Elsevier

Biological Psychiatry

Volume 73, Issue 8, 15 April 2013, Pages 714-720
Biological Psychiatry

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

https://doi.org/10.1016/j.biopsych.2013.01.003Get rights and content

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Section snippets

Participants

The study was approved by the Institutional Review Board of the Medical University of South Carolina (MUSC). Written informed consent was obtained from all participants. The experiment was carried out at Brain Stimulation Laboratory in the Department of Psychiatry at MUSC.

Healthy, right-handed, non-treatment-seeking, nicotine-dependent smokers (≥10 cigarettes/day) between 21 and 60 years old were recruited through local flyers, newspaper, and Internet advertisements. All study procedures were

Participant Characteristics

Table 1 shows the demographic information for study subjects. Sixteen non-treatment-seeking participants (12 men and 4 women) signed informed consent, and 14 completed the study. Two men completed the first visit (one was sham, one was real TMS) but were terminated from the study for missing their second visit. The average age of participants who completed the protocol was 42.6 years (SD = 11.5), and participants smoked an average of 18.1 cigarettes per day (SD = 6.6). Participants had been

Discussion

This study found that a lab-based paradigm of smoking-related cue exposure produced reliable increases in subjective craving to smoke. With this background, high-frequency rTMS over the left DLPFC for 15 min, compared with sham stimulation, significantly reduced cue-induced cravings to smoke. Across the group, the reduction in cue-induced craving was positively correlated with level of nicotine dependence. That is, more TMS-induced craving reductions were seen in those with higher levels of

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