Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Turku, Finland.
Neurocenter and Turku PET Center, Turku University Hospital, Turku, Finland.
Nat Med. 2022 Jun;28(6):1249-1255. doi: 10.1038/s41591-022-01834-y. Epub 2022 Jun 13.
Drug addiction is a public health crisis for which new treatments are urgently needed. In rare cases, regional brain damage can lead to addiction remission. These cases may be used to identify therapeutic targets for neuromodulation. We analyzed two cohorts of patients addicted to smoking at the time of focal brain damage (cohort 1 n = 67; cohort 2 n = 62). Lesion locations were mapped to a brain atlas and the brain network functionally connected to each lesion location was computed using human connectome data (n = 1,000). Associations with addiction remission were identified. Generalizability was assessed using an independent cohort of patients with focal brain damage and alcohol addiction risk scores (n = 186). Specificity was assessed through comparison to 37 other neuropsychological variables. Lesions disrupting smoking addiction occurred in many different brain locations but were characterized by a specific pattern of brain connectivity. This pattern involved positive connectivity to the dorsal cingulate, lateral prefrontal cortex, and insula and negative connectivity to the medial prefrontal and temporal cortex. This circuit was reproducible across independent lesion cohorts, associated with reduced alcohol addiction risk, and specific to addiction metrics. Hubs that best matched the connectivity profile for addiction remission were the paracingulate gyrus, left frontal operculum, and medial fronto-polar cortex. We conclude that brain lesions disrupting addiction map to a specific human brain circuit and that hubs in this circuit provide testable targets for therapeutic neuromodulation.
药物成瘾是一个公共健康危机,急需新的治疗方法。在极少数情况下,区域性脑损伤可能导致成瘾缓解。这些病例可用于确定神经调节的治疗靶点。我们分析了两组在局灶性脑损伤时吸烟成瘾的患者(队列 1 n = 67;队列 2 n = 62)。将病变位置映射到大脑图谱上,并使用人类连接组数据(n = 1,000)计算与每个病变位置功能连接的大脑网络。确定与成瘾缓解的关联。使用具有局灶性脑损伤和酒精成瘾风险评分的独立患者队列(n = 186)评估可推广性。通过与 37 个其他神经心理学变量进行比较来评估特异性。破坏吸烟成瘾的病变发生在许多不同的脑区,但具有特定的脑连接模式。这种模式涉及与背侧扣带、外侧前额叶皮质和脑岛的正连接,以及与内侧前额叶和颞叶皮质的负连接。该回路在独立的病变队列中具有可重复性,与降低的酒精成瘾风险相关,并且与成瘾指标特异性相关。与成瘾缓解的连接特征最佳匹配的中枢是旁扣带回、左侧额盖和内侧额极皮质。我们得出结论,破坏成瘾的脑损伤映射到特定的人类大脑回路,并且该回路中的中枢为治疗性神经调节提供了可测试的靶点。