School of Medicine (Neuroscience), Ninewells Hospital and Medical School, University of Dundee, UK.
Advanced Interventions Service, Area 7, Level 6, South Block, Ninewells Hospital and Medical School, UK.
Brain. 2016 Jun;139(Pt 6):1844-54. doi: 10.1093/brain/aww069. Epub 2016 Apr 28.
Converging evidence has linked the anterior mid-cingulate cortex to negative affect, pain and cognitive control. It has previously been proposed that this region uses information about punishment to control aversively motivated actions. Studies on the effects of lesions allow causal inferences about brain function; however, naturally occurring lesions in the anterior mid-cingulate cortex are rare. In two studies we therefore recruited 94 volunteers, comprising 15 patients with treatment-resistant depression who had received bilateral anterior cingulotomy, which consists of lesions made within the anterior mid-cingulate cortex, 20 patients with treatment-resistant depression who had not received surgery and 59 healthy control subjects. Using the Ekman 60 faces paradigm and two Stroop paradigms, we tested the hypothesis that patients who received anterior cingulotomy were impaired in recognizing negative facial affect expressions but not positive or neutral facial expressions, and impaired in Stroop cognitive control, with larger lesions being associated with more impairment. Consistent with this hypothesis, we found that larger volume lesions predicted more impairment in recognizing fear, disgust and anger, and no impairment in recognizing facial expressions of surprise or happiness. However, we found no impairment in recognizing expressions of sadness. Also consistent with the hypothesis, we found that larger volume lesions predicted impaired Stroop cognitive control. Notably, this relationship was only present when anterior mid-cingulate cortex lesion volume was defined as the overlap between cingulotomy lesion volume and Shackman's meta-analysis-derived binary masks for negative affect and cognitive control. Given substantial evidence from healthy subjects that the anterior mid-cingulate cortex is part of a network associated with the experience of negative affect and pain, engaging cognitive control processes for optimizing behaviour in the presence of such stimuli, our findings support the assertion that this region has a causal role in these processes. While the clinical justification for cingulotomy is empirical and not theoretical, it is plausible that lesions within a brain region associated with the subjective experience of negative affect and pain may be therapeutic for patients with otherwise intractable mood, anxiety and pain syndromes.
越来越多的证据表明，前扣带回皮质与负面情绪、疼痛和认知控制有关。此前有人提出，该区域利用有关惩罚的信息来控制厌恶驱动的行为。关于病变的研究允许对大脑功能进行因果推断；然而，前扣带回皮质的自然发生病变很少见。因此，在两项研究中，我们招募了 94 名志愿者，其中包括 15 名接受双侧扣带回前切断术的难治性抑郁症患者，该手术包括在前扣带回皮质内进行的病变，20 名未接受手术的难治性抑郁症患者和 59 名健康对照者。我们使用埃克曼 60 张面孔范式和两个斯特鲁普范式，测试了以下假设：接受扣带回前切断术的患者在识别负面面部表情方面存在障碍，但在识别正面或中性面部表情方面没有障碍，在斯特鲁普认知控制方面存在障碍，病变越大，障碍越大。与这一假设一致，我们发现，更大的体积病变预测对恐惧、厌恶和愤怒的识别能力下降，对惊讶或幸福的面部表情识别能力没有下降。然而，我们没有发现对悲伤表情的识别障碍。这一假设也与我们的发现一致，即更大的体积病变预测斯特鲁普认知控制障碍。值得注意的是，只有在前扣带皮质病变体积被定义为扣带前切断术病变体积与 Shackman 的负面情绪和认知控制元分析衍生的二进制掩模之间的重叠时，才会出现这种关系。鉴于来自健康受试者的大量证据表明，前扣带皮质是与负面情绪和疼痛体验相关的网络的一部分，参与认知控制过程以优化在存在这些刺激时的行为，我们的研究结果支持了这样一种观点，即该区域在这些过程中具有因果作用。虽然扣带前切断术的临床依据是经验性的，而不是理论性的，但对于那些患有其他无法治愈的情绪、焦虑和疼痛综合征的患者来说，位于与负面情绪和疼痛的主观体验相关的大脑区域内的病变可能是一种治疗方法。
