title: Dynamic risk control by human nucleus accumbens.
abstract: Real-world decisions about reward often involve a complex counterbalance of risk and value. Although the nucleus accumbens has been implicated in the underlying neural substrate, its criticality to human behaviour remains an open question, best addressed with interventional methodology that probes the behavioural consequences of focal neural modulation. Combining a psychometric index of risky decision-making with transient electrical modulation of the nucleus accumbens, here we reveal profound, highly dynamic alteration of the relation between probability of reward and choice during therapeutic deep brain stimulation in four patients with treatment-resistant psychiatric disease. Short-lived phasic electrical stimulation of the region of the nucleus accumbens dynamically altered risk behaviour, transiently shifting the psychometric function towards more risky decisions only for the duration of stimulation. A critical, on-line role of human nucleus accumbens in dynamic risk control is thereby established.
authors.affiliation: 1 Institute of Neurology, UCL, London, UK p.nachev@ucl.ac.uk bryan.strange@upm.es.
authors.forename: Parashkev
authors.initials: P
authors.lastname: Nachev
authors.affiliation: 2 Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Technical University of Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lopez-Sosa
authors.affiliation: 2 Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Technical University of Madrid, Spain.
authors.forename: Javier Jesus
authors.initials: JJ
authors.lastname: Gonzalez-Rosa
authors.affiliation: 2 Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Technical University of Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Galarza
authors.affiliation: 3 Department of Neurosurgery, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Josue
authors.initials: J
authors.lastname: Avecillas
authors.affiliation: 4 CINAC, HM Puerta del Sur, Hospitales de Madrid, Móstoles, and CEU-San Pablo University, Madrid, Spain.
authors.forename: Jose Angel
authors.initials: JA
authors.lastname: Pineda-Pardo
authors.affiliation: 5 Department of Psychiatry, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Lopez-Ibor
authors.affiliation: 5 Department of Psychiatry, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Reneses
authors.affiliation: 3 Department of Neurosurgery, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Barcia
authors.affiliation: 2 Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Technical University of Madrid, Spain p.nachev@ucl.ac.uk bryan.strange@upm.es.
authors.forename: Bryan
authors.initials: B
authors.lastname: Strange
mesh_terms: D003657:Decision Making / Q000502:physiology*; D046690:Deep Brain Stimulation; D006801:Humans; D009714:Nucleus Accumbens / Q000502:physiology*; D012201:Reward; D012309:Risk-Taking
keywords: decision-making; nucleus accumbens; reward; risk; subcortical electrical stimulation