减少执行功能和奖励连接与重复经颅磁刺激戒烟反应相关:一项双盲、随机、假刺激对照试验。

Reduced executive and reward connectivity is associated with smoking cessation response to repetitive transcranial magnetic stimulation: A double-blind, randomized, sham-controlled trial.

机构信息

Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, 29425, USA.

Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, 29425, USA.

出版信息

Brain Imaging Behav. 2024 Feb;18(1):207-219. doi: 10.1007/s11682-023-00820-3. Epub 2023 Nov 23.

Abstract

Repetitive transcranial magnetic stimulation (rTMS) can reduce cue-elicited craving, decrease cigarette consumption, and increase the abstinence rate in tobacco use disorders (TUDs). We used functional magnetic resonance imaging (fMRI) to investigate the effect of 10 sessions of rTMS on cortical activity and neural networks in treatment-seeking smokers. Smoking cue exposure fMRI scans were acquired before and after the 10 sessions of active or sham rTMS (10 Hz, 3000 pulses per session) to the left dorsal lateral prefrontal cortex (DLPFC) in 42 treatment-seeking smokers (≥ 10 cigarettes per day). Brain activity and functional connectivity were compared before and after 10 sessions of rTMS. Ten sessions of rTMS significantly reduced the number of cigarettes consumed per day (62.93%) compared to sham treatment (39.43%) at the end of treatment (p = 0.027). fMRI results showed that the rTMS treatment increased brain activity in the dorsal anterior cingulate cortex (dACC) and DLPFC, but decreased brain activity in the bilateral medial orbitofrontal cortex (mOFC). The lower strength of dACC and mOFC connectivity was associated with quitting smoking (Wald score = 5.00, p = 0.025). The reduction of cigarette consumption significantly correlated with the increased brain activation in the dACC (r = 0.76, p = 0.0001). By increasing the brain activity in the dACC and prefrontal cortex and decreasing brain activity in the mOFC, 10 sessions of rTMS significantly reduced cigarette consumption and increased quit rate. Reduced drive-reward and executive control functional connectivity was associated with the smoking cessation effect from rTMS. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02401672.

摘要

重复经颅磁刺激(rTMS)可减少线索诱发的渴求,减少吸烟量,并提高烟草使用障碍(TUD)的戒断率。我们使用功能磁共振成像(fMRI)来研究 10 个疗程的 rTMS 对寻求治疗的吸烟者大脑皮质活动和神经网络的影响。在 42 名寻求治疗的吸烟者(每天≥10 支香烟)中,使用 10Hz、每次 3000 个脉冲的左背外侧前额叶皮质(DLPFC)的活跃或假 rTMS 治疗前后进行吸烟线索暴露 fMRI 扫描。比较 rTMS 治疗前后的大脑活动和功能连接。与假治疗相比,rTMS 治疗 10 个疗程后,每天吸烟量明显减少(治疗结束时 62.93%对 39.43%,p=0.027)。fMRI 结果显示,rTMS 治疗增加了背侧前扣带皮层(dACC)和 DLPFC 的大脑活动,但降低了双侧内侧眶额皮层(mOFC)的大脑活动。dACC 和 mOFC 连接强度降低与戒烟有关(Wald 分数=5.00,p=0.025)。吸烟量的减少与 dACC 大脑激活的增加显著相关(r=0.76,p=0.0001)。通过增加 dACC 和前额叶皮质的大脑活动,降低 mOFC 的大脑活动,10 个疗程的 rTMS 可显著减少吸烟量,提高戒烟率。驱动-奖励和执行控制功能连接的减少与 rTMS 的戒烟效果有关。试验注册:ClinicalTrials.gov 标识符:NCT02401672。

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