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ORIGINAL RESEARCH article

Front. Neurol.

Sec. Applied Neuroimaging

Volume 16 - 2025 | doi: 10.3389/fneur.2025.1653926

Repetitive Transcranial Magnetic Stimulation Reduces Nicotine Dependence and Potentially Modulates White Matter Microstructure in Smokers: A Pilot Study by Diffusion Spectrum Imaging

Provisionally accepted
Dongyan  ChenDongyan Chen1Zhiqiang  LiZhiqiang Li1Mei  XieMei Xie1Tao  WangTao Wang1Ruiyang  LiRuiyang Li1Yao  ChenYao Chen1Siyin  LiSiyin Li1Qiaoli  ZhangQiaoli Zhang1Yuting  LingYuting Ling2Xiaoyun  LiangXiaoyun Liang2Huan  MaoHuan Mao3Lihao  ZhaiLihao Zhai1Jianjun  ZhangJianjun Zhang1*
  • 1Department of Radiology, Zhejiang Hospital, Hangzhou, China
  • 2Institute of Research and Clinical Innovations, Neusoft Medical Systems Co., Ltd., Shanghai, China
  • 3Yiruide Medical Equipment New Technology Co., Ltd., Wuhan, China

The final, formatted version of the article will be published soon.

The present study aims to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on smoking cessation and white matter (WM) structure related to the mesolimbic dopamine pathway using diffusion spectrum imaging (DSI). The rTMS over the left dorsolateral prefrontal cortex (DLPFC) was repeated 10 times in 18 smokers. Quantitative anisotropy (QA) and fractional anisotropy (FA) were calculated for the anisotropy assessment, and mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD) were determined for the diffusivity evaluation. Nicotine dependence, and craving and withdrawal symptoms were evaluated using the Fagerstrőm Test for Nicotine Dependence (FTND), the short version of the Tobacco Craving Questionnaire (sTCQ), the visual analogue scale (VAS), and the Minnesota Nicotine Withdrawal Scale (MNWS). After 10 times of rTMS, the FTND, MNWS and VAS scores significantly decreased, when compared to baseline, and withdrawal symptoms were partially alleviated. Furthermore, cigarette consumption was significantly decreased by rTMS, and four participants completely stopped smoking after rTMS treatment. Importantly, the smokers only had a reduction of AD in the right nucleus accumbens (NAc) fibers after rTMS, and a strong positive correlation was observed between the change in cigarette consumption and change in AD values in the right NAc fibers after rTMS treatment. These results suggest that rTMS over the left DLPFC is a potential effective strategy for nicotine dependence and craving, which is probably due to the modulation of the right NAc fibers. The right NAc emerged as a region of interest that warrants further investigation as a potential therapeutic target.

Keywords: repetitive transcranial magnetic stimulation, Nicotine, Smoking Cessation, Whitematter, Diffusion spectrum imaging

Received: 25 Jun 2025; Accepted: 30 Sep 2025.

Copyright: © 2025 Chen, Li, Xie, Wang, Li, Chen, Li, Zhang, Ling, Liang, Mao, Zhai and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Jianjun Zhang, zhangyp31113@163.com

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