Smoking Cessation Induced by Deep Repetitive Transcranial Magnetic Stimulation of the Prefrontal and Insular Cortices: A Prospective, Randomized Controlled Trial
Smoking Cessation Induced by Deep Repetitive Transcranial Magnetic Stimulation of the Prefrontal and Insular Cortices: A Prospective, Randomized Controlled Trial
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DOI：
10.1016/j.biopsych.2014.05.020
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发表时间：
2014-11-01
影响因子：
10.6
通讯作者：
Zangen, Abraham
中科院分区：
文献类型：
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作者：
Dinur-Klein, Limor;Dannon, Pinhas;Zangen, Abraham
背景：吸烟是发达国家可预防死亡的主要原因。我们之前在动物模型和人类中的研究表明，反复激活线索诱导的渴望网络，然后对背侧前额叶皮层（PFC）进行电磁刺激，可以导致药物渴望和消费的持久减少。我们假设，这些电路的破坏深经颅磁刺激（TMS）的PFC和approximately可以诱导caseization.Methods：成年人（N = 115）谁吸烟至少20支/天，以前的治疗失败，从一般人群中招募。参与者被随机分配接受13次高频，低频或假刺激的日常会话，或没有吸烟提示。使用H型线圈进行深部TMS，靶向外侧PFC和双侧延髓。通过测量尿样中的可替宁水平和记录参与者的自我报告作为主要结果变量来评估治疗期间的香烟消耗量。使用标准化的questionnaire.Results：高（但不是低）频率的深度TMS治疗显着降低香烟消费和尼古丁依赖的依赖性和渴望进行了评估。这种治疗与暴露于吸烟线索相结合，增强了卷烟消费量的减少，导致治疗结束时的戒烟率为44%，治疗后6个月估计为33%。这项研究进一步暗示了外侧PFC和外侧PFC在尼古丁成瘾中的作用，并建议使用深高-这些地区的频率TMS吸烟线索作为一个有前途的治疗策略。
Background: Tobacco smoking is the leading cause of preventable death in developed countries. Our previous studies in animal models and humans suggest that repeated activation of cue-induced craving networks followed by electromagnetic stimulation of the dorsal prefrontal cortex (PFC) can cause lasting reductions in drug craving and consumption. We hypothesized that disruption of these circuitries by deep transcranial magnetic stimulation (TMS) of the PFC and insula bilaterally can induce smoking cessation.Methods: Adults (N = 115) who smoke at least 20 cigarettes/day and failed previous treatments were recruited from the general population. Participants were randomized to receive 13 daily sessions of high-frequency, low-frequency or sham stimulation following, or without, presentation of smoking cues. Deep TMS was administered using an H-coil version targeting the lateral PFC and insula bilaterally. Cigarette consumption was evaluated during the treatment by measuring cotinine levels in urine samples and recording participants' self-reports as a primary outcome variable. Dependence and craving were assessed using standardized questionnaires.Results: High (but not low) frequency deep TMS treatment significantly reduced cigarette consumption and nicotine dependence. The combination of this treatment with exposure to smoking cues enhanced reduction in cigarette consumption leading to an abstinence rate of 44% at the end of the treatment and an estimated 33% 6 months following the treatment.Conclusions: This study further implicates the lateral PFC and insula in nicotine addiction and suggests the use of deep high-frequency TMS of these regions following presentation of smoking cues as a promising treatment strategy.