They were smokers. Then the stroke overcame their addiction.

A scan of the affected brain often creates a map of irreparable losses and reveals spots that cause impaired memory or tremors.

In rare cases, however, this scan may reveal the opposite: the plots of areas of the brain where the injury miraculously relieves someone’s symptoms show how doctors can do it.

Researchers have revised a series of brain images of nicotine-dependent smokers to help them recover from a stroke or other traumatic brain injury. The researchers said the results showed a network of interconnected areas of the brain that they believed could be linked to addiction-related illnesses that could affect tens of millions of Americans.

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A dateless illustration provided by Joutsa, Fox et al., Nature Medicine 2022 shows the brain damage associated with addiction remission in red. (Via Joutsa, Fox et al., Nature Medicine 2022, The New York Times)

The study, published in the scientific journal Nature Medicine on Monday, supports a more recent idea: addiction lives in areas connected to filamentous nerve fibers, not in one area of ​​the brain.

The results could provide a clear set of goals for treating addiction that delivers electrical impulses to the brain, and new approaches that promise to help people quit smoking.

“One of the biggest problems with addiction is that we don’t know where the main problem is in the brain. We need to be targeted in treating it,” he said. One of the main authors of the study is Juho Jutsa, a neurologist at Turku University in Finland. “From now on, we hope we have a very good understanding of these areas and industries.”

Research over the past two decades has confirmed that addiction is a brain disease. But many people still believe that addiction is voluntary.

Some independent experts say the latest study is particularly strong evidence of the role of the brain in substance use disorders. Smokers who have had a stroke or other brain injury, and those who have damaged certain neural networks, have lost their appetite immediately.

The researchers repeated their findings in a separate group of patients with brain injuries who completed a risk assessment of alcoholism. The brain network, which is associated with a lower risk of alcohol dependence, has been shown to reduce nicotine dependence, suggesting that the scheme may be the basis for a broader set of addictions.

“I think it can be one of the most influential publications of the decade, not just this year,” he said. Thomas McLellan, an honorary professor of psychiatry at the University of Pennsylvania and a former deputy director of the National Office of Medicine. Control Policy not involved in the study. “This will break many stereotypes that are still prevalent in the field of addiction: this addiction is a bad upbringing; addiction – a weak personality; Addiction is immoral. ”

In recent years, a sequence of studies has identified specific areas of the brain where injuries or trauma are associated with addiction. But goals have changed.

“People have not succeeded in showing consistency in the areas involved,” the doctor said. Hamed Ekhtiari is an addiction treatment expert at the Institute of Brain Research in Talsa, Oklahoma.

Recently, Joutsa used sophisticated statistical techniques on old scans that examined nerve injuries in smokers in Iowa. An earlier analysis by the same scanners suggested that patients who had suffered a stroke would quit smoking.

However, Jusa looked at the same scans on a pixel-by-pixel basis and noticed that many patients without insulin injuries were reluctant to smoke. “There was something in the Insula story, but it’s not a whole story,” he said.

Working with Dr. Michael Fox, an associate professor of neurology at Harvard Medical School, examined a second set of scanners for smokers who had suffered a stroke in Jusa Rochester, New York. In all, they reviewed 129 cases.

The team struggled to find certain areas of the brain that reliably helped injured patients quit smoking. Instead, the researchers looked at standard communication diagrams of the brain that showed how activity in one region was related to activity in another region.

Suddenly, researchers were able to find nodes and other areas of the brain that were immediately relieved by the nicotine cravings of the injured.

“Our therapies in different areas of our therapeutic goals are not regions of the brain, but brain circuits that are connected, as we thought before,” Fox said. “If you take into account the connection to the brain, you can improve the treatment.”

The study did not take into account how patients’ home life, such as smoking, affected their habits. Patients who were believed to be in remission after the injury reported that they quit smoking immediately, did not want to smoke, and did not resume smoking.

Researchers, however, have questioned whether other changes, such as intelligence or mood swings, can help explain the loss of nicotine cravings in some patients. They didn’t make any changes in the end.

External experts said that the parts of the brain identified in the study were familiar to them from previous studies. Dr. Martijn Figie, a psychiatrist at the Advanced Circuit Therapeutics Center in Mount Sinai, Manhattan, studies how electrical impulses to the brain treat obsessive compulsive disorder, depression, and addiction. According to him, addiction is generally associated with poor functioning of the brain’s cognitive control scheme and overactivity of reward-related schemes.

By using invasive techniques, such as electrical stimulation of the patient’s head or deep brain stimulation, doctors can mimic the effects of trauma, slowing down activity in some areas and stimulating activity in others. The study identified an area called the middle frontal-polar cortex that appeared to be a good candidate for excitatory stimulation; it coincided with the goal of treatment recently approved by U.S. regulators to help the region quit smoking.

This treatment uses electromagnetic coils placed on the patient’s scalp to transmit electrical impulses to the surface of the brain. Other methods include implantation of electrodes in certain areas of the brain or permanent removal of certain areas of the brain.

“This paper is really interesting because it clearly outlines the goals available for treatment,” Figi said.

Although brain stimuli are widely used to treat depression and obsessive compulsive disorder, the use of this therapy to treat addiction has been slower. Researchers say that it will take years for technology to improve.

Although studies have shown that electrical or magnetic stimulation can reduce the craving for addictive substances, it is unclear how long these effects will last. Some of the most promising goals are deep in the brain; To achieve them, deep brain stimulation or a specific type of spiral that has only recently become available may be required, Figs said.

Researchers say that knowing where the brain’s stimuli are directed does not solve the question of how often to use them. And because the connections are different in different people’s brains, there is a need to adapt treatment options.

Researchers have partially reflected the ban on thinking addiction as a brain disorder, in which addicts are slower to respond to brain stimulation than in people with depression or movement disorders.

There may also be structural difficulties. Judy Luigges, an assistant professor of psychiatry at the University of Amsterdam Medical Centers, has been recruited from thousands of patients to addiction treatment centers in the Netherlands to study deep brain stimulation. Within three years, only two patients were prosecuted.

Luigjes and colleagues may have partially avoided the procedure in patients with substance use disorders because their motivation to deal with the disease varied more than in patients with obsessive compulsive disorder.

And the instability often associated with substance abuse makes it difficult to invest in time-consuming treatment. Only one-third of the patients who came to see the Luigges study group brought a family member or friend.

Some scientists are working to address these concerns. For example, the Mount Sinai addiction group reduced barriers to treatment by providing patients with less invasive brain stimulation at home or in community centers rather than in a hospital.

But the brain may be an entry point to treat addiction, but Luigges said it’s probably not the most important. Other scientists argue that in recent years, the focus on the brain addiction model has diverted attention and money from research and environmental factors that contribute to addiction.

“We put a lot of hope, money and energy to one side,” he said, noting that the field focuses on brain stimulation. “I don’t know if it will pay off as we thought.”

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