Damage to the insula leads to decreased nicotine withdrawal during abstinence.
Damage to the insula leads to decreased nicotine withdrawal during abstinence.
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DOI：
10.1111/add.13061
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发表时间：
2015-12
期刊：
影响因子：
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通讯作者：
van Wijngaarden E
中科院分区：
文献类型：
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作者：
Abdolahi A;Williams GC;Benesch CG;Wang HZ;Spitzer EM;Scott BE;Block RC;van Wijngaarden E
目前烟草依赖的药物治疗通常耐受性良好，但复发率相对较高。它们主要针对大脑的中皮质边缘“奖励”通路。然而，最近的证据表明，岛叶皮层，一个在成瘾模型中被忽视的大脑半球中央区域，也可能在促进药物使用的认知和情感过程中发挥重要作用。我们研究了缺血性卒中引起的岛叶损伤与非岛叶损伤是否会减弱急性戒烟，并降低住院期间使用尼古丁替代疗法（NRT）的可能性。数据来自一项纵向研究，随访3个月，从2013年6月开始，到2014年5月结束。位于美国纽约州罗切斯特的三家急症护理医院。100五十六例因急性缺血性卒中住院的吸烟者（38例为岛叶梗死，118例为非岛叶梗死，由3名神经放射科医生评估）。在住院期间（强制戒烟期）使用威斯康星州吸烟戒断量表（WSWS）和明尼苏达尼古丁戒断量表（MNWS）评估戒断症状的频率和严重程度。还评估了住院期间的NRT使用情况。平均而言，有岛叶损伤的吸烟者入院时的WSWS评分（平均值= 5.89，SD = 4.72）低于无岛叶损伤的吸烟者（平均值= 9.20，SD = 4.71; p < 0.001）（协变量调整后平均值差异为-3.12，95%CI：-4.97，-1.27）。当使用MNWS时也观察到类似的差异（p = 0.02）。此外，与非岛叶病变的受试者相比，岛叶病变的受试者似乎不太可能在入院期间使用NRT（OR = 0. 72，95% CI：0. 32，1. 64）。与非岛叶损伤的吸烟者相比，目前岛叶皮层脑区受损的吸烟者似乎经历更少和更不严重的烟草戒断症状，并且似乎不太可能在住院期间需要尼古丁替代治疗。这些发现支持了岛叶皮层在戒断过程中调节戒断的潜在作用，这是一种负责维持成瘾行为的动机。
Current pharmacotherapies for tobacco dependence are generally well tolerated but have relatively high rates of relapse. They primarily target the brains’ mesocorticolimbic “reward” pathway. However, recent evidence suggests that the insular cortex, a central cerebral hemispheric region historically overlooked in addiction models, may also play an important role in cognitive and emotional processes that facilitate drug use. We examined whether insular versus non-insular damage from ischemic stroke attenuated acute withdrawal from cigarette smoking and reduced the likelihood of nicotine replacement therapy (NRT) use during hospitalization. Data were derived from a longitudinal study with 3 months follow-up, beginning June 2013 and ending May 2014. Three acute care hospitals in Rochester, NY, USA. One-hundred-fifty-six current smokers hospitalized for acute ischemic stroke (38 with insular infarctions and 118 with non-insular infarctions, assessed by 3 neuroradiologists). The Wisconsin Smoking Withdrawal Scale (WSWS) and Minnesota Nicotine Withdrawal Scale (MNWS) were administered during hospitalization (a period of forced abstinence) to assess the frequency and severity of withdrawal symptoms. NRT use was also assessed during hospitalization. On average, smokers with insular damage had a lower WSWS score during admission (mean = 5.89, SD = 4.72) compared with those with non-insular damage (mean = 9.20, SD = 4.71; p < 0.001) (covariate-adjusted difference in means of −3.12, 95% CI: −4.97, −1.27). A similar difference was also noted when the MNWS was used (p = 0.02). Furthermore, participants with insular lesions appeared to be less likely to use NRT during admission compared with those with non-insular lesions (OR = 0.72, 95% CI: 0.32, 1.64). Current smokers with damage to their insular cortex brain region appear to experience fewer and less severe tobacco withdrawal symptoms, and appear to be less likely to require nicotine replacement therapy during hospitalization, compared with smokers with non-insular damage. These findings support the potential role of the insular cortex in regulating withdrawal during abstinence, a motivator responsible for the maintenance of addictive behaviors.