Brain stimulation methods to treat tobacco addiction.
BACKGROUND
Tobacco smoking is the leading cause of preventable deaths worldwide, but many smokers are simply unable to quit. Psychosocial and pharmaceutical treatments have shown modest results on smoking cessation rates, but there is an urgent need to develop treatments with greater efficacy. Brain stimulation methods are gaining increasing interest as possible addiction therapeutics.


OBJECTIVE
The purpose of this paper is to review the studies that have evaluated brain stimulation techniques on tobacco addiction, and discuss future directions for research in this novel area of addiction interventions.


METHODS
Electronic and manual literature searches identified fifteen studies that administered repetitive transcranial magnetic stimulation (rTMS), cranial electrostimulation (CES), transcranial direct current stimulation (tDCS) or deep brain stimulation (DBS).


RESULTS
rTMS was found to be the most well studied method with respect to tobacco addiction. Results indicate that rTMS and tDCS targeted to the dorsolateral prefrontal cortex (DLPFC) were the most efficacious in reducing tobacco cravings, an effect that may be mediated through the brain reward system involved in tobacco addiction. While rTMS was shown to reduce consumption of cigarettes, as yet no brain stimulation technique has been shown to significantly increase abstinence rates. It is possible that the therapeutic effects of rTMS and tDCS may be improved by optimization of stimulation parameters and increasing the duration of treatment.


CONCLUSIONS
Although further studies are needed to confirm the ability of brain stimulation methods to treat tobacco addiction, this review indicates that rTMS and tDCS both represent potentially novel treatment modalities.
Biobehavioural Addictions and Concurrent Disorders Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada. vicky_wing@camh.net
Victoria C
VC
Wing
Mera S
MS
Barr
Caroline E
CE
Wass
Nir
N
Lipsman
Andres M
AM
Lozano
Zafiris J
ZJ
Daskalakis
Tony P
TP
George
D016206:Databases, Bibliographic; D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D017397:Prefrontal Cortex / Q000502:physiology*; D014029:Tobacco Use Disorder / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*