TMS-fMRI for Neural Pathway in Smokers
| Status: | Recruiting |
|---|---|
| Conditions: | Smoking Cessation, Tobacco Consumers |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - 60 |
| Updated: | 1/16/2019 |
| Start Date: | January 2015 |
| End Date: | December 2020 |
Repetitive TMS Modulates Dorsal Lateral Prefrontal-Ventral Medial Prefrontal Pathway to Decrease Craving in Smokers
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). Several studies have
shown that TMS can reduce cue-elicited craving in smokers. Previous research by 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 (DLPFC) can reduce
cue-induced craving compared to sham TMS. However, the mechanism by which craving is reduced
by rTMS is poorly understood both at behavioral and neural levels. Neuroimaging studies in
nicotine dependence have revealed cue-related responses in numerous brain areas, including
frontal, parietal cortices and subcortical areas. Recently functional magnetic resonance
imaging (fMRI) studies by the group have shown that cue-induced craving induced brain
activation in ventral medial prefrontal cortex (VMPFC), including medial frontal, orbital
frontal and anterior cingulate. This Chair Research Development Fund (CRDF) pilot proposal
will integrate two new techniques- TMS and fMRI to investigate DLPFC-VMPFC pathway in
smokers. Using double-masked methods investigators hypothesize that cue-induced exposure will
induce brain activity in VMPFC, and 15 minutes rTMS over DLPFC will reduce cue-induced
craving through modulating DLPFC-VMPFC pathway (increased activity DLPFC and decreased
activity VMPFC).
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). Several studies have
shown that TMS can reduce cue-elicited craving in smokers. Previous research by 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 (DLPFC) can reduce
cue-induced craving compared to sham TMS. However, the mechanism by which craving is reduced
by rTMS is poorly understood both at behavioral and neural levels. Neuroimaging studies in
nicotine dependence have revealed cue-related responses in numerous brain areas, including
frontal, parietal cortices and subcortical areas. Recently functional magnetic resonance
imaging (fMRI) studies by the group have shown that cue-induced craving induced brain
activation in ventral medial prefrontal cortex (VMPFC), including medial frontal, orbital
frontal and anterior cingulate. This Chair Research Development Fund (CRDF) pilot proposal
will integrate two new techniques- TMS and fMRI to investigate DLPFC-VMPFC pathway in
smokers. Using double-masked methods investigators hypothesize that cue-induced exposure will
induce brain activity in VMPFC, and 15 minutes rTMS over DLPFC will reduce cue-induced
craving through modulating DLPFC-VMPFC pathway (increased activity DLPFC and decreased
activity VMPFC).
Inclusion Criteria:
- Smoke 10 or more cigarettes per day and have a carbon monoxide (CO) level > 10 ppm
indicative of recent smoking.
- Not received substance abuse treatment within the previous 30 days.
- Meet criteria for nicotine dependence as determined by the FTND.
- Be in stable mental and physical health.
- If female, test non-pregnant and use adequate birth control.
- No evidence of focal or diffuse brain lesion on MRI.
- Be willing to provide informed consent.
- Be able to comply with protocol requirements and likely to complete all study
procedures.
Exclusion Criteria:
- Current dependence, defined by DSM-V criteria, on any psychoactive substances other
than nicotine or caffeine.
- Contraindication to MRI (e.g., presence of metal in the skull, orbits or intracranial
cavity, claustrophobia).
- Contraindication to rTMS (history of neurological disorder or seizure, increased
intracranial pressure, brain surgery, or head trauma with loss of consciousness for >
15 minutes, implanted electronic device, metal in the head, or pregnancy).
- History of autoimmune, endocrine, viral, or vascular disorder affecting the brain.
- History or MRI evidence of neurological disorder that would lead to local or diffuse
brain lesions or significant physical impairment.
- Unstable cardiac disease, uncontrolled hypertension, severe renal or liver
insufficiency, or sleep apnea.
- Life time history of major Axis I disorders such as: Bipolar Affective disorder
(BPAD), Schizophrenia, Post-traumatic Stress disorder (PTSD) or Dementia or Major
Depression.
- Self report of >21 standard alcohol drinks per week in any week in the 30 days prior
to screening.
- Other forms of nicotine delivery, such as nicotine patch, electronic cigarettes
We found this trial at
1
site
171 Ashley Avenue
Charleston, South Carolina 29425
Charleston, South Carolina 29425
843-792-1414
Principal Investigator: Xingbao Li, M.D
Phone: 843-792-5729
Medical University of South Carolina The Medical University of South Carolina (MUSC) has grown from...
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