Transcranial Magnetic Stimulation Combined With Nicotine Replacement Therapy for Smoking Cessation: A Randomized Controlled Trial

•rTMS combined with nicotine increased the chances of abstinence in smokers•1 Hz-rTMS on right prefrontal cortex led most of the smokers to stay abstinent•The stimulation-induced reduction in compulsivity may explain this result.

BackgroundFurther evidence suggests that repetitive Transcranial Magnetic Stimulation (rTMS) is an effective method to reduce tobacco craving among smokers.HypothesisAs 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.MethodsThirty-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.ResultsAt 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.Conclusions1-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.