Adrian Ephraim decided to go cold turkey
In 2020, as part of COVID-19 health regulations, the South African government banned the sale of tobacco products for four months.

Heavy smokers who puffed their way through more than a packet of cigarettes a day cut down or quit for six months after their brains were stimulated with magnetic pulses, researchers say.

The apparent success of the simple procedure has led the scientists to organise a large-scale trial, which will launch early next year at 15 medical centres around the world.

Smokers who took part in a pilot study had already tried anti-smoking drugs, nicotine gum and patches or psychotherapy to no avail, raising hopes that magnetic stimulation might offer an effective alternative for those who want to give up but have so far failed.

Nearly half of the smokers in one group, who were treated with high-frequency magnetic pulses, gave up after a three-week course of stimulation and more than a third were still abstaining six months later.

"This is a new approach to the problem," said Abraham Zangen, a neuroscientist at Ben-Gurion University in Israel.

Scientists working in the field said more trials are needed to prove the value of the procedure, and that it should only be offered within a psychotherapy-based programme designed for smokers.

For the pilot study, Zangen recruited 115 people aged 21 to 70 who smoked at least 20 cigarettes a day. Only those who had tried to give up before by using at least two different treatments, including nicotine supplements, cognitive behavioural therapy or anti-smoking drugs such Chantix (also known as Champix)and Zyban, could take part.

The smokers were divided into three groups. The first had 15 minutes of high-frequency magnetic stimulation every weekday for two weeks, followed by three sessions in the third week. The second group had the same number of sessions of low-frequency magnetic stimulation. The third batch of smokers thought they were having their brains stimulated, but the device was turned off to provide a control group.

Before each session, one of Zangen's PhD students lit a cigarette and took a puff in front of half of the smokers in each group. This was designed to awaken their cravings for a smoke and hopefully make them more susceptible to treatment.

Zangen targeted the prefrontal cortex and insula regions of the brain with a technique called deep, repeated transcranial magnetic stimulation. Throughout the study, he asked the smokers to record how much they smoked.

The results showed a placebo effect, or an improvement without any proper intervention, in the control group and also in the smokers who received low-frequency stimulation. In both of these groups, the smokers cut down on average from 26 to 20 cigarettes a day.

But the results were more impressive in the smokers who had high-frequency brain stimulation. In this group, 44% quit after the three-week course. Six months later, 36% said they were still not smoking.

To check that the smokers were telling the truth, Zangen tested their urine for a breakdown product of nicotine called cotinine. The results were in line with the smokers' claims.

Though the findings are promising, the study was too small to be convincing. Zangen said a much larger trial, involving medical centres in several countries, is due to start in the next few months to test the stimulation on far more smokers.

If the procedure turns out to be effective, smokers might not need to have their brains stimulated regularly to avoid relapsing, Zangen said.

"It's quite easy to quit for a few days or even for a few weeks, but if we can help people quit for more than three months, then they are actually quite unlikely to relapse."

Peter Eichhammer, who has studied brain stimulation at the University of Regensburg, said that, although the procedure might be effective, it was important for smokers to receive treatment in a dedicated ­psychotherapy-based programme. – © Guardian News & Media 2013

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Ian Sanne is a co-founder and Division Head of HE²RO. He is has a faculty appointment at the University of Witwatersrand as well as being a founder and managing director of Right to Care and the Clinical HIV Research Unit.