Gambling Disorder (GD) is characterized by unsuccessful efforts to reduce or stop gambling despite negative consequences, that are hypothesized to result from deficits in inhibitory control networks of the brain, including the pre-supplementary motor area (pre-SMA). Modulation of the pre-SMA networks with Transcranial Magnetic stimulation (TMS) has shown efficacy towards deficits in inhibitory control in other neuropsychiatric disorders: we hypothesize that inhibitory stimulation of the pre-SMA with a particularly brief and effective form of TMS (Theta Burst Stimulation – TBS) may be effective in reducing clinical severity and behavioral manifestations of GD. The aims of this study are: identifying circuit-level mechanisms of action and therapeutic targets and assessing the efficacy of TMS in modulating inhibitory control and symptom severity in this population. Herein, we present the preliminary clinical and behavioral results of a placebo-controlled double blind study with 10 sessions of active or placebo cTBS over the pre-SMA in GD subjects that combines TMS, multimodal structural and functional MRI and behavioral measures. To assess the severity of GD symptoms we have used the Gambling Urges Questionnaire score, to reflect the hypothesized reduction of craving/urges to gamble, while for behavioral measures we have employed the Stop Signal Task (SST), performed during MRI. Secondary outcome measures will be the Pathological Gambling 
Modification of Y-BOCS and the BIS-11, the HAM-A, the HAM-D, the SDS and the Fagerstrom Test for Nicotine Dependence.

MODULATING INHIBITORY CONTROL NETWORKS IN GAMBLING DISORDER WITH THETA BURST STIMULATION