Repetitive Transcranial Magnetic Stimulation of the Dorsolateral Prefrontal Cortex Reduces Nicotine Cue Craving

Medical University of South Carolina (XL, KJH, MO, TL, JJB, CAH, KTB, MSG). Electronic address: .
Biological psychiatry (Impact Factor: 10.26). 02/2013; 73(8). DOI: 10.1016/j.biopsych.2013.01.003
Source: PubMed


Repetitive transcranial magnetic stimulation (rTMS) can noninvasively stimulate the brain and transiently amplify or block behaviors mediated through a region. We hypothesized that a single high-frequency rTMS session over the left dorsolateral prefrontal cortex (DLPFC) would reduce cue craving for cigarettes compared with a sham TMS session.

Sixteen non-treatment-seeking, nicotine-dependent participants were randomized to receive either real high-frequency rTMS (10 Hz, 100% resting motor threshold, 5-sec on, 10-sec off for 15 min; 3000 pulses) or active sham (eSham) TMS over the DLPFC in two visits with 1 week between visits. The participants received cue exposure before and after rTMS and rated their craving after each block of cue presentation.

Stimulation of the left DLFPC with real, but not sham, rTMS reduced craving significantly from baseline (64.1±5.9 vs. 45.7±6.4, t = 2.69, p = .018). When compared with neutral cue craving, the effect of real TMS on cue craving was significantly greater than the effect of sham TMS (12.5±10.4 vs. -9.1±10.4; t = 2.07, p = .049). More decreases in subjective craving induced by TMS correlated positively with higher Fagerström Test for Nicotine Dependence score (r = .58, p = .031) and more cigarettes smoked per day (r = .57, p = .035).

One session of high-frequency rTMS (10 Hz) of the left DLPFC significantly reduced subjective craving induced by smoking cues in nicotine-dependent participants. Additional studies are needed to explore rTMS as an aid to smoking cessation.

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    • "In sum, these studies support the view that rTMS leading to beneficial clinical outcomes in depression and schizophrenia modulates release of neuromediators and brain activity in regions with high glucocorticoid receptor density. rTMS over the left DLPFC can also alleviate symptoms in other conditions such as substance use disorders [3] and posttraumatic stress disorders [4] which are also importantly related to HPA axis dysfunction [5]. It would thus be interesting to investigate whether rTMS over the left DLPFC modulates the HPA axis in these conditions. "
    Brain Stimulation 12/2014; 8(2). DOI:10.1016/j.brs.2014.11.021 · 4.40 Impact Factor
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    • "There is no evidence as yet, but if DLPFC stimulation could selectively correct this abnormality, this could confer an advantage to the comorbid sample in terms of response, but again, it could not explain the puzzlingly better 6-month outcome of the comorbid sample, compared to the MDD-only. Craving for several substances has been shown to be reduced through DLPFC stimulation, including nicotine (Amiaz et al., 2009; Li et al., 2013; Pripfl et al., 2014), cocaine (Camprodon et al., 2007; Politi et al., 2008), and alcohol (Boggio et al., 2008). However, alcohol-related cues which increase craving, are likely to increase activity in the prefrontal cortex (Olbrich et al., 2006). "
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