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Deep rTMS of the insula and prefrontal cortex in smokers with schizophrenia: Proof-of-concept study
Patients with schizophrenia have a high prevalence of cigarette smoking and respond poorly to conventional treatments, highlighting the need for new therapies. We conducted a mechanistic, proof-of-concept study using bilateral deep repetitive transcranial magnetic stimulation (dTMS) of insular and p...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8881463/ https://www.ncbi.nlm.nih.gov/pubmed/35217662 http://dx.doi.org/10.1038/s41537-022-00224-0 |
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author | Moeller, Scott J. Gil, Roberto Weinstein, Jodi J. Baumvoll, Topaz Wengler, Kenneth Fallon, Natalka Van Snellenberg, Jared X. Abeykoon, Sameera Perlman, Greg Williams, John Manu, Lucian Slifstein, Mark Cassidy, Clifford M. Martinez, Diana M. Abi-Dargham, Anissa |
author_facet | Moeller, Scott J. Gil, Roberto Weinstein, Jodi J. Baumvoll, Topaz Wengler, Kenneth Fallon, Natalka Van Snellenberg, Jared X. Abeykoon, Sameera Perlman, Greg Williams, John Manu, Lucian Slifstein, Mark Cassidy, Clifford M. Martinez, Diana M. Abi-Dargham, Anissa |
author_sort | Moeller, Scott J. |
collection | PubMed |
description | Patients with schizophrenia have a high prevalence of cigarette smoking and respond poorly to conventional treatments, highlighting the need for new therapies. We conducted a mechanistic, proof-of-concept study using bilateral deep repetitive transcranial magnetic stimulation (dTMS) of insular and prefrontal cortices at high frequency, using the specialized H4 coil. Feasibility of dTMS was tested for disruption of tobacco self-administration, insula target engagement, and insula circuit modulation, all of which were a priori outcomes of interest. Twenty patients completed the study, consisting of weekday dTMS sessions (randomization to active dTMS or sham; double-blind; 10 patients per group), a laboratory tobacco self-administration paradigm (pre/post assessments), and multimodal imaging (three MRI total sessions). Results showed that participants assigned to active dTMS were slower to initiate smoking their first cigarette compared with sham, consistent with smoking disruption. The imaging analyses did not reveal significant Time × Group interactions, but effects were in the anticipated directions. In arterial spin labeling analyses testing for target engagement, an overall decrease in insula blood flow, measured during a post-treatment MRI versus baseline, was numerically more pronounced in the active dTMS group than sham. In fMRI analyses, resting-state connectivity between the insula and default mode network showed a numerically greater change from baseline in the active dTMS group than sham, consistent with a functional change to insula circuits. Exploratory analyses further suggested a therapeutic effect of dTMS on symptoms of psychosis. These initial observations pave the way for future confirmatory studies of dTMS in smoking patients with schizophrenia. |
format | Online Article Text |
id | pubmed-8881463 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-88814632022-03-17 Deep rTMS of the insula and prefrontal cortex in smokers with schizophrenia: Proof-of-concept study Moeller, Scott J. Gil, Roberto Weinstein, Jodi J. Baumvoll, Topaz Wengler, Kenneth Fallon, Natalka Van Snellenberg, Jared X. Abeykoon, Sameera Perlman, Greg Williams, John Manu, Lucian Slifstein, Mark Cassidy, Clifford M. Martinez, Diana M. Abi-Dargham, Anissa Schizophrenia (Heidelb) Article Patients with schizophrenia have a high prevalence of cigarette smoking and respond poorly to conventional treatments, highlighting the need for new therapies. We conducted a mechanistic, proof-of-concept study using bilateral deep repetitive transcranial magnetic stimulation (dTMS) of insular and prefrontal cortices at high frequency, using the specialized H4 coil. Feasibility of dTMS was tested for disruption of tobacco self-administration, insula target engagement, and insula circuit modulation, all of which were a priori outcomes of interest. Twenty patients completed the study, consisting of weekday dTMS sessions (randomization to active dTMS or sham; double-blind; 10 patients per group), a laboratory tobacco self-administration paradigm (pre/post assessments), and multimodal imaging (three MRI total sessions). Results showed that participants assigned to active dTMS were slower to initiate smoking their first cigarette compared with sham, consistent with smoking disruption. The imaging analyses did not reveal significant Time × Group interactions, but effects were in the anticipated directions. In arterial spin labeling analyses testing for target engagement, an overall decrease in insula blood flow, measured during a post-treatment MRI versus baseline, was numerically more pronounced in the active dTMS group than sham. In fMRI analyses, resting-state connectivity between the insula and default mode network showed a numerically greater change from baseline in the active dTMS group than sham, consistent with a functional change to insula circuits. Exploratory analyses further suggested a therapeutic effect of dTMS on symptoms of psychosis. These initial observations pave the way for future confirmatory studies of dTMS in smoking patients with schizophrenia. Nature Publishing Group UK 2022-02-25 /pmc/articles/PMC8881463/ /pubmed/35217662 http://dx.doi.org/10.1038/s41537-022-00224-0 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Article Moeller, Scott J. Gil, Roberto Weinstein, Jodi J. Baumvoll, Topaz Wengler, Kenneth Fallon, Natalka Van Snellenberg, Jared X. Abeykoon, Sameera Perlman, Greg Williams, John Manu, Lucian Slifstein, Mark Cassidy, Clifford M. Martinez, Diana M. Abi-Dargham, Anissa Deep rTMS of the insula and prefrontal cortex in smokers with schizophrenia: Proof-of-concept study |
title | Deep rTMS of the insula and prefrontal cortex in smokers with schizophrenia: Proof-of-concept study |
title_full | Deep rTMS of the insula and prefrontal cortex in smokers with schizophrenia: Proof-of-concept study |
title_fullStr | Deep rTMS of the insula and prefrontal cortex in smokers with schizophrenia: Proof-of-concept study |
title_full_unstemmed | Deep rTMS of the insula and prefrontal cortex in smokers with schizophrenia: Proof-of-concept study |
title_short | Deep rTMS of the insula and prefrontal cortex in smokers with schizophrenia: Proof-of-concept study |
title_sort | deep rtms of the insula and prefrontal cortex in smokers with schizophrenia: proof-of-concept study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8881463/ https://www.ncbi.nlm.nih.gov/pubmed/35217662 http://dx.doi.org/10.1038/s41537-022-00224-0 |
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