MUSC Health among first to offer brain stimulation to try to help smokers quit

As a food truck operator who whips up tasty Polish dishes like pierogi, golabki and kielbasa, Victor Krupka is proud to carry on his family’s culinary traditions. But he had a tradition of his own that he was ready to get rid of: smoking. So when he heard MUSC Health was among the first sites in the country to offer deep brain stimulation to help people quit, he signed up.

“I've been a smoker for over 30 years. Smoked about a pack and a half, or almost about a pack and a half a day. I have tried to quit, very unsuccessfully. I tried Chantix. I've tried just stopping on my own, tried cutting back. Nothing really worked,” the Charleston, South Carolina, man said. “In my opinion, the majority of smokers thought about quitting at some point in their lives."

The treatment, the first of its kind cleared by the Food and Drug Administration for addiction, is called BrainsWay. MUSC Health is one of just 10 sites in the U.S. to offer it.

As its name suggests, the treatment targets two areas of the brain that are involved in decision making, impulse control and emotion: the prefrontal cortex and the bilateral insula. It uses a process known as transcranial magnetic stimulation, or TMS, to send magnetic pulses to try to boost the strength of the targeted brain areas — and help the smoker fight off cravings.

But friends who smoke figured Krupka would fail. While more than half of adult cigarette smokers try to quit each year, only 7.5% succeed. Nicotine is extremely addictive. “They thought I was going to try this, then go right back to smoking.”

And frankly, Krupka thought that might happen, too. “I was hoping it would work, you know what I mean? But I was very skeptical at first. Just knowing myself, and from the results of all my prior attempts, I thought it probably wouldn’t work.”

But he went in for his first appointment anyway on the campus of the Medical University of South Carolina. He wanted to give it his best shot. 

“Before I even started the sessions, I got myself ready. For probably about two weeks prior to the first session, I started off by getting off my brand of smokes and buying the cheapest, most disgusting brand that didn't bring me as much satisfaction. I also limited myself to only one cigarette per hour, and no more than that, by setting up a timer on my phone,” Krupka said.

“One of my many craving triggers was also driving. So I would put my cigarettes way in the back of the car where I couldn't reach them. This enabled me to break the habit of smoking every time I got in the car. I just thought, if I'm going to do this, I'm going to go all the way."

 

That enthusiasm was welcome news to TMS expert Baron Short, M.D., an associate professor in the Department of Psychiatry and Behavioral Sciences at MUSC. He’s a leader of the team giving the BrainsWay treatments. “With Victor, we were trying to get him to start cutting back, not immediately go from a pack and a half to zero cigarettes a day,” Short said.

Krupka said he was told to avoid cigarettes for two hours before his first appointment. “That was a little hard for me at first. They do a breathalyzer test in the beginning. So we checked the levels of carbon monoxide my first day. And then I think it's a scale from 1 to 30. My first day, I think I was at like 46. It was kind of embarrassing. I didn't even make the chart.”

Then, Short and his team put what the doctor described as a device that looks like a salon hairdryer helmet on Krupka’s head. “But it’s more fitted to the head than that. It’s an arm that’s attached to a power supply unit. The doctor can set the stimulation parameters of the device,” Short said.

Krupka described it from his perspective. “The nurse fits a cloth helmet over your head and adjusts what feels like a cushioned, tight-fitting bike helmet over that while you sit in what looks like a dentist's chair that doesn't recline. Ear plugs and mouthguard are optional but highly recommended."

Then, Short said, they try to cause cravings. “Asking them not to smoke two hours before the visit is one way we do that. The other is we show them images or video related to smoking to drive their cravings. We may even give them a cigarette to hold and lighter to light, but we don’t let them light the cigarette. On a scale of 1 to 7, we're trying to get them to around a 4 to 5. We're not trying to get them to crawl out of their skin, but we are trying to get them to crave quite significantly.”

 

The treatment that follows takes about 20 minutes. “It doesn't hurt,” Krupka said. “It's a very, very weird sensation. It's hard to describe, but it pulses on each side, like somebody tapping you on the head very quickly — but not very hard. Just enough to rattle you. The first time it fired, it almost threw me off the chair. But then after a couple of times, I kind of got used to it.”

He came back every day for three weeks, then once a week for three more weeks. By the tenth appointment, he was able to quit. He believes the visits that followed, which included counseling from Short, have helped him continue to fight his way through cravings.

“I'm not as congested as I was before. I'm not coughing every morning when I wake up,” Krupka said. “I feel like my lungs are already starting to heal themselves.”

The treatment is not yet covered by insurance, something Short is trying to change. “It’s a clinical treatment for people who have tried medicines and behavior therapy but who are still smoking a lot, and they have reasons to quit. More than 34 million adults smoke cigarettes. About 480,000 die each year, accounting for about 1 in 5 deaths, so we need more options to try.”

He said the out-of-pocket cost is equivalent to about a year’s worth of cigarette purchases. “If your goal is to quit, you can look at the fact that you’d spend this money over a year anyway on cigarettes. Why not spend it quitting and save money next year and the years after that?”

Krupka thinks the treatment finally allowed him to give up smoking after years of trying. At his last appointment, his carbon monoxide level was down to a healthy three. 

“It's still not easy. Sometimes, those cravings are still like same as day one. But like Dr. Short said, ‘You’ve just got to battle one craving at a time.’”