Summary: Non-invasive brain stimulation may improve smoking abstinence rates for 3 to 6 months after quitting.
Source: Society for the Study of Addiction
A new systematic review published by the scientific journal Addiction has found that non-invasive brain stimulation (NIBS) may improve smoking abstinence rates 3 to 6 months after quitting, compared with sham brain stimulation.
In recent years, NIBS has emerged as a new therapeutic option for alcohol use disorder and other substance-related and addictive disorders. NIBS methods have showed promising results for the treatment of tobacco use disorder, but little is known about the effectiveness of NIBS on long-term abstinence.
A team of researchers from the University Hospital of Dijon, in France, conducted a systematic review and meta-analysis to assess the effectiveness of NIBS for long-term smoking cessation.
The team searched several scientific databases for randomized controlled trials of NIBS on adult smokers seeking smoking cessation, with follow-up of more than 4 weeks and then combined the results to measure the overall effect of NIBS on smoking cessation.
Seven studies were included, yielding 699 patients in total. In all included studies, the control groups received sham NIBS.
By pooling the 7 included studies, the risk ratio of sustained abstinence of any form of NIBS relative to sham NIBS was 2.39, meaning smokers who received NIBS had a 2.39 times higher likelihood of long-term smoking abstinence than smokers who received sham NIBS.
The risk ratio was higher when looking at different types of NIBS or stimulation of specific parts of the brain. A high risk of bias was found in 4 included studies.
Lead author Dr Benjamin Petit says, “While our review appears modest, with only seven included studies, a low confidence level and a substantial inter-study variability, the results appear to be robust and we feel confident in suggesting that NIBS is a technique of interest for both short-term and sustained smoking cessation.
“In addition, we identified several scientific trials currently underway in this particular field. In the near future, NIBS might be recognized as a promising new option for assisting individuals who wish to stop smoking.”
The two commonly used forms of NIBS are transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). TDCS sends a low-intensity direct current through the brain using electrodes placed on the patient’s scalp. The weak electrical current modulates neuronal excitability.
TMS uses a metallic coil placed against the patient’s scalp. The coil generates magnetic pulses which induce brief electric currents in the cortical tissue. Depending on the frequency of the pulses, the excitability of the targeted area is either increased or decreased.
Non-invasive brain stimulation for smoking cessation: a systematic review and meta-analysis
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.
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.
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; I2 = 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; I2 = 0%) or when using deep rTMS targeting the lateral prefrontal cortex and insula bilaterally (RR = 4.64; 95% CI = 1.61–13.39; I2 = 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.
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.