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14 Saving Adam from the apple: using transcranial magnetic stimulation as a transdiagnostically relevant tool to decrease cue-reactivity
  1. Colleen A Hanlon

Abstract

Professor Hanlon’s scientific research has been to map neural circuit irregularities in substance dependent populations and then modulate these circuits using brain stimulation techniques or neurofeedback. She is leading NIH-funded research directed at longitudinal investigations of neural connectivity in cocaine & alcohol dependent individuals undergoing substance abuse treatment, & developing patient-tailored brain stimulation protocols which may either enhance cognitive control or attenuate craving in treatment seeking individuals. Her trainees & collaborators are pioneering non-invasive neuromodulatory strategies for treating addiction including continuous Theta Burst Stimulation to the medial prefrontal cortex, & real-time fMRI biofeedback. She has also received independent funding to pursue research in PTSD, Tourette Syndrome, & Stroke rehabilitation.

Abstract The struggle between internal self-control and external temptation from environmental cues is a tale as old as written history, yet as relevant today as any time in the past. For most individuals, the occasional surrender to a tempting cue will not impair their ability to fulfill daily and longer term responsibilities. For other individuals, including those with substance use disorders, elevated reactivity to positive or negative cues causes a disabling cascade of events ultimately impeding long-term goals. In these populations, salient cues evoke elevated activity in a consistent network of neural regions. This network contains the ventral medial prefrontal cortex (MPFC), anterior cingulate cortex (ACC), and insula.

Our laboratory has spent the last 7 years systematically and empirically developing a non-invasive, neural circuit based intervention to dampen cue-reactivity in various drug and alcohol dependent populations. This talk will briefly review the data that motivated our selection of a candidate neural circuit, and will then summarize the results of 7 studies, culminating in the first 2 double-blinded, sham controlled clinical trials of MPFC TMS as a behavioral treatment adjuvant among treatment-engaged cocaine users and alcohol users.

The intent of this talk is to highlight one example of a systematic path for TMS treatment development in patients. This path is not necessarily optimal, exclusive, or appropriate for every neurologic or psychiatric disease. Rather, it is one example of a reasoned, empirically-derived pathway which we hope will serve as scaffolding for future investigators seeking to develop TMS treatment protocols.

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