title: Transcranial Magnetic Stimulation Combined With Nicotine Replacement Therapy for Smoking Cessation: A Randomized Controlled Trial.
abstract: BACKGROUND
  Further evidence suggests that repetitive Transcranial Magnetic Stimulation (rTMS) is an effective method to reduce tobacco craving among smokers.
  
  
  OBJECTIVE
  As relapse is common within a few days after smoking cessation, we hypothesized that combining the anti-craving effects of rTMS with Nicotine replacement therapy (NRT) to attenuate withdrawal symptoms could increase abstinence rates in smokers with severe nicotine dependence who quit smoking.
  
  
  METHODS
  Thirty-seven smokers who failed to quit with the usual treatments were randomly assigned to two treatment groups to receive either active (n = 18) or sham (n = 19) 1-Hz rTMS of the right dorsolateral prefrontal cortex. The day after quitting smoking, each patient combined NRT (21-mg patch) with active or sham rTMS (10 sessions) for 2 weeks. Cessation support was then continued with NRT alone using lower-dose patches. Abstinence rates and self-report craving scales were used to assess the therapeutic results during the combined treatment and for up to 12 weeks after quitting.
  
  
  RESULTS
  At the end of the combined treatment, there were significantly more abstinent participants in the active rTMS group (n = 16) than in the sham rTMS group (n = 9) (P = 0.027). The craving scales analysis revealed that active rTMS (P = 0.011) but not sham rTMS (P = 0.116) led to a significant decrease in the compulsive factor. However, no lasting rTMS effect was found.
  
  
  CONCLUSIONS
  1-Hz rTMS combined with NRT improved the success rate of abstinence in smokers during tobacco cessation. The stimulation-induced reduction in compulsivity may explain this result.
authors.affiliation: Department of Psychiatry and Addictology, University Hospital of Dijon, 21079 Dijon, France; EA 4452, LPPM, University of Burgundy, 21000 Dijon, France. Electronic address: benoit.trojak@chu-dijon.fr.
authors.forename: Benoit
authors.initials: B
authors.lastname: Trojak
authors.affiliation: Department of Psychiatry and Addictology, University Hospital of Dijon, 21079 Dijon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Meille
authors.affiliation: Addiction Division, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 1202 Geneva, Switzerland.
authors.forename: Sophia
authors.initials: S
authors.lastname: Achab
authors.affiliation: Department of Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; INSERM U 1114, FMTS, Strasbourg University Hospital, 67091 Strasbourg, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Lalanne
authors.affiliation: Department of Psychiatry and Addictology, University Hospital of Dijon, 21079 Dijon, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Poquet
authors.affiliation: Department of Psychiatry and Addictology, University Hospital of Dijon, 21079 Dijon, France.
authors.forename: Eddy
authors.initials: E
authors.lastname: Ponavoy
authors.affiliation: Department of Psychiatry and Addictology, University Hospital of Dijon, 21079 Dijon, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Blaise
authors.affiliation: Department of Psychiatry and Addictology, University Hospital of Dijon, 21079 Dijon, France; EA 4452, LPPM, University of Burgundy, 21000 Dijon, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Bonin
authors.affiliation: Department of Psychiatry and Addictology, University Hospital of Dijon, 21079 Dijon, France; EA 4452, LPPM, University of Burgundy, 21000 Dijon, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Chauvet-Gelinier
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy / Q000379:methods; D066249:Craving / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000502:physiology*; D016037:Single-Blind Method; D016540:Smoking Cessation / Q000379:methods*; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000188:drug therapy* / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cessation; Combination; Craving; Nicotine; Tobacco; Transcranial magnetic stimulation