Transcranial Magnetic Stimulation
I lead a clinical research program designed to develop and optimize non-invasive electromagnetic therapeutics. We have primarily focused on transcranial magnetic stimulation (TMS) as a tool to treat substance dependence (e.g. tobacco cessation, alcohol dependence), chronic pain, and other mood disorders – all of which are directly relevant to cancer prevention and survivorship outcomes. Our therapeutic discovery pipeline is divided into 5 themes: 1) Target Identification studies – often achieved through functional and structural MRI measurements in the population interest, 2) Target Engagement studies – typically multimodal imaging studies evaluating the effect of the intervention on cue-reactivity or pain, 3) NIH-supported Clinical Trials – larger, double-blind sham-controlled investigations of safety and efficacy, 4) Methods Refinement – utilizing computational modeling and variance observed in our clinical data, we are able to revisit dosing parameters and develop novel pulse sequences for subsequent testing, 5) Preclinical Translational Research – leveraging the strength of animal models we work closely with basic scientists to investigate novel electromagnetic therapeutics.
Through this thematic approach we have made contributions to several areas of science:
1. Evaluating individual differences in neural connectivity and cue-reactivity in substance dependent individuals.
2. Leading National and International efforts to develop a Brain Stimulation based approach for drug and alcohol use disorders (including smoking cessation). Transcranial magnetic stimulation (TMS) is an FDA-approved treatment for depression which has been used for over a decade. In 2020, after demonstrating positive outcomes in a multisite double-blind sham-controlled investigation, a unique form of TMS (‘Deep TMS’) received FDA-clearance for use as a smoking cessation aid. It is now emerging as a promising new tool for the attenuation of craving among multiple substance dependent populations. I am happy to be playing an active part in shaping this emerging field- including recently serving as the senior author on a consensus paper:
Ekhtiari,H et al. Transcranial Electrical and Magnetic Stimulation (tES and TMS) for Addiction Medicine: A consensus paper on the present state of the science and the road ahead. Neurosci Biobehav Rev. 2019 Jul 1. PMID: 31271802
3. Methods Refinement. With a staff of engineers and biostatisticians we are continually investigating various aspects of these dosing parameters and attempting to develop open-source tools which can be used by the field of therapeutic brain stimulation at large.
4. Translational/Collaborative research. I have actively collaborated with teams of clinician scientists in Psychiatry, Neurology, Radiology, and Pain Management on various research projects. I am also committed to translational research efforts – working closely with preclinical researchers in 2 NIH supported P50 centers at MUSC and looking forward to greater involvement in the NIAAA P50 and NIDA P50 at Wake Forest Health Sciences. In 2020, for example, our lab joined forces with Dr. Paul Czoty’s laboratory in Physiology & Pharmacology and performed some first-in-class research devoted to developing a non-human primate model for TMS studies. The fruits of these efforts were submitted for publication in August 2020.
5. Mentorship, Teaching, and National Service. I participate in the research training and education community at both a local level (serving as a mentor to over 50 medical, graduate, post-graduate, and fellowship trainees since 2005 on a national and international scale) as well as leading an annual outreach event at the College of Problems on Drug Dependence (CPDD) meeting (2015-2018), serving on the Liaison Committee (2016-2019) and the Education and Training Committee (2019-present) for the American College of Neuropsychopharmacology, Grassroots Advocacy Team for the Society for Neuroscience (2017-2019), Chair of the Education Outreach and Public Policy Committee for CPDD (2017-2019), ad hoc participation in over 20 NIH study sections, and serving as a standing member of NIH NPAS study section (effective 10/2018)I also serve as a consultant and mentor on NIH grants led by several Assistant and Associate Professors whom I have mentored in TMS practices including Rebecca Price (Associate Professor, University of Pittsburg, “Evaluating TMS for OCD patients”, R21 consultant), Christine Sheffer (Assistant Professor, Roswell Park Cancer Institute, “Evaluating TMS for smoking cessation”, R01 consultant), Michael Wesley (Assistant Professor, University of Kentucky, K01 co-mentor), Andrada Neacsiu (Assistant Professor, Duke University), Eleanor Cole (Research fellow, Stanford), Claudia Padula (Assistant Professor, PaloAlto VA, Stanford, VA merit consultant). I am actively involved in mentoring all members of our laboratory as well as graduate students, medical students, and residents.