Changes in Addictive Behaviors After Brain Lesions

项目摘要/摘要 对药物成瘾的认知和行为过程至关重要的神经结构网络，包括 尼古丁，包括眶前皮质、前扣带回、岛叶皮质、杏仁核和纹状体。 然而，还没有研究表明人类这种神经网络的不同组成部分会受到怎样的损害 影响吸毒成瘾的维持。根据通过CEBRA授予的R21的任期(Cutting- EDGE基础研究奖)，我们开始在烟瘾患者中解决这一重要问题 谁吸烟，谁遭受了中风，包括任何这些地区。研究发现，虽然脑部的病变 大鼠腹内侧前额叶皮质(VMPFC)与线索诱发的冲动明显受损有关。 在实验室，他们与戒烟可能性的增加无关。事实上，脑部的损伤 岛叶皮质与轻松、立即、不复发和不复发的戒烟能力有关 持久的吸烟冲动。虽然这些结果是初步的，但这些结果表明，虽然VMPFC的损伤可能会扰乱 暗示诱导的冲动，它们不会阻止吸烟成瘾。然而，半岛，它也在 冲动，似乎对维持吸烟成瘾和驾驶吸烟行为最为关键。结果还包括 提示脑岛在心理过程中起作用，这可能导致戒烟困难。 抽烟。受到这些耐人寻味但初步的结果的鼓舞，我们的主要目标是(1)扩大和 在更大的样本中确认这些发现，使用更精确的解剖学分析来表征大小和 病变的位置；(2)检查戒烟难易程度是否存在性别差异 病变后；及(3)对患中风的吸烟者进行前瞻性研究并监测其吸烟情况 在皮损发作后的几年内表现。这项拟议的研究是一种新方法的开始 有可能开发出更有效的治疗方法来打破成瘾的恶性循环。具体来说， 这项拟议的研究提出的一种治疗方法是直接调节 岛上。项目叙事 大脑深处一个叫做脑岛的李子大小的区域与吸烟成瘾密切相关，而且 对这一结构的破坏可以完全消除身体吸烟的冲动。显然，脑损伤并不是 尼古丁成瘾的治疗选择，但如果得到证实，这些结果可能会为治疗提供帮助 吸烟者戒烟，或者是为了在使用现有疗法的同时监测吸烟者的进展。

Project Summary/ Abstract A network of neural structures crucial for the cognitive and behavioral processes of drug addiction, including nicotine, includes the orbitofrontal cortex, anterior cingulate, insular cortices, the amygdala, and the striatum. However, no work has addressed how damage to different components of this neural network in humans may impact the maintenance of addiction to drugs. Under the tenure of an R21 awarded through CEBRA (Cutting- Edge Basic Research Awards), we began addressing this important issue in patients addicted to cigarette smoking and who had suffered a stroke that included any of these areas. It was found that although lesions of the ventromedial prefrontal cortex (VMPFC) were associated with a marked impairment of cue-induced urge in the laboratory, they were not associated with an increased likelihood of quitting smoking. In fact, lesions of the insular cortex were associated with an ability to quit smoking easily, immediately, without relapses and without a lasting urge to smoke. Although preliminary, these results suggest that, while VMPFC lesions may disrupt cue-induced urges, they do not disrupt smoking addiction. However, the insula, which also plays a key role in urges, seems most critical for maintaining smoking addiction and driving smoking behavior. The results also suggest that the insula functions in psychological processes that may contribute to the difficulty of quitting smoking. Encouraged by these intriguing, but preliminary, results, our primary aims are to (1) expand and confirm these findings in a larger sample, using more precise anatomical analyses to characterize the size and placement of lesions; (2) examine whether there are gender differences in terms of the ease to quit smoking after a lesion; and (3) conduct prospective studies on smokers who suffer strokes and monitor their smoking behavior for several years after the lesion onset. The proposed research is a beginning of a novel approach with potential for developing more effective therapies for breaking the vicious cycle of addiction. Specifically, one therapeutic approach called up by the proposed research would be to directly modulate the function of the insula. Project Narrative A prune-sized region deep in the brain called the insula is intimately involved in smoking addiction, and damage to this structure can completely erase the body's urge to smoke. Obviously brain damage is not a treatment option for nicotine addiction, but if confirmed, these results may offer leads for therapies to help smokers kick the habit, or for monitoring smokers' progress while using existing therapies.