- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02401672
Repetitive Transcranial Magnetic Stimulation (rTMS) for Nicotine Addiction (rTMS)
August 31, 2020 updated by: Xingbao Li, Medical University of South Carolina
Developing rTMS as a Potential Treatment for Nicotine Addiction
Cigarette smoking remains a significant public health concern.
A magnetic field applied to the outside of the skull can produce electrical activity in the brain without significant pain or the need for anesthesia.
Sessions of magnetic stimulation or superficial stimulation that does not reach the brain will be used to determine if magnetic stimulation can reduce cue-induced craving and cigarettes consumption in adult nicotine-dependent cigarette smokers.
This project may lead to a new therapy for smoking cessation.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
Cigarette smoking causes significant morbidity and mortality in the United States.
Smoking cessation is difficult, with the average smoker attempting to quit five times before permanent success.
Moreover, the majority of smoking quit attempts result in relapse.
Brain stimulation for smoke cessation is an exciting new area that builds on advancing neuroscience knowledge concerning the functional neurocircuitry of addiction.
Cortical stimulation can now be performed non-invasively by transcranial magnetic stimulation (TMS).
A few studies have shown that TMS can reduce cue-elicited craving in smokers.
Previous research by our group has shown that a single session of 15 minutes high frequency (10 Hz) repetitive TMS (rTMS) at 100% motor threshold over the left dorsal lateral prefrontal cortex (an area that is likely involved in inhibiting craving) can reduce cue-induced craving compared to sham TMS.
However, methodological concerns surrounding these preliminary findings limit definitive conclusions about the effectiveness of TMS over a longer period of time.
This R21 proposal will integrate more rigorous experimental conditions, a true double-blind methodology, MRI guided stimulation site and a longer-term follow-up assessment.
Using rigorous double-masked methods and MRI guided stimulation site, we propose that using active rTMS or sham rTMS, to determine whether 10 sessions over a two week period consisting of 15 minute high frequency rTMS can reduce cue-induced craving and cigarette consumption for cigarette smokers.
The project will also optimize rational rTMS parameters to make TMS to an efficacious treatment for nicotine dependence.
In the two years of project, we plan to recruit 42 treatment-seeking nicotine-dependent cigarette smokers, both males and females of all ethnic and racial groups between the ages of 18 and 60 to participate in the study.
The 42 participants will be randomly assigned to receive active prefrontal TMS or sham prefrontal TMS.
The data from this R21 will provide the information needed for launching a definitive larger-scale investigation into potential clinical applications of TMS in smoke cessation.
The results from this pilot will also likely supply substantial information about the utility of cortical stimulation for smoke cessation.
Study Type
Interventional
Enrollment (Actual)
42
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
South Carolina
-
Charleston, South Carolina, United States, 29425
- Medical University of South Carolina
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-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 60 years (Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Be between the ages of 18 and 60 years old.
- Smoke 10 or more cigarettes per day and have a carbon monoxide (CO) level > 10 ppm indicative of recent smoking.
- Not received substance abuse treatment within the previous 30 days.
- Meet criteria for nicotine dependence as determined by the FTND.
- Be in stable mental and physical health.
- If female, test non-pregnant and use adequate birth control.
- No evidence of focal or diffuse brain lesion on MRI.
- Be willing to provide informed consent.
- Be able to comply with protocol requirements and likely to complete all study procedures.
Exclusion Criteria:
- Current dependence, defined by DSM-V criteria, on any psychoactive substances other than nicotine or caffeine.
- Contraindication to MRI (e.g., presence of metal in the skull, orbits or intracranial cavity, claustrophobia).
- Contraindication to rTMS (history of neurological disorder or seizure, increased intracranial pressure, brain surgery, or head trauma with loss of consciousness for > 15 minutes, implanted electronic device, metal in the head, or pregnancy).
- History of autoimmune, endocrine, viral, or vascular disorder affecting the brain.
- History or MRI evidence of neurological disorder that would lead to local or diffuse brain lesions or significant physical impairment.
- Unstable cardiac disease, uncontrolled hypertension, severe renal or liver insufficiency, or sleep apnea.
- Life time history of major Axis I disorders such as: Bipolar Affective disorder (BPAD), Schizophrenia, Post-traumatic Stress disorder (PTSD) or Dementia or Major Depression.
- Self report of >21 standard alcohol drinks per week in any week in the 30 days prior to screening.
- Other forms of nicotine delivery, such as nicotine patch, electronic cigarettes
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Active TMS
Repetitive TMS pulse stimulation
|
Transcranial magnetic stimulation (TMS) is a noninvasive (and relatively painless) brain stimulation technology that can focally stimulate the brain of an awake individual.
A localized pulsed magnetic field transmitted through a TMS coil is able to focally stimulate the cortex by depolarizing superficial neurons inducing electrical currents in the brain.
If TMS pulses are delivered repetitively and rhythmically, the process is called repetitive TMS (rTMS).
|
Sham Comparator: Sham TMS
The sham TMS system will be connected to an electrical generator on a 9 V battery and electrodes will be placed over the prefrontal cortex.
The regulator is triggered by the TMS machine to allow brief, microsecond, pulses of the electrical current through to the skin on the subjects' forehead.
Electrical stimulation will be triggered by the TMS machine to correspond to the sham TMS pulses.
|
Transcranial magnetic stimulation (TMS) is a noninvasive (and relatively painless) brain stimulation technology that can focally stimulate the brain of an awake individual.
A localized pulsed magnetic field transmitted through a TMS coil is able to focally stimulate the cortex by depolarizing superficial neurons inducing electrical currents in the brain.
If TMS pulses are delivered repetitively and rhythmically, the process is called repetitive TMS (rTMS).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Nicotine Consumption: Number of Cigarettes Per Day
Time Frame: 2 weeks of treatment
|
Nicotine consumption: We use cigarette diary for participant to record number of cigarettes smoked per day.
|
2 weeks of treatment
|
Percentage of Change of Cigarettes Per Day
Time Frame: 2 weeks
|
percentage of change of cigarettes per day =100* ( cigarettes smoked per day at baseline - cigarettes smoked per day at the end of treatment) / cigarettes smoked per day at baseline
|
2 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Average Nicotine Craving as Assessed by the Questionnaire of Smoking Urges-Brief
Time Frame: 2 weeks of treatment
|
The Brief Questionnaire of Smoking Urges (QSU-Brief) consists of 10 statements about the respondent's feelings and thoughts about his or her desire to smoke cigarettes as he or she is completing the questionnaire.
A higher number represents a stronger smoking urges.
A lower score represents a weaker smoking urges.
The lowest score is 10.
The highest score is 70.
|
2 weeks of treatment
|
The Number of Participants Quitting on the Target Quit Date
Time Frame: 2 weeks of treatment
|
Quitting smoking on the target quit date.
|
2 weeks of treatment
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Li X, Hartwell KJ, Owens M, Lematty T, Borckardt JJ, Hanlon CA, Brady KT, George MS. Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex reduces nicotine cue craving. Biol Psychiatry. 2013 Apr 15;73(8):714-20. doi: 10.1016/j.biopsych.2013.01.003. Epub 2013 Feb 26.
- Li X, Hartwell KJ, Henderson S, Badran BW, Brady KT, George MS. Two weeks of image-guided left dorsolateral prefrontal cortex repetitive transcranial magnetic stimulation improves smoking cessation: A double-blind, sham-controlled, randomized clinical trial. Brain Stimul. 2020 Sep-Oct;13(5):1271-1279. doi: 10.1016/j.brs.2020.06.007. Epub 2020 Jun 10.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
May 14, 2014
Primary Completion (Actual)
December 30, 2018
Study Completion (Actual)
December 30, 2018
Study Registration Dates
First Submitted
March 16, 2015
First Submitted That Met QC Criteria
March 24, 2015
First Posted (Estimate)
March 30, 2015
Study Record Updates
Last Update Posted (Actual)
September 21, 2020
Last Update Submitted That Met QC Criteria
August 31, 2020
Last Verified
August 1, 2020
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- pro00032313
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
Yes
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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