Methods: We enrolled 42 treatment-seeking nicotine-dependent smokers (!10 cigarettes per day) in a randomized, double-blind, sham-controlled trial. Participants received 10 daily sessions over 2 weeks of either active or sham MRI-guided rTMS (10Hz, 3000 pulses each session) to the LDLPFC concurrently with video smoking cues. The primary outcome was a reduction in biochemically confirmed cigarette consumption with a secondary outcome of abstinence on the target quit date. We also recorded cueinduced craving and withdrawal symptoms. Results: Compared to sham (n ¼ 17), participants receiving active rTMS (n ¼ 21) smoked significantly fewer cigarettes per day during the 2-week treatment (mean [SD], 13.73[9.18] vs. 11.06[9.29], P < .005) and at 1-month follow-up (12.78[9.53] vs. 7.93[7.24], P < .001). Active rTMS participants were also more likely to quit by their target quit rate (23.81%vs. 0%, OR 11.67, 90% CL, 0.96e141.32, x 2 ¼ 4.66, P ¼ .031). Furthermore, rTMS significantly reduced mean craving throughout the treatments and at follow-up (29.93[13.12] vs. 25.01[14.45], P < .001). Interestingly across the active treatment sample, more lateral coil location was associated with more success in quitting (À43.43[0.40] vs. À41.79[2.24], P < .013). Conclusions: Daily MRI-guided rTMS to the LDLPFC for 10 days reduces cigarette consumption and cued craving for up to one month and also increases the likelihood of smoking cessation. Trial registration: ClinicalTrials.gov identifier: NCT02401672.

Sex Differences in the Association of Cigarette Craving With Insula Structure

“…Future studies to validate and clarify this sex difference are necessary. Brain-based smoking cessation interventions, such as transcranial magnetic stimulation, have been evaluated for smoking cessation ( Li et al, 2017 ) and reduced cigarette consumption and nicotine dependence after stimulation of the insula ( Dinur-Klein et al, 2014 ) or the left dorsolateral prefrontal cortex ( Li et al, 2020 ; Abdelrahman et al, 2021 ). Such interventions may improve their efficacy by targeting different brain regions, and perhaps different subregions of the insula, in men vs women.…”

Repetitive transcranial magnetic stimulation: an innovative medical therapy

“…It has been shown that rTMS is promising treatment option for many neuropsychiatric conditions like depression, 2,24,25 OCD, 28 BD, 36,37 negative symptoms 29 and auditory hallucinations 30,31 in schizophrenia, addiction,s [33][34][35] anxiety and anxiety related disorders, [39][40][41] fibromyalgia, 44,45 chronic pain, 42,43 and dementia/Alzheimer's disease. [46][47][48][49] It is also very important that many studies reported that rTMS causes significant improvement of cognition.…”

“…According to a recent study, daily rTMS (MRI-guided) in the left DLPFC for 10 days may reduce cigarette consumption as well as the desire for up to a month and at the same time increases the likelihood of smoking cessation. 34 In addition, rTMS appears to be a promising treatment for cocaine use disorder, as it appears to have a therapeutic role in reducing cocaine use and associated symptoms such as sleep disturbance and other adverse symptoms. 35 Bipolar Disorder rTMS is a promising treatment option for patients with both monopolar and bipolar depression.…”

Four electric field modeling methods of Dosing Prefrontal Transcranial Magnetic Stimulation (TMS): Introducing APEX MT dosimetry

“…However, there is currently no widely adopted E-field dosing approach or consensus on the optimal E-field dosing threshold. Here we investigate four E-field modeling methods that could be used to prospectively dose prefrontal TMS, demonstrating the benefits and drawbacks of each approach through modeling on our 38 previously acquired scans [8](Fig. 1AeD; Supplementary Section 1 for E-field modeling methods).…”