Haque Saarah, Bellmunt-Gil Albert, Davidson Benjamin, Lüscher Christian, Fox Michael D, Joutsa Juho, Burke Matthew J
Neuropsychiatry program, Department of Psychiatry and Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Turku, Finland.
Commun Med (Lond). 2025 Mar 12;5(1):69. doi: 10.1038/s43856-025-00760-7.
The orbitofrontal cortex (OFC) and its role in the regulation of urges/compulsion has been identified as a critical component of circuit-based addiction models. Building on such models, it was recently shown that brain lesions disrupting addictive behavior can be mapped to a common brain circuit.
We present a case of a 42-year-old woman with chronic treatment-refractory alcohol use disorder who experienced early remission following a traumatic brain injury (TBI) with focal left OFC intracerebral hemorrhage. Using a network mapping approach (normative connectome, n = 1000), functional connectivity was computed from the traced OFC lesion across all brain voxels.
The case lesion map topography converges on a brain lesion map previously described as disrupting addictive behavior, but with an inverse connectivity profile (spatial correlation r = -0.59). This spatial correlation is more negative than what would be expected by chance (permutation test 1-sided, p = 0.04) or by random lesion cases (1-sided, p < 0.001).
Based on these results, we suggest that potentially just disrupting this brain network, regardless of the directionality, could facilitate remission. However, this case report cannot control for multiple psychosocial factors potentially impacting alcohol remission and caution is also needed for considering TBI as a mechanism for generating an isolated focal lesion. Overall, this case contributes to our understanding of circuit-based models of addictive behavior and could be useful in generating hypotheses for neuromodulatory treatment strategies.
眶额皮质（OFC）及其在冲动/强迫调节中的作用已被确定为基于回路的成瘾模型的关键组成部分。基于此类模型，最近有研究表明，破坏成瘾行为的脑损伤可映射到一个共同的脑回路。
我们报告了一例42岁患有慢性难治性酒精使用障碍的女性病例，该患者在发生左侧OFC局灶性脑出血的创伤性脑损伤（TBI）后实现了早期缓解。使用网络映射方法（标准连接组，n = 1000），从追踪到的OFC病变处计算所有脑体素的功能连接性。
该病例的病变图谱地形与先前描述的破坏成瘾行为的脑损伤图谱一致，但连接性特征相反（空间相关性r = -0.59）。这种空间相关性比偶然预期的（置换检验单侧，p = 0.04）或随机病变病例（单侧，p < 0.001）更负。
基于这些结果，我们认为，无论方向性如何，潜在地仅破坏这个脑网络可能会促进缓解。然而，本病例报告无法控制可能影响酒精缓解的多种心理社会因素，并且在将TBI视为产生孤立局灶性病变的机制时也需要谨慎。总体而言，本病例有助于我们理解基于回路的成瘾行为模型，并可能有助于生成神经调节治疗策略的假设。
