Deep rTMS Modulating Insula Synaptic Density and Smoking Behavior in Schizophrenia

NCT ID: NCT05724810

Last Updated: 2024-04-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

38 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-04-04

Study Completion Date

2028-08-31

Brief Summary

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Purpose of the study: Evaluate the effect of deep repetitive transcranial magnetic stimulation (deep rTMS; hereafter abbreviated as "dTMS") on synaptic density measured with positron emission tomography (PET) and the radiotracer \[11C\]UCB-J. The investigators also seek to link plasticity changes in the regions targeted by the electric field (especially, the insula) to changes in the functioning of insula circuits and behavioral cigarette usage in patients with schizophrenia (SCZ).

Importance of the study: This is the first study designed to directly evaluate the mechanism of action (MOA) of dTMS for smoking disruption in patients with SCZ. Patients with SCZ are a vulnerable population in high, immediate need of new smoking therapeutics for reducing premature morbidity and mortality.

Detailed Description

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Conditions

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Schizophrenia Smoking Cessation Tobacco Use

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

After enrollment, participants will be randomized between-subjects to active dTMS or sham.
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
Active and sham cards do not differ in appearance, and both coils are enclosed within the same helmet, enabling double-blind administration.

Study Groups

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Active deep transcranial magnetic stimulation (dTMS)

Each treatment consists of 60 trains, each lasting 3 sec and interleaved with a 15 sec delay. The entire treatment is delivered over 20 min. The treatment goes for 5 days/week and for a total of 3 weeks.

Group Type EXPERIMENTAL

Active deep transcranial magnetic stimulation (dTMS)

Intervention Type DEVICE

First, the investigators will find the position of the right abductor pollicis brevis (APB) motor cortex, finding the minimal motor threshold (MT) required for its activation, which determines the strength of the pulses. After determining the MT, dTMS stimulation is applied 6 cm anterior to the motor "hot spot", at 120% of the MT. The target threshold is built toward gradually. During the first treatment, participants receive stimulation at 100% of the MT. During the second treatment, stimulation intensity increases to 110% of the MT. Beginning at the third treatment and continuing onward, participants receive treatment at 120% of the MT for the course of the treatment.

Sham

Active and sham cards do not differ in appearance, and both coils are enclosed within the same helmet, enabling double-blind administration. The same procedure will be done, the only difference is that the sham card does not deliver any stimulation.

Group Type SHAM_COMPARATOR

Sham dTMS

Intervention Type DEVICE

Sham group will go through the same procedure. The only difference is that the sham card does not deliver stimulation.

Interventions

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Active deep transcranial magnetic stimulation (dTMS)

First, the investigators will find the position of the right abductor pollicis brevis (APB) motor cortex, finding the minimal motor threshold (MT) required for its activation, which determines the strength of the pulses. After determining the MT, dTMS stimulation is applied 6 cm anterior to the motor "hot spot", at 120% of the MT. The target threshold is built toward gradually. During the first treatment, participants receive stimulation at 100% of the MT. During the second treatment, stimulation intensity increases to 110% of the MT. Beginning at the third treatment and continuing onward, participants receive treatment at 120% of the MT for the course of the treatment.

Intervention Type DEVICE

Sham dTMS

Sham group will go through the same procedure. The only difference is that the sham card does not deliver stimulation.

Intervention Type DEVICE

Other Intervention Names

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repetitive transcranial magnetic stimulation (rTMS)

Eligibility Criteria

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Inclusion Criteria

1. Ages 18-60
2. DSM-5 criteria for schizophreniform, schizophrenia, schizoaffective disorder, or psychotic disorder not otherwise specified (NOS).
3. DSM-5 diagnosis of nicotine use disorder with current daily smoking, and a desire to cut down or quit.
4. Negative urine toxicology (other than cannabis) maintained throughout study participation
5. Fluent English Speaker
6. Capacity for informed consent

Exclusion Criteria

1. Clinically significant psychopathology other than schizophrenia, schizophreniform, schizoaffective disorder, or psychotic disorder NOS
2. Current or past substance use disorder, except TUD
3. Current use of smoking cessation medications/products
4. Change in schizophrenia medication within 4 weeks
5. Hospitalization in the last 3 months
6. History of suicidal or homicidal tendencies
7. History of epilepsy, stroke, cerebral aneurysm, significant head injury resulting in \>10 min loss of consciousness, movement disorder, clinically significant electrolyte abnormalities, or use of clozapine (seizure risks)
8. Pregnancy or lactation (females)
9. Lack of effective birth control (females)
10. Contraindications to MRI or PET
11. Clinical Global Impressions (CGI) rating of 6 (severely ill) or 7 (extremely ill)
12. Prisoners
13. Contraindications to dTMS\*
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute on Drug Abuse (NIDA)

NIH

Sponsor Role collaborator

Stony Brook University

OTHER

Sponsor Role lead

Responsible Party

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Anissa Abi-Dargham

Distinguished Professor and Chair of Psychiatry

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Stony Brook University

Stony Brook, New York, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Anissa Abi-Dargham, MD

Role: CONTACT

631-638-1575

Scott J Moeller, PhD

Role: CONTACT

631-638-3223

Facility Contacts

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Anissa Abi-Dargham, MD

Role: primary

631-638-1575

Scott J Moeller, PhD

Role: backup

631-638-3223

References

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Moeller SJ, Gil R, Weinstein JJ, Baumvoll T, Wengler K, Fallon N, Van Snellenberg JX, Abeykoon S, Perlman G, Williams J, Manu L, Slifstein M, Cassidy CM, Martinez DM, Abi-Dargham A. Deep rTMS of the insula and prefrontal cortex in smokers with schizophrenia: Proof-of-concept study. Schizophrenia (Heidelb). 2022 Feb 25;8(1):6. doi: 10.1038/s41537-022-00224-0.

Reference Type BACKGROUND
PMID: 35217662 (View on PubMed)

Other Identifiers

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1R61DA056423

Identifier Type: NIH

Identifier Source: org_study_id

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