Non‐invasive brain stimulation for smoking cessation: a systematic review and meta‐analysis

Abstract

Background and Aims: Non-invasive brain stimulation (NIBS) methods have showed promising results for the treatment of tobacco use disorder, but little is known about the efficacy of NIBS on sustained tobacco abstinence. We aimed to assess its effectiveness for long-term smoking cessation.Methods: Systematic review and meta-analysis of randomized controlled trials (RCT).PubMed, Cochrane library, Embase, PsycINFO and clinical trials registries were systematically searched for relevant studies up to May 2021. Relevant studies included adult smokers seeking smoking cessation, included in an RCT using NIBS [specifically repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)], and with follow-up of more than 4 weeks. There were no restrictions on location. Abstinence rates in the active NIBS groups were compared with abstinence rates in sham NIBS or in usual treatment groups, from 4 weeks to 12 months following the quit attempt. Smoking abstinence was measured on an intention-to-treat basis and we used risk ratios (RRs) as measures of effect size.Results: Seven studies were included (n = 699 patients). In all included studies, the control groups were receiving sham NIBS and only data from 3 to 6 months were analysable. By pooling the seven included studies, the RR of sustained abstinence of any form of NIBS relative to sham NIBS was 2.39 [95% confidence interval (CI) = 1.26-4.55; I 2 = 40%]. Subgroup analyses found that the RR was even higher when excitatory rTMS was used on the left dorsolateral prefrontal cortex (RR = 4.34; 95% CI = 1.69-11.18; I 2 = 0%) or when using deep rTMS targeting the lateral prefrontal cortex and insula bilaterally (RR = 4.64; 95% CI = 1.61-13.39; I 2 = 0%). A high risk of bias was found in four included studies. We also determined, using grades of recommendation, assessment, development and evaluation, that overall there was a low level of confidence in the results. Conclusion:Non-invasive brain stimulation (NIBS) may improve smoking abstinence rates from 3 to 6 months after quitting smoking, compared with sham NIBS or usual treatment.

Nicotine dependence and insula subregions: functional connectivity and cue-induced activation

“…Brain stimulation is currently viewed as a promising therapy for smoking cessation [81,82] and studies targeting the insula have demonstrated mixed success in affecting smoking-related variables, such as craving and withdrawal [13,16]. TMS has received clearance by the U.S. Food and Drug Administration for smoking cessation [83], and while several studies have shown encouraging results, including one indicating that high-frequency deep TMS to the insula and prefrontal cortex reduces nicotine dependence [84], others have shown weak or no effects [13,45].…”

Abandon du tabagisme au moyen de la stimulation magnétique transcrânienne répétitive

“…La plupart des études évaluant la SMTr comme thérapie antitabagique se sont penchées sur les effets générés lorsqu’on cible le cortex préfrontal dorsolatéral à l’aide de bobines en forme de 8. Ces études de moindre envergure ont rapporté des résultats mitigés et non concluants 7 . Depuis 2014, la bobine H4 — une bobine en H qui cible l’insula et le cortex préfrontal de façon bilatérale — a été utilisée dans 2 essais cliniques.…”

Repetitive transcranial magnetic stimulation for smoking cessation

“…These smaller studies reported mixed, inconclusive results. 7 Since 2014, the H4-coil -an H-coil that targets the insula and prefrontal cortex bilaterally -has been used in 2 clinical trials. As both trials that used the H4-coil had positive results, it is the only coil that has received approval for smoking cessation from Health Canada.…”