Action Potential

Nicorette be damned! Quitting smoking is easy...if you've had a stroke. Naqvi et al. report that stroke-induced damage to the insula associates with smoking cessation in today's issue of Science.

The insula lies in the pocket separating the temporal lobe from the parietal lobe and is thought to provide emotional context for sensory information. Sixteen of nineteen smokers who suffered strokes that affected the insula quit smoking immediately. Smokers who sustained damage to the insula were more likely to quit than smokers who had sustained damage to other brain regions. Although several of the patients with insular damage also sustained damage to the putamen, which is part of the striatum thought to be involved in learning drug use behaviors, no other brain region associated with smoking cessation in the stroke patients.

Do smokers with insular damage lose pleasure in smoking? After smoking cessation, none of the patients with insular damage reported losing pleasure in eating or drinking, suggesting that they had not lost motivation or the ability to experience pleasure. Do these patients lose other habits? Unfortunately, the authors did not address this possibility.

These findings suggest that the insula is important in experiencing the need to smoke and is therefore a target for smoking cessation therapy. Considering the insula's proximity to language centers, surgical lesion of the insula is certainly not advisable. However, targeted pharmacological therapy might some day help smokers quit. According to the authors, the efficacy of smoking cessation programs might be determined by imaging insular activation.