Can TMS Aid Smoking Cessation Efforts?

A new study suggests that a combination of transcranial magnetic stimulation (TMS) and standard cognitive-behavioral therapy (CBT) can improve short-term smoking abstinence rates, in comparison to CBT paired with sham TMS.
 
A team of researchers led by Andreas Fallgatter, MD, a professor and head of psychiatry at the University of Tubingen in Germany, recruited and tested a group of 74 smokers for nicotine dependence using the Fagerstrom Test for Nicotine Dependence. Participants completed a 3-week group CBT session, administered over the course of 6 semi-weekly meetings.
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Between the second and third meetings, smoking quit dates were established, after which 42 patients were randomly assigned to receive intermittent theta burst stimulation (iTBS), a repetitive TMS protocol, between the third and sixth CBT meetings. These participants were given a total of 4 iTBS sessions. The remaining 41 patients continued with CBT in combination sham TMS.
 
The researchers found that, after 3 months, abstinence rates were close to 50% following 4 sessions of iTBS plus CBT, compared to an approximately 30% abstinence rate among smokers treated with CBT plus sham TMS. The investigators note that the iTBS effect was lost at 6 months and 12 months after the initiation of treatment. However, more patients in the iTBS group remained smoke-free at 12 months than in the cohort receiving CBT plus sham treatment.
 
The team also saw general improvement in behavioral indices such as temptation, smoking urges, and confidence measures among both groups, but no difference in any of the behavioral endpoints between the patients receiving active treatment and sham control participants. After 12 months, 19 patients remained in the active TMS group, compared to 11 in the sham group, meaning “more subjects survived in the active TMS group,” said Fallgatter in presenting the findings at the 12th World Congress of Biological Psychiatry, held June 14 - 18 in Athens, Greece.
 
Abstinence rates were also slightly higher in the active TMS group than those seen in the sham TMS group, where abstinence rates lingered around the 20% rate at 1 year—the rate seen with other smoking cessation therapies.
 
Fallgatter and colleagues also looked for increases in activity of the dorsolateral prefrontal cortex in response to stimulation with iTBS, using near-infrared spectroscopy (NIRS), a noninvasive option for measuring brain activity.
 
The researchers found “increased activity in the [actively] stimulated TMS group in the dorsolateral prefrontal cortex in response to smoking-related optical cues,” said Fallgatter, who added that too few TMS stimulation sessions may have been used to achieve long-term abstinence.
 
Thus, "for the next study, we need to do some kind of booster stimulation after 6 [months] or 12 months to maintain higher abstinence rates,” he said. “But we believe that this noninvasive approach plus CBT is not only possible in smoking cessation but in other addiction disorders as well."

—Mark McGraw