Changing Thought and Action in Tobacco Dependence With Transcranial Magnetic Stimulation
Condition: Tobacco Dependence
MeSH terms: Tobacco Use Disorder
Study type: Interventional

Summary: 
      This study will examine the effects of high frequency, repetitive Transcranial Magnetic
      Stimulation (rTMS) on decision-making and smoking behavior.
    

Detailed description: 
      Tobacco use is the greatest cause of preventable death in the US and cigarette smokers
      exhibit substantial relapse following treatment. Understanding the brain mechanisms involved
      in tobacco dependence is an important step toward reducing the high rate of relapse
      associated with current behavioral and pharmacological treatments for smoking cessation. This
      study seeks to examine the effects of high frequency, repetitive Transcranial Magnetic
      Stimulation (rTMS) on decision-making and smoking behavior. A concept central to this study
      is that "quitting" tobacco necessitates making conscious choices not to smoke (to delay
      gratification) and these choices are influenced by the balance of activity between the
      frontal-parietal systems that process the value of rewards and limbic systems that are
      involved with immediate gratification. We aim to: 1) determine how two different levels of
      cortical excitation (10 Hz and 20Hz), induced by different rTMS frequencies, influence reward
      and risk-taking choices and cigarette consumption. Additionally, we aim to 2) determine how
      limbic activation due to acute nicotine withdrawal and/or satiation modifies the effects in
      aim 1. Twenty non-smoking and 20 smoking participants will receive two levels of high
      frequency rTMS and comparable sham stimulation (using electrical scalp stimulation) delivered
      over the left prefrontal cortex. Smokers will also crossover between nicotine satiation and
      acute withdrawal conditions to determine how rTMS interacts with limbic activation associated
      with nicotine use and withdrawal. In addition, changes in preattentional (brainstem-thalamus
      processing as measured using the P50 midlatency auditory evoked potential) and attentional
      (thalamocortical processing as measured using the Psychomotor Vigilance Task; PVT) will be
      assessed before and after treatment to quantitatively determine changes in
      preattentional/arousal and attentional function.
    

Intervention name(s): repetitive transcranial magnetic stimulation (rTMS) 10 Hertz (Hz); repetitive transcranial magnetic stimulation (rTMS) 20Hz; SHAM repetitive transcranial magnetic stimulation (rTMS)
Intervention type(s): Device; Device; Device
Intervention description(s): All participants will receive 90 10-pulse trains of 1 sec duration with an interval of 20 seconds. Smokers will receive the treatment twice, once in a nicotine-satiated condition, and once in a nicotine-withdrawal condition.; All participants will receive 45 20-pulse trains of 1 second duration with an interval of 20 seconds. Smokers will receive the treatment twice, once in a nicotine-satiated condition, and once in a nicotine-withdrawal condition.; The look and sound of active rTMS is reproduced with the same coil used in the active conditions. The magnetic field in the sham coil is markedly attenuated at only 5% of stimulator output. The feel of active stimulation will be reproduced by delivering monophasic current pulses to the left, frontalis muscle with a Isolated Stimulator and two carbon rubber electrodes. Smokers will receive Sham rTMS in both the nicotine-satiated and nicotine-withdrawal conditions.
Other intervention name(s): "TMS" or Transcranial Magnetic Stimulation; "TMS" or Transcranial Magnetic Stimulation; "TMS" or Transcranial Magnetic Stimulation
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Basic Science
Keywords: Tobacco cessation; Tobacco dependence; Transcranial Magnetic Stimulation; Nicotine Dependence; Delayed Discounting