BACKGROUND Previous studies have found that repetitive transcranial magnetic stimulation (rTMS) to the left dorsal lateral prefrontal cortex (LDLPFC) transiently reduces smoking craving, decreases cigarette consumption, and increases abstinence rates. OBJECTIVE We investigated whether 10 daily MRI-guided rTMS sessions over two weeks to the LDLPFC paired with craving cues could reduce cigarette consumption and induce smoking cessation. METHODS We enrolled 42 treatment-seeking nicotine-dependent smokers (≥10 cigarettes per day) in a randomized, double-blind, sham-controlled trial. Participants received 10 daily sessions over 2 weeks of either active or sham MRI-guided rTMS (10Hz, 3000 pulses each session) to the LDLPFC concurrently with video smoking cues. The primary outcome was a reduction in biochemically confirmed cigarette consumption with a secondary outcome of abstinence on the target quit date. We also recorded cue-induced craving and withdrawal symptoms. RESULTS Compared to sham (n=17), participants receiving active rTMS (n=21) smoked significantly fewer cigarettes per day during the 2-week treatment (mean [SD], 13.73[9.18] vs. 11.06[9.29], P<.005) and at 1-month follow-up (12.78[9.53] vs. 7.93[7.24], P<.001). Active rTMS participants were also more likely to quit by their target quit rate (23.81%vs. 0%, OR 11.67, 90% CL, 0.96-141.32, x2=4.66, P=.031). Furthermore, rTMS significantly reduced mean craving throughout the treatments and at follow-up (29.93[13.12] vs. 25.01[14.45], P<.001). Interestingly across the active treatment sample, more lateral coil location was associated with more success in quitting (-43.43[0.40] vs. -41.79[2.24], P<.013). CONCLUSIONS Daily MRI-guided rTMS to the LDLPFC for 10 days reduces cigarette consumption and cued craving for up to one month and also increases the likelihood of smoking cessation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02401672.

中文翻译：

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为期两周的图像引导左背外侧前额皮质重复经颅磁刺激改善戒烟：双盲、假对照、随机临床试验


背景先前的研究发现，对左背外侧前额皮质（LDLPFC）进行重复经颅磁刺激（rTMS）可暂时降低吸烟渴望，减少香烟消费，并提高戒烟率。目的 我们研究了两周内每天 10 次 MRI 引导下的 rTMS 治疗对低密度脂蛋白前皮层 (LDLPFC) 的影响，并结合烟瘾线索，是否可以减少香烟消费并诱导戒烟。方法 我们在一项随机、双盲、假对照试验中招募了 42 名寻求治疗的尼古丁依赖吸烟者（每天吸烟≥10 支）。参与者在 2 周内每天接受 10 次 LDLPFC 主动或假 MRI 引导 rTMS（每次 10Hz，3000 个脉冲）治疗，同时伴有视频吸烟提示。主要结果是经生化证实的香烟消费量减少，次要结果是在目标戒烟日期戒烟。我们还记录了提示引起的渴望和戒断症状。结果 与假手术组 (n=17) 相比，接受主动 rTMS 的参与者 (n=21) 在为期 2 周的治疗期间每天吸烟量显着减少（平均 [SD]，13.73[9.18] 与 11.06[9.29]，P< .005）和 1 个月随访时（12.78[9.53] vs. 7.93[7.24]，P<.001）。活跃的 rTMS 参与者也更有可能按照目标戒烟率戒烟（23.81% vs. 0%，OR 11.67，90% CL，0.96-141.32，x2=4.66，P=.031）。此外，rTMS 显着降低了治疗期间和随访期间的平均渴望（29.93[13.12] vs. 25.01[14.45]，P<.001）。有趣的是，在积极治疗样本中，线圈位置越靠外侧与戒烟成功率越高相关（-43.43[0.40] vs. -41.79[2.24]，P<.013）。 结论 每日 MRI 引导下的 LDLPFC 重复经颅磁刺激 (rTMS) 持续 10 天，可以减少长达一个月的吸烟量和暗示渴望，同时还增加戒烟的可能性。试验注册 ClinicalTrials.gov 标识符：NCT02401672。