Poster No:
67
Submission Type:
Abstract Submission
Authors:
Nicole Petersen1, Michael Apostol1, Timothy Jordan2, Andrew Leuchter1
Institutions:
1UCLA, Los Angeles, CA, 2Emory University School of Medicine, Atlanta, GA
First Author:
Co-Author(s):
Introduction:
Cigarette smoking is the leading preventable cause of death worldwide. Noninvasive neuromodulation by transcranial magnetic stimulation (TMS) is a promising treatment in need of ongoing protocol development. A theoretical model of cigarette craving and withdrawal relief proposed that the salience network may act as an attentional "switch" during acute craving, allocating neural resources between the default mode and executive control networks. Therefore, we sought to relieve craving by stimulating strategic nodes of these networks using TMS: We selected the dlPFC as an executive control network node, the superior frontal gyrus (SFG) as a salience network node, and the posterior parietal cortex (PPC) as a default mode network node. Our primary objective was to identify the most effective target for reducing cigarette craving and withdrawal, and our secondary objective was to investigate the network perturbations produced by stimulating each target. Considering sex differences in nicotine withdrawal and neural correlates of craving, we also planned to determine whether the most effective stimulation target for men and women differed.
Methods:
Data were collected using a repeated-measures, crossover trial. Investigators were not blinded, nor were participants, who were aware of the location of the stimulating magnet but not which locations were designated as control and experimental sites. Participants were men and women (44%) aged 21-45 (M = 33.3 years), who met DSM-5 criteria for tobacco use disorder and endorsed daily smoking for at least one year. TMS was delivered to the dorsolateral prefrontal cortex (dlPFC), superior frontal gyrus (SFG), and posterior parietal cortex (PPC). Area v5 of the visual cortex served as an active control site. Participants were scanned with resting-state fMRI and completed behavioral assessments before and after TMS. Self-reports of craving, withdrawal, and negative affect were obtained, and resting-state functional connectivity of three canonical networks (executive control, default mode, and salience networks) was measured.
Results:
Seventy-two participants completed at least one data collection session, and 57 completed all 4, yielding 61, 60, 62, and 66 complete stimulation sessions to the dlPFC, SFG, PPC, and v5, respectively. Stimulation to the SFG significantly reduced craving (95% CI, 0.0476-7.9559) and withdrawal (95% CI, 0.9225-8.1063) more than control stimulation. Effect sizes were larger in men (up D = 0.59) than in women (up to D =0.30). Neither PPC nor control site stimulation produced significant effects on craving, withdrawal, or negative affect. Functional connectivity analyses revealed that SFG stimulation did not produce significant changes to the networks examined, whereas dlPFC stimulation led to increased connectivity between somatomotor, default mode, and dorsal attention networks.
Conclusions:
We found that stimulation to the SFG significantly reduced both craving and withdrawal in individuals with Tobacco Use Disorder compared to the control target, replicating earlier findings. Negative affect was not significantly impacted by stimulation to any target as compared to the control target. Our findings are also consistent with previous evidence that stimulation to the dlPFC reduces craving. The effect sizes for men were larger than the effect sizes for women. These findings demonstrate that SFG is a promising target for smoking cessation trials and can be implemented using standard TMS equipment, potentially increasing patient access and tolerability over existing TMS protocols for smoking cessation. Contrary to our hypotheses, we did not find that canonical network connectivity explained the observed behavioral results, suggesting that further research into the neural mechanisms of craving and withdrawal relief are needed.
Brain Stimulation:
TMS 1
Modeling and Analysis Methods:
fMRI Connectivity and Network Modeling 2
Keywords:
Addictions
FUNCTIONAL MRI
MRI
Transcranial Magnetic Stimulation (TMS)
1|2Indicates the priority used for review
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TMS
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