Brain Stimulation Shows Success in Helping Patients Quit Smoking

Sometimes the best-laid plans go up in smoke. 

Anyone who’s ever tried to quit smoking — and failed repeatedly — knows the feeling of defeat and frustration. 

Whether they try the nicotine patch, oral medications, hypnosis or cold turkey, some just can’t overcome the addiction to nicotine, which has been compared to heroin for its seemingly indomitable grip on users.

A treatment at MUSC Health offers hope with a procedure that targets the area of the brain that controls impulsive thoughts and behaviors. 

 

“Using transcranial magnetic stimulation (TMS), a form of brain stimulation, doctors have been able to help patients quell the urge to smoke,” says Dr. A.J. Manett an assistant professor of psychiatry who works with MUSC Health’s Brain Stimulation Service. 

Approved by the FDA in 2020 as a method to help smokers quit smoking, TMS targets the prefrontal cortex, located near the forehead, with a series of electromagnetic pulses.

The TMS Smoking Cessation Program includes 18 sessions, lasting 25 to 30 minutes, over a six-week period. Each treatment session includes three phases: an initial provocation, followed by brain stimulation and ending with counseling, Dr. Manett says. 

“The initial provocation triggers a patient’s craving to smoke. This is typically done by having the patient watch videos of people smoking, or by having the patient hold a cigarette in their hand. Once the patient feels a strong craving, we start the TMS treatment session, which lasts about 18 minutes, and then follow up with brief counseling.”  

On the first day, the patient is fitted with a special fabric cap with Velcro straps, to be worn in subsequent sessions. The head is measured and markings are made on the cap to identify the precise regions to be targeted with the electromagnetic pulses. No imaging or biofeedback is required at any time during the treatments. Moreover, since only a specific part of the brain is treated, the patient has no lingering side effects elsewhere in the body that often accompany medications.

“Patients just wear the cap and the helmet during the sessions,” Dr. Manett says. “The device can be noisy, so we provide ear plugs. Sometimes patients will describe a tapping or a poking sensation on their scalp, but the treatment is not painful and is well tolerated.” 

While TMS as a treatment for smokers is new, TMS itself is not new. It’s been around for nearly 40 years and has emerged as an important treatment for multiple brain disorders in the past 15 years, Dr. Manett says.  

“It operates on the idea that the parts of the brain that control our emotions, memories and behavior are collections of circuits and aren’t that different from electronic wiring. Sometimes it works just fine; other times the wiring is faulty. The goal of TMS is to use electromagnetic pulses to train these brain circuits to act differently to provide relief for our patients.”

The treatment can be successful for patients, even if they have not been able to quit in the past using medications. “We treated someone in his 40s who had begun smoking at age 13 and smoked two packs per day for his entire adult life,” he says. “He had tried – and failed – every other method of treatment to quit smoking. By the time he had completed the program, he was nicotine free, and has been for over a year.” 

Dr. Manett says the studies for this FDA-approved treatment show that more than 25% of adults who smoked a pack a day were able to quit smoking by the end of TMS treatments and had a four-week, continuous quit rate. Among those who couldn’t quit, their average number of weekly cigarettes dropped from 132 to 30. Less than 10% of smokers who used other means to quit are successful.  

Nationwide, about 15% of the population smoke cigarettes. The percentage is higher in the Southeast, Dr. Manett says. Smoking is related to one-fourth of all deaths in people 35 and older.

The TMS Smoking Cessation Program offers a new and safe option for smokers who want to quit.

“What’s really exciting about TMS is that people often feel like they have tried all kinds of treatment before and feel like nothing has worked to help them on the road to recovery. With TMS for smoking cessation, we have a new way to treat this addiction that is more effective than what we could offer in the past.”

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To make an appointment with Dr. Manett on the MUSC downtown campus, call 843-792-5716.