Brain Lesions Disrupting Addiction Map to a Common Human Brain Circuit20 June, 2022
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Substance use disorders (SUDs) affect 8–10% of the adult population, are a leading cause of death in the young and are considered a public health crisis in the USA and other countries. Existing treatments are inadequate and long-term success rates are poor.
This clinical need has driven the search for new therapies, including modulation of brain regions implicated in addiction. Trials of deep brain stimulation (DBS), transcranial magnetic stimulation (TMS) and surgical lesioning have targeted several different brain regions, with no consensus on the optimal target. Given this ambiguity, a TMS device recently cleared by the U.S. Food and Drug Administration (FDA) for smoking cessation was designed to target multiple brain regions. To better guide neuromodulation therapies, we need to know which brain regions are causally involved in addiction remission in human patients.
A unique source of information that can help answer this question is cases where brain damage such as a stroke results in remission of addiction in a patient. These cases are valuable because they provide a causal link between therapeutic benefit and human neuroanatomy. For example, lesions involving the insula are more likely to disrupt nicotine addiction than lesions that spare the insula. However, lesions disrupting addiction have been reported outside the insula in many different brain locations, leaving localization unclear.
Recently, it has been possible to link lesions in different brain locations to a common neuroanatomical substrate using the human connectome, a map of human brain connectivity. When lesions result in therapeutic benefit, this approach can identify effective therapeutic targets. For example, lesion locations that improve essential tremor are all connected to the exact spot in the thalamus that is an effective target for DBS. In this study, we apply this method to lesions resulting in addiction remission.
Source: Nature Medicine
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