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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    • "Substance À Cocaine (Camprodon et al., 2007;Politi et al., 2008); alcohol (De Ridder et al., 2011;Herremans et al., 2012Herremans et al., , 2013H€ oppner et al., 2011;Mishra et al., 2010;Rapinesi et al., 2013) À Nicotine (Amiaz et al., 2009;Eichhammer et al., 2003;Hayashi et al., 2013;Li et al., 2013a;Rose et al., 2011;Wing et al., 2012) À Methamphetamine (Li et al., 2013b) Target region À Right DLPFC (Herremans et al., 2012Herremans et al., , 2013Mishra et al., 2010) À Left DLPFC (Amiaz et al., 2009;Camprodon et al., 2007;Eichhammer et al., 2003;Hayashi et al., 2013;H€ oppner et al., 2011;Li et al., 2013a,b;Politi et al., 2008;Rapinesi et al., 2013;Wing et al., 2012) À Dorsal anterior cingulated cortex (De Ridder et al., 2011) À Superior frontal gyrus (Rose et al., 2011) Stimulation frequency À HF-rTMS (Amiaz et al., 2009;Camprodon et al., 2007;Eichhammer et al., 2003;Herremans et al., 2012Herremans et al., , 2013H€ oppner et al., 2011;Li et al., 2013a;Mishra et al., 2010;Politi et al., 2008;Rapinesi et al., 2013;Rose et al., 2011;Wing et al., 2012) À LF-rTMS (De Ridder et al., 2011;Hayashi et al., 2013;Li et al., 2013b;Rose et al., 2011) Number of sessions À More than one session (Amiaz et al., 2009;De Ridder et al., 2011;Eichhammer et al., 2003;H€ oppner et al., 2011;Li et al., 2013b;Mishra et al., 2010;Politi et al., 2008;Rapinesi et al., 2013;Rose et al., 2011;Wing et al., 2012) À Single session (Camprodon et al., 2007;Herremans et al., 2012Herremans et al., , 2013Li et al., 2013a) Outcome of interest À Craving (Amiaz et al., 2009;Camprodon et al., 2007;De Ridder et al., 2011;Eichhammer et al., 2003;Hayashi et al., 2013;Herremans et al., 2012Herremans et al., , 2013H€ oppner et al., 2011;Li et al., 2013a,b;Mishra et al., 2010;Politi et al., 2008;Rapinesi et al., 2013;Rose et al., 2011;Wing et al., 2012) À Drug consumption (Amiaz et al., 2009;Eichhammer et al., 2003) À Breath carbon monoxide levels (Wing et al., 2012) À Urine test results (Amiaz et al., 2009) and blood (De Ridder et al., 2011)16 NIBS for addiction medicine: From monitoring to modulation ARTICLE IN PRESS Although the preliminary results of rTMS/tES in treatment domain are promising, extending their applications to the clinical domains remains challenging. In Section 4, we discuss some of the problems which need further investigation, before these techniques can be employed by clinicians. "
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    ABSTRACT: Addiction is a chronic relapsing brain disease with significant economical and medical burden on the societies but with limited effectiveness in the available treatment options. Better understanding of the chemical, neuronal, regional, and network alterations of the brain due to drug abuse can ultimately lead to tailoring individualized and more effective interventions. To this end, employing new assessment and intervention procedures seems crucial. Noninvasive brain stimulation (NIBS) techniques including transcranial electrical and magnetic stimulations (tES and TMS) have provided promising opportunities for the addiction medicine in two main domains: (1) providing new insights into neurochemical and neural circuit changes in the human brain cortex and (2) understanding the role of different brain regions by using NIBS and modulating cognitive functions, such as drug craving, risky decision making, inhibitory control and executive functions to obtain specific treatment outcomes. In spite of preliminary positive results, there are several open questions, which need to be addressed before routine clinical utilization of NIBS techniques in addiction to medicine, such as how to account for interindividual differences, define optimal cognitive and neural targets, optimize stimulation protocols, and integrate NIBS with other therapeutic methods. Therefore, in this chapter we revise the available literature on the use of NIBS (TMS and tES) in the diagnostic, prognostic, and therapeutic aspects of the addiction medicine.
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    • "Those smokers with higher baseline craving scores have a greater scope for reductions in craving than the smokers with lower baseline craving scores. In contrast with previous findings (Shiffman et al., 2003;Unrod et al., 2013), but in accord with others (Canterberry et al., 2013;Kober et al.,Li et al., 2013) the number of cigarettes smoked per day was associated with reductions in craving. This finding may be also related to individual differences in baseline craving ratings. "
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    ABSTRACT: Although extensive research has demonstrated that cigarette craving can be effectively attenuated, very few studies have explored associations between individual variables and craving reduction. This study explored whether individual characteristics predict craving decreases during virtual reality cue exposure treatment (VR-CET). Participants were 41 treatment-seeking smokers (73% women) with a mean age of 39.4 (SD=13.2), who had been smoking 15.0 (SD=7.1) cigarettes per day for 20.0 (SD=10.7) years. Their mean score on the Fagerström Test of Nicotine Dependence (FTND) was 4.8 (SD=2.3). Participants completed five cue exposure sessions using virtual reality for smoking cessation over a five-week period. The percentage of reduction in craving was calculated by comparing self-reported craving after the first and last exposure sessions. Sociodemographic characteristics (gender, age, years of education and marital status), tobacco-related [duration of daily smoking, cigarettes per day, FTND and Nicotine Dependence Syndrome Scale (NDSS)] and psychological characteristics [depressive symptoms (Beck's Depression Inventory-Second Edition, BDI-II), impulsiveness (delay discounting) and anxiety (State-Trait Anxiety Inventory, STAI)] were examined as possible predictors for craving reductions. Multiple regression revealed that greater decreases in craving were associated with younger age (β=-.30, p=.043), cigarettes smoked per day (β=.30, p=.042), higher values on delay discounting (β=.34, p=.020) and higher BDI-II scores (β=.30, p=.035). These findings suggest that smokers with certain individual characteristics may benefit most from interventions aimed at reducing craving through VR-CET. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · May 2015 · Addictive behaviors
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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. "

    Full-text · Article · Dec 2014 · Brain Stimulation
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