Deep TMS of the insula using the H-coil modulates dopamine release: a crossover [ 11 C] PHNO-PET pilot trial in healthy humans

Saima Malik, Mark Jacobs, Sang Soo Cho, Isabelle Boileau, Daniel Blumberger, Markus Heilig, Alan Wilson, Zafiris J. Daskalakis, Antonio P. Strafella, Abraham Zangen, Bernard Le Foll

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Modulating the function of the insular cortex could be a novel therapeutic strategy to treat addiction to a variety of drugs of abuse as this region has been implicated in mediating drug reward and addictive processes. The recent advent of the H-coil has permitted the targeting of deeper brain structures which was not previously feasible. The goal of this study was to bilaterally target the insular region using the H-coil with repetitive Transcranial Magnetic Stimulation (rTMS) and subsequently measure changes in dopamine levels using Positron Emission Tomography (PET) with [11C]-(+)-propyl-hexahydro-naphtho-oxazin (PHNO). This was a within-subject, crossover, blinded and sham-controlled pilot study. Eight healthy, right-handed subjects, aged 19–45, participated in the investigation. All subjects underwent 3 PHNO-PET scans preceded by rTMS (sham, 1 Hz or 10 Hz), on 3 separate days. Low frequency rTMS (1 Hz), targeting the insular cortex, significantly decreased dopamine levels in the substantia nigra, sensorimotor striatum and associative striatum. Replicating this study in tobacco smokers or alcoholics would be a logical follow-up to assess whether H-coil stimulation of the bilateral insula can be employed as a treatment option for addiction. Trial registration: NCT02212405.

Original languageEnglish (US)
Pages (from-to)1306-1317
Number of pages12
JournalBrain Imaging and Behavior
Issue number5
StatePublished - Oct 1 2018
Externally publishedYes


  • Deep rTMS
  • Dopamine
  • H-coil
  • Insula
  • PET
  • PHNO

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Cognitive Neuroscience
  • Radiology Nuclear Medicine and imaging
  • Behavioral Neuroscience


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