Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420644 Rochester, NY 14642, USA.
Departments of Medicine, Psychiatry, and Clinical and Social Sciences in Psychology, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, USA.
Drug Alcohol Depend. 2019 Aug 1;201:178-181. doi: 10.1016/j.drugalcdep.2019.04.017. Epub 2019 Jun 7.
Damage to the insula disrupts nicotine-induced cravings and is associated with greater odds of cessation. The role of laterality in regulating these changes is unclear. Neuroimaging studies in cigarette smokers show left hemispheric activation during a period of forced withdrawal and right hemispheric activation after having just smoked. Among current smokers hospitalized for stroke involving their insula, we compared left versus right insular damage and its effect on smoking outcomes.
A total of 37 smokers hospitalized with unilateral insular strokes (14 right, 23 left) were administered questionnaires to assess urge (Questionnaire on Smoking Urges) before (retrospectively) and during hospitalization and 3 months post-stroke, withdrawal during hospitalization (Wisconsin Smoking Withdrawal Scale), and prolonged abstinence at 3 months post-stroke. Crude and adjusted linear regression models were performed controlling for baseline covariates.
Right and left insular-damaged smokers experienced a significant decrease in urge from baseline to hospitalization and three-month follow-up (p < 0.01). Smokers with left-sided insular infarcts relative to right-sided experienced a larger decrease in acute urge (adjusted β=-1.16, 95% CI: -2.59, 0.27, p = 0.11) but not chronically (adjusted β=-0.06, 95% CI: -1.53, 1.40, p = 0.93). Left-sided insular damage was also associated with significantly fewer and less severe withdrawal symptoms during hospitalization (adjusted β=-3.52, 95% CI: -7.01, -0.04, p = 0.05). No differences were noted between groups for prolonged abstinence (p = 0.50).
Left insular adaptations are suggestive to have an impact on acute changes in urge and withdrawal more so than the right insula, however lateral asymmetries did not exist for long-term changes.
脑岛损伤会破坏尼古丁引起的渴望，并且与戒烟的可能性更大相关。调节这些变化的侧别作用尚不清楚。对吸烟人群的神经影像学研究显示，在强制戒断期间左半球激活，而在刚刚吸烟后右半球激活。在因脑岛中风住院的当前吸烟者中，我们比较了左脑岛和右脑岛损伤及其对吸烟结果的影响。
共纳入 37 名因单侧脑岛中风住院的吸烟者（14 名右脑，23 名左脑），在住院期间和住院前（回顾性）以及中风后 3 个月，通过吸烟渴求问卷（吸烟渴求问卷）评估渴求，住院期间的戒烟（威斯康星戒烟量表）和中风后 3 个月的长期戒烟。对空腹和调整后的线性回归模型进行了控制基线协变量的分析。
右脑和左脑岛损伤的吸烟者从基线到住院和 3 个月随访期间的渴求显著降低（p < 0.01）。与右脑损伤相比，左脑损伤的吸烟者在急性渴求时的下降幅度更大（调整后的β=-1.16，95%CI：-2.59，0.27，p = 0.11），但在慢性渴求时没有（调整后的β=-0.06，95%CI：-1.53，1.40，p = 0.93）。左脑岛损伤也与住院期间更少和更轻的戒断症状相关（调整后的β=-3.52，95%CI：-7.01，-0.04，p = 0.05）。两组在长期戒烟方面无差异（p = 0.50）。
左脑岛的适应可能对急性渴望和戒断的变化有影响，比右脑岛更明显，但在长期变化方面不存在侧别不对称。
