经颅磁刺激预防复吸吸烟:可行性和潜在疗效。

Preventing relapse to smoking with transcranial magnetic stimulation: Feasibility and potential efficacy.

机构信息

City University of New York School of Medicine, City College of New York, Harris Hall, 160 Convent Ave, New York, NY 10031, USA; Roswell Park Cancer Institute, Carlton House, Room 402, Buffalo, NY 14263, USA, USA.

Advanced Recovery Research Center, Virginia Tech Carilion Research Institute, 2 Riverside Circle, R-3113, Roanoke, VA 24016, USA.

出版信息

Drug Alcohol Depend. 2018 Jan 1;182:8-18. doi: 10.1016/j.drugalcdep.2017.09.037. Epub 2017 Nov 4.

Abstract

Many smokers attempt to quit every year, but 90% relapse within 12 months. Converging evidence suggests relapse is associated with insufficient activation of the prefrontal cortex. Delay discounting rate reflects relative activity in brain regions associated with relapse. High-frequency repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (LDLPFC) increases cortical excitability and reduces delay discounting rates, but little is known about feasibility, tolerability, and potential efficacy for smoking cessation. We hypothesized that 8 sessions of 20Hz rTMS of the LDLPFC combined with an evidence-based self-help intervention will demonstrate feasibility, tolerability, and potential efficacy in a limited double-blind randomized control trial. Smokers (n=29), abstinent for 24h, motivated to quit, and not using cessation medications, were randomized to active 20Hz rTMS at 110% of Motor Threshold or sham stimulation that replicated the look and sound of active stimulation. Stimulation site was located using the 6cm rule and neuro-navigation. Multiple clinical, feasibility, tolerability, and efficacy measures were examined. Active rTMS decreased delay discounting of $100 (F (1, 25.3694)=4.14, p=.05) and $1000 (F (1, 25.169)=8.42, p<.01), reduced the relative risk of relapse 3-fold (RR 0.29, CI 0.10-0.76, Likelihood ratio χ2 with 1 df=6.40, p=.01), increased abstinence rates (active 50% vs. sham 15.4%, Χ (df=1)=3.80, p=.05), and increased uptake of the self-help intervention. Clinical, feasibility, and tolerability assessments were favorable. Combining 20Hz rTMS of the LDLPFC with an evidence-based self-help intervention is feasible, well-tolerated, and demonstrates potential efficacy.

摘要

许多吸烟者每年都试图戒烟,但 90%的人在 12 个月内复发。越来越多的证据表明,复发与前额叶皮层的激活不足有关。延迟折扣率反映了与复发相关的大脑区域的相对活动。左背外侧前额叶皮层(DLPFC)的高频重复经颅磁刺激(rTMS)可增加皮质兴奋性并降低延迟折扣率,但对于戒烟的可行性、耐受性和潜在疗效知之甚少。我们假设,20Hz rTMS 对 LDLPFC 的 8 次治疗结合基于证据的自助干预,将在有限的双盲随机对照试验中证明其可行性、耐受性和潜在疗效。符合条件的参与者为 29 名,吸烟史 24 小时以上,有戒烟意愿,未使用戒烟药物的吸烟者,随机分为接受 110%运动阈值的 20Hz rTMS 或模仿刺激外观和声音的假刺激。刺激部位使用 6cm 规则和神经导航定位。对多项临床、可行性、耐受性和疗效指标进行了评估。活跃的 rTMS 降低了 100 美元(F(1,25.3694)=4.14,p=.05)和 1000 美元(F(1,25.169)=8.42,p<.01)的延迟折扣,将复发的相对风险降低了 3 倍(RR 0.29,CI 0.10-0.76,似然比 χ2 检验 df=1=6.40,p=.01),增加了戒烟率(活跃组 50%比假刺激组 15.4%,Χ(df=1)=3.80,p=.05),并增加了自助干预的参与度。临床、可行性和耐受性评估结果良好。将 LDLPFC 的 20Hz rTMS 与基于证据的自助干预相结合是可行的、耐受良好的,并且显示出潜在的疗效。

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