Efficacy of insula deep repetitive transcranial magnetic stimulation combined with varenicline for smoking cessation: A randomized, double-blind, sham controlled trial

Christine Ibrahim, Victor M. Tang, Daniel M. Blumberger, Saima Malik, Rachel F. Tyndale, Alisson P. Trevizol, Mera S. Barr, Zafiris J. Daskalakis, Abraham Zangen, Bernard Le Foll

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Current smoking cessation treatments are limited in terms of efficacy, particularly with regards to long term abstinence. There is a large amount of evidence implicating the insula in nicotine addiction. Objective: To examine the efficacy of bilateral repetitive transcranial magnetic stimulation (rTMS) directed to the insular cortex with the H11 coil, relative to sham stimulation, on smoking abstinence and smoking outcomes in smokers who are receiving standard varenicline treatment. Methods: This randomized, double-blind, sham controlled trial recruited 42 participants who were randomized to receive either active (n = 24) or sham (n = 18) high frequency rTMS directed to the insula (4 weeks), while receiving varenicline treatment (12 weeks). The primary outcome was 7-day point prevalence abstinence at the end of 12 weeks. Results: Smokers in the active group had significantly higher abstinence rates than those in the sham group (82.4% vs. 30.7%, p = 0.013) at the end of treatment (Week 12). Secondary outcome measures of abstinence rate at the end of rTMS treatment (Week 4), abstinence rate at 6 months, and smoking outcomes (e.g., craving, withdrawal) showed no significant differences between groups. No differences were found in adverse events reported between the groups. Conclusion: This study provides evidence of the potential benefit of having a combined treatment for smoking cessation using insula rTMS with the H11 coil and varenicline. Maintenance rTMS sessions and continuation of varenicline for those in abstinence may induce longer-term effects and should be considered in future studies.

Original languageEnglish
Pages (from-to)1501-1509
Number of pages9
JournalBrain Stimulation
Volume16
Issue number5
DOIs
StatePublished - 1 Sep 2023

Keywords

  • Deep transcranial magnetic stimulation
  • Insula
  • Smoking cessation
  • Tobacco use disorder
  • Varenicline

ASJC Scopus subject areas

  • Clinical Neurology
  • Biophysics
  • General Neuroscience

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