Developing rTMS as a Potential Treatment for Nicotine Addiction

描述（由申请人提供）：吸烟在美国导致显著的发病率和死亡率。戒烟是很困难的，在永久成功之前，吸烟者平均要尝试戒烟五次。此外，大多数试图戒烟的人都以复吸告终。脑刺激戒烟是一个令人兴奋的新领域，建立在先进的神经科学知识，有关成瘾的功能神经回路。皮质刺激现在可以通过经颅磁刺激（TMS）进行无创。一些研究表明，经颅磁刺激可以减少吸烟者因线索而产生的渴望。我们小组之前的研究表明，与假经颅磁刺激相比，单次15分钟的高频（10赫兹）重复经颅磁刺激（rTMS）在左侧背外侧前额叶皮层（一个可能参与抑制渴望的区域）进行100%运动阈值的训练可以减少线索诱导的渴望。然而，围绕这些初步发现的方法学问题限制了对经颅磁刺激在较长时间内的有效性的明确结论。R21提案将整合更严格的实验条件，真正的双盲方法，MRI引导刺激点和长期随访评估。采用严格的双掩模方法和MRI引导的刺激点，我们建议使用主动rTMS或假rTMS，以确定在两周的时间内，由15分钟的高频rTMS组成的10次训练是否可以减少吸烟者的线索诱导的渴望和香烟消费。本项目还将优化合理的经颅磁刺激参数，使经颅磁刺激成为治疗尼古丁依赖的有效方法。在两年的项目中，我们计划招募42名寻求治疗的尼古丁依赖吸烟者，年龄在18至60岁之间的所有民族和种族的男性和女性参与研究。42名参与者将被随机分配接受活跃前额叶经颅磁刺激或假前额叶经颅磁刺激。该R21的数据将提供开展经颅磁刺激在戒烟中的潜在临床应用的明确的更大规模调查所需的信息。这样做的结果是

DESCRIPTION (provided by applicant): Cigarette smoking causes significant morbidity and mortality in the United States. Smoking cessation is difficult, with the average smoker attempting to quit five times before permanent success. Moreover, the majority of smoking quit attempts result in relapse. Brain stimulation for smoke cessation is an exciting new area that builds on advancing neuroscience knowledge concerning the functional neurocircuitry of addiction. Cortical stimulation can now be performed non-invasively by transcranial magnetic stimulation (TMS). A few studies have shown that TMS can reduce cue-elicited craving in smokers. Previous research by our group has shown that a single session of 15 minutes high frequency (10 Hz) repetitive TMS (rTMS) at 100% motor threshold over the left dorsal lateral prefrontal cortex (an area that is likely involved in inhibiting craving) can reduce cue-induced craving compared to sham TMS. However, methodological concerns surrounding these preliminary findings limit definitive conclusions about the effectiveness of TMS over a longer period of time. This R21 proposal will integrate more rigorous experimental conditions, a true double-blind methodology, MRI guided stimulation site and a longer-term follow-up assessment. Using rigorous double-masked methods and MRI guided stimulation site, we propose that using active rTMS or sham rTMS, to determine whether 10 sessions over a two week period consisting of 15 minute high frequency rTMS can reduce cue-induced craving and cigarette consumption for cigarette smokers. The project will also optimize rational rTMS parameters to make TMS to an efficacious treatment for nicotine dependence. In the two years of project, we plan to recruit 42 treatment-seeking nicotine- dependent cigarette smokers, both males and females of all ethnic and racial groups between the ages of 18 and 60 to participate in the study. The 42 participants will be randomly assigned to receive active prefrontal TMS or sham prefrontal TMS. The data from this R21 will provide the information needed for launching a definitive larger-scale investigation into potential clinical applications of TMS in smoke cessation. The results from this pilot will also likely supply substantial information about the utility of cortical stimulation for smoke cessation.