TMS for Reward Learning
Recruiting in Palo Alto (17 mi)
Age: 18 - 65
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Rutgers, The State University of New Jersey
Must not be taking: Central nervous system
Disqualifiers: Neurological, Seizure, Bipolar, Schizophrenia, others
No Placebo Group
Approved in 3 Jurisdictions
Trial Summary
What is the purpose of this trial?
Our specific aim is to examine the effects of TMS on reward processing during goal-directed behavior. In these experiments the investigators will utilize a scalp-recorded brain oscillation called frontal midline theta that is believed to index the sensitivity of the cingulate cortex to reward feedback. Here the investigators will asked whether this electrophysiological signal can be modulated up or down using TMS while participants engage in decision making tasks, and if so, whether it would affect the encoding of rewards and subsequent choices during task performance.
Will I have to stop taking my current medications?
The trial does not specify if you need to stop taking your current medications, but it excludes those on uninterruptable central nervous system medication. It's best to discuss your specific medications with the trial coordinators.
What data supports the effectiveness of the treatment Transcranial Magnetic Stimulation (TMS) for Reward Learning?
Research shows that high-frequency repetitive transcranial magnetic stimulation (rTMS) over the prefrontal region can increase dopamine release, which is linked to reward learning. Additionally, rTMS has been found to reduce cravings and improve cognitive function in individuals with addictive disorders, suggesting its potential effectiveness in enhancing reward learning.12345
Is repetitive transcranial magnetic stimulation (rTMS) generally safe for humans?
Repetitive transcranial magnetic stimulation (rTMS) is generally considered safe when used within recommended guidelines. Common side effects are usually minor, such as headaches, and there is a low risk of more serious events like seizures, which can be minimized by screening for risk factors.678910
How is TMS treatment different from other treatments for reward learning?
TMS (Transcranial Magnetic Stimulation) is unique because it noninvasively stimulates specific brain regions, like the prefrontal cortex, to enhance dopamine release, which is important for reward learning. Unlike medications, it uses magnetic fields to influence brain activity directly, offering a novel approach to modifying brain function related to reward processing.2451112
Eligibility Criteria
This trial is for individuals struggling with addiction. Participants should be able to perform decision-making tasks and have no conditions that would interfere with TMS treatment or the measurement of brain activity.Inclusion Criteria
Be willing to provide informed consent
Be able to comply with protocol requirements and likely to complete all study procedures
I am between 18 and 55 years old.
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Exclusion Criteria
I have a history of an immune, hormone, viral, or blood vessel disorder that affects my brain.
I don't have a history of major neurological issues, head injuries, or any metal implants in my head.
I have never been diagnosed with bipolar disorder, schizophrenia, PTSD, dementia, or major depression.
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Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants receive single-pulse TMS during goal-directed behavior tasks over two sessions within two weeks
2 weeks
2 sessions (in-person)
Follow-up
Participants are monitored for safety and effectiveness after treatment
4 weeks
Treatment Details
Interventions
- Transcranial Magnetic Stimulation (Behavioural Intervention)
Trial OverviewThe study tests if Active single pulse Transcranial Magnetic Stimulation (TMS) to the frontal cortex can influence reward processing in the brain during goal-directed behavior, potentially affecting choices and task performance.
Participant Groups
2Treatment groups
Experimental Treatment
Group I: Single-pulse Trough Phase TMSExperimental Treatment1 Intervention
Participants will receive a single active TMS pulse during the trough phase target of each task trial and delivered at 110% of participants' resting motor threshold over the predefined frontal target . For the second TMS session, participants will receive single pulse Sham TMS during the peak phase target of each task trial and delivered at 110% of participants' resting motor threshold over the predefined frontal target. Total number of TMS pulse for each session is 520 pulses
Group II: Single-pulse Peak Phase TMSExperimental Treatment1 Intervention
Participants will receive a single active TMS pulse during the peak phase target of each task trial and delivered at 110% of participants' resting motor threshold over the predefined frontal target . For the second TMS session, participants will receive single pulse Sham TMS during the peak phase target of each task trial and delivered at 110% of participants' resting motor threshold over the predefined frontal target. Total number of TMS pulse for each session is 520 pulses
Transcranial Magnetic Stimulation is already approved in United States, Canada, European Union for the following indications:
🇺🇸 Approved in United States as Transcranial Magnetic Stimulation for:
- Major Depressive Disorder
- Obsessive Compulsive Disorder
🇨🇦 Approved in Canada as Transcranial Magnetic Stimulation for:
- Major Depressive Disorder
🇪🇺 Approved in European Union as Transcranial Magnetic Stimulation for:
- Major Depressive Disorder
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Rutgers University - NewarkNewark, NJ
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Who Is Running the Clinical Trial?
Rutgers, The State University of New JerseyLead Sponsor
References
Effects of High Frequency Repeated Transcranial Magnetic Stimulation and Continuous Theta Burst Stimulation on Gambling Reinforcement, Delay Discounting, and Stroop Interference in Men with Pathological Gambling. [2019]Repeated transcranial magnetic stimulation (rTMS) can reduce cravings and improve cognitive function in substance dependent individuals. Whether these benefits extend to individuals with pathological gambling (PG) is unclear. High-frequency rTMS of the medial prefrontal cortex (PFC) and continuous theta burst stimulation (cTBS) of the right dorsolateral PFC can reduce impulsive choice in healthy volunteers.
Reward-related activity in the human motor cortex. [2021]The human primary motor cortex (M1) participates in motor learning and response selection, functions that rely on feedback on the success of behavior (i.e. reward). To investigate the possibility that behavioral contingencies alter M1 activity in humans, we tested intracortical inhibition with single and paired (subthreshold/suprathreshold) transcranial magnetic stimulation during a slot machine simulation that delivered variable money rewards for three-way matches and required no movement. A two-way match before the third barrel had stopped (increased reward expectation) was associated with more paired-pulse inhibition than no match. Receiving a large reward on the preceding trial augmented this effect. A control task that manipulated attention to the same stimuli produced no changes in excitability. The origin of this reward-related activity is not clear, although dopaminergic ventral tegmental area neurons project to M1, where they are thought to inhibit output neurons and could be the source of the finding. Transcranial magnetic stimulation of M1 may be useful as a quantitative measure of reward-related activity.
A single session of repetitive transcranial magnetic stimulation of the prefrontal cortex reduces cue-induced craving in patients with gambling disorder. [2020]Gambling disorder (GD) is common and disabling addictive disorder. In patients with substance use disorders, the application of repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) offers promise to alleviate craving. We hypothesized that applying real compared to sham rTMS over the left DLPFC would reduce gambling craving in patients with GD.
The effects of high-frequency rTMS over the left dorsolateral prefrontal cortex on reward responsiveness. [2016]High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) over the prefrontal region has been shown to increase endogenous dopamine release in the striatum, which is closely associated with probabilistic reward learning.
A Light in the Darkness: Repetitive Transcranial Magnetic Stimulation (rTMS) to Treat the Hedonic Dysregulation of Addiction. [2021]: The present paper discusses the potential use of repetitive transcranial magnetic stimulation (rTMS) for the treatment of addiction, within a conceptual framework that includes the "dark side" of addiction. New findings suggest that rTMS may rescue specific reward system dysfunction that underlies the pathophysiology of addiction by exposing widely under-recognized and untreated key clinical and psychopathological aspects of addictive disorders. Our paper sheds light on the relevance of these hidden dimensions for the development of effective treatment interventions. In particular, we argue that rTMS may have an impact on craving by reversing the allostatic load of hedonic dysregulation.
Safety Review for Clinical Application of Repetitive Transcranial Magnetic Stimulation. [2023]Studies using repetitive transcranial magnetic stimulation (rTMS) in healthy individuals and those with neuropsychiatric diseases have rapidly increased since the 1990s, due to the potential of rTMS to modulate the cortical excitability in the brain depending on the stimulation parameters; therefore, the safety considerations for rTMS use are expected to become more important. Wassermann published the first safety guidelines for rTMS from the consensus conference held in 1996, and Rossi and colleague then published the second safety guidelines from the multidisciplinary consensus meeting held in Siena, Italy in 2008, on behalf of the International Federation of Clinical Neurophysiology. More than 10 years after the second guidelines, the updated third safety guidelines were recently published in 2021. The general safety guidelines for conventional rTMS have not substantially changed. Because the most frequently used rTMS protocol is conventional (low- and high-frequency) rTMS in research and clinical settings, we focus on reviewing safety issues when applying conventional rTMS with a focal cortical stimulation coil. The following issues will be covered: 1) possible adverse events induced by rTMS; 2) checklists to screen for any precautions and risks before rTMS; 3) safety considerations for dosing conventional rTMS; and 4) safety considerations for using rTMS in stroke and traumatic brain injury.
Decreasing procedural pain over time of left prefrontal rTMS for depression: initial results from the open-label phase of a multi-site trial (OPT-TMS). [2021]There is much interest in whether daily left prefrontal repetitive transcranial magnetic stimulation (rTMS) over several weeks may become a clinically useful antidepressant treatment. Although rTMS appears largely safe, many patients report that this procedure is somewhat painful, which may restrict its ultimate appeal and utility. We analyzed interim results from the open-label phase of a multi-site randomized trial of rTMS as a treatment for depression to investigate whether the procedural pain of left prefrontal rTMS changes over time.
Transcranial magnetic stimulation (TMS) safety: a practical guide for psychiatrists. [2019]Repetitive transcranial magnetic stimulation (rTMS) is increasingly being utilised as a treatment option for depression, and with this comes a need for a practical review of safety issues intended for clinicians. This article provides an overview of the current literature regarding safety issues with rTMS for depression, and provides recommendations for clinical practice.
Adverse events of repetitive transcranial magnetic stimulation in older adults with depression, a systematic review of the literature. [2021]In the last decade, repetitive transcranial magnetic stimulation (rTMS) has been introduced as a non-invasive neuromodulation therapy for depression. Little is known, however, about (serious) adverse events (AE) of rTMS in older adults with a depression. In this article, we want to study what is known about (serious) AE of rTMS in older adults (>60 years) with late-life depression (LLD).
A review of the safety of repetitive transcranial magnetic stimulation as a clinical treatment for depression. [2021]There is growing interest worldwide in rTMS as a clinical treatment for depression. Apart from efficacy, its safety as a clinical treatment must be considered before its widespread use can be advocated. All published, sham-controlled rTMS depression trials were reviewed for reported side-effects and outcomes of formal neuropsychological testing. In addition, all reports of seizures occurring with rTMS were reviewed. Other safety concerns (effects on hearing; headache, pain, induced currents in electrical circuits, histotoxicity, electromagnetic field exposure, psychiatric complications, safety in pregnancy) are discussed. Common side-effects were of a minor nature, e.g. headache. There was a low incidence of accidental seizures and induced hypomania, both of which were associated with identified risk factors for which subjects should be screened. Long-term effects of repeated rTMS sessions are as yet unknown. When given within recommended guidelines, the overall safety profile of rTMS is good, and supports its further development as a clinical treatment.
Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex reduces nicotine cue craving. [2022]Repetitive transcranial magnetic stimulation (rTMS) can noninvasively stimulate the brain and transiently amplify or block behaviors mediated through a region. We hypothesized that a single high-frequency rTMS session over the left dorsolateral prefrontal cortex (DLPFC) would reduce cue craving for cigarettes compared with a sham TMS session.
Recovery of reward function in problematic substance users using a combination of robotics, electrophysiology, and TMS. [2023]Theoretical and empirical work suggest that addictive drugs potentiate dopaminergic reinforcement learning signals and disrupt the reward function of its neural targets, including the anterior midcingulate cortex (aMCC) and the basal ganglia. Here, we aim to use prefrontal 10-Hz TMS to enhance aMCC reward activity and reward learning by the basal ganglia in problematic substance users.