Abstract
Chronic smoking impairs brain functions in the prefrontal cortex and the projecting meso-cortical limbic system. The purpose of this pilot study is to examine whether modulating the frontal brain activity using high-frequency repetitive transcranial magnetic stimulation (rTMS) can improve smoking cessation and to explore the changing pattern of the brain activity after treatment. Fourteen treatment-seeking smokers were offered a program involving 10 days of rTMS treatment with a follow-up for another 25 days. A frequency of 20 Hz rTMS was sequentially applied on the left dorso-lateral prefrontal cortex (DLPFC) and the superior medial frontal cortex (SMFC). The carbon monoxide (CO) level, withdrawal, craving scales, and neuroimaging data were collected. Ten smokers completed the entire treatment program, and 90% of them did not smoke during the 25-day follow-up time. A significant smoking craving reduction and resting brain activity reduction measured by the cerebral blood flow (CBF) and brain entropy (BEN) were observed after 10 days of 20 Hz rTMS treatments compared to the baseline. Although limited by sample size, these pilot findings definitely showed a high potential of multiple-target high-frequency rTMS in smoking cessation and the utility of fMRI for objectively assessing the treatment effects.
Highlights
Cigarette smoking is a leading cause of preventable disease and premature death (Benowitz, 2010)
This pilot study showed that a 20 Hz repetitive transcranial magnetic stimulation (rTMS) sequentially applied to the left dorso-lateral prefrontal cortex (DLPFC) and the superior medial frontal cortex (SMFC) for 10 days produced a high smoking cessation rate, which was confirmed by both the behavioral measures and the fMRI data: rTMS caused smoking cessation for the entire 25-day follow-up time, reduced craving for smoking, reduced brain entropy (BEN) in the prefrontal cortex as well as insula, and decreased cerebral blood flow (CBF) in the right hemisphere
The promising high smoking cessation rate (90% of the 10 participants) and craving reduction were consistent with the previous studies (Camprodon et al, 2007; Politi et al, 2008; Li et al, 2013a; Dinur-Klein et al, 2014; Pripfl et al, 2014; Shen et al, 2016), suggesting that high-frequency rTMS is a promising tool to treat chronic smoking
Summary
Cigarette smoking is a leading cause of preventable disease and premature death (Benowitz, 2010). Long-term smoking cessation, is known to be difficult for most smokers because of nicotine dependence (Shiffman et al, 2008; Hughes et al, 2011; Stead et al, 2012). Due to the chronic nAchRs upregulation, abstinence from nicotine will dramatically increase the availability of unbound α4β2 nAchRs, which in turn leads to smoking craving (Staley et al, 2006) and the subsequent smoking relapse. Due to these neurobiological changes caused by chronic nicotine binding, treating smoking has proven to be highly difficult. The currently available effective methods, including medicines such as varenicline, bupropion, and nicotine replacement and psychotherapy, can still only provide around 25% abstinence rates at 6 months after the initial treatment (Hughes et al, 2011; Zwar et al, 2014)
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