title: Basal ganglia plus insula damage yields stronger disruption of smoking addiction than basal ganglia damage alone.
abstract: BACKGROUND
  The main objective of this study was to elucidate the importance of the basal ganglia (BG) and insula (INS) for nicotine addiction and smoking behavior.
  
  
  METHODS
  We used a lesion study examining the effects of BG and INS damage on changes in smoking behavior and nicotine dependence over time in a prospective manner. We studied whether combined BG and INS damage yields more substantial disruption of smoking and nicotine dependence than damage to the BG alone and compared with damage to other brain regions outside the BG and INS (brain-damaged comparison [BDC] group). We obtained neuroanatomical and behavioral data for 63 neurological patients with stroke at 1 month after onset and at 3-, 6-, and 12-month follow-ups. All patients were smokers at lesion onset.
  
  
  RESULTS
  The BG and BG + INS groups had significantly higher and more sustained rates of smoking cessation than patients with damage elsewhere. By 12 months after onset, only 14.3% of the patients in the BDC group were classified as nonsmokers. In the BG group, 37% were not smoking by the 12-month follow-up, and in the BG + INS group, smoking cessation was even more pronounced, as 75% of this group was not smoking at the 12-month epoch.
  
  
  CONCLUSIONS
  The findings show that damage to the BG alone can cause disruption of smoking addiction, and when BG damage is combined with INS damage, the disruption increases. The latter finding is consistent with the proposal that the INS has a key role in smoking addiction.
authors.affiliation: Department of Neurology, Division of Behavioral Neurology and Cognitive Neuroscience, Iowa City, IA;
authors.forename: Natassia
authors.initials: N
authors.lastname: Gaznick
authors.forename: Daniel
authors.initials: D
authors.lastname: Tranel
authors.forename: Ashton
authors.initials: A
authors.lastname: McNutt
authors.forename: Antoine
authors.initials: A
authors.lastname: Bechara
mesh_terms: D000328:Adult; D000368:Aged; D001479:Basal Ganglia / Q000473:pathology*; D002540:Cerebral Cortex / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D011446:Prospective Studies; D012907:Smoking; D016540:Smoking Cessation; D020521:Stroke / Q000473:pathology; D014029:Tobacco Use Disorder / Q000473:pathology*