Preventing relapse to smoking with transcranial magnetic stimulation: Feasibility and potential efficacy.
Many smokers attempt to quit every year, but 90% relapse within 12 months. Converging evidence suggests relapse is associated with insufficient activation of the prefrontal cortex. Delay discounting rate reflects relative activity in brain regions associated with relapse. High-frequency repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (LDLPFC) increases cortical excitability and reduces delay discounting rates, but little is known about feasibility, tolerability, and potential efficacy for smoking cessation. We hypothesized that 8 sessions of 20Hz rTMS of the LDLPFC combined with an evidence-based self-help intervention will demonstrate feasibility, tolerability, and potential efficacy in a limited double-blind randomized control trial. Smokers (n=29), abstinent for 24h, motivated to quit, and not using cessation medications, were randomized to active 20Hz rTMS at 110% of Motor Threshold or sham stimulation that replicated the look and sound of active stimulation. Stimulation site was located using the 6cm rule and neuro-navigation. Multiple clinical, feasibility, tolerability, and efficacy measures were examined. Active rTMS decreased delay discounting of $100 (F (1, 25.3694)=4.14, p=.05) and $1000 (F (1, 25.169)=8.42, p<.01), reduced the relative risk of relapse 3-fold (RR 0.29, CI 0.10-0.76, Likelihood ratio χ2 with 1 df=6.40, p=.01), increased abstinence rates (active 50% vs. sham 15.4%, Χ2 (df=1)=3.80, p=.05), and increased uptake of the self-help intervention. Clinical, feasibility, and tolerability assessments were favorable. Combining 20Hz rTMS of the LDLPFC with an evidence-based self-help intervention is feasible, well-tolerated, and demonstrates potential efficacy.
['Sheffer|Christine E|CE|', 'Bickel|Warren K|WK|', 'Brandon|Thomas H|TH|', 'Franck|Christopher T|CT|', 'Deen|Darwin|D|', 'Panissidi|Luana|L|', 'Abdali|Syed Amir|SA|', 'Pittman|Jami C|JC|', 'Lunden|Sara E|SE|', 'Prashad|Neelam|N|', 'Malhotra|Ria|R|', 'Mantovani|Antonio|A|']
D000328:Adult D000073865:Cigarette Smoking D004311:Double-Blind Method D005240:Feasibility Studies D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D010865:Pilot Projects D017397:Prefrontal Cortex D012008:Recurrence D055502:Secondary Prevention D016540:Smoking Cessation D050781:Transcranial Magnetic Stimulation D016896:Treatment Outcome
Transcranial magnetic stimulation Feasibility Smoking cessation Relapse prevention