Quitting smoking with ease after a stroke

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A new research published in the Journal of Addictive Behaviors suggested an association between brain stroke and smoke cessation. The researchers found that smokers who suffered a brain stroke in a specific region (the insular cortex), show an increased likelihood of quit smoking. The insular cortex could thus be responsible for addictive behaviors, as subjects who suffered damage in this area experienced fewer withdrawal symptoms after smoking cessation, compared to smokers who had strokes in other brain regions.

The lead author Amir Abdolahi explained that “these findings indicate that the insular cortex may play a central role in addiction. When this part of the brain is damaged during a stroke, smokers are about twice as likely to stop smoking, and their craving and withdrawal symptoms are far less severe (1).” Other studies already pointed out that the insular cortex could possess a role in drug use by affecting the cognitive process. However, it is unclear if changes in this region can influence addiction.

According to the Centers for Disease Control and Prevention (CDC) quitting smoking can add years to a patient’s life. Smoking causes more than 480,000 deaths each year in the United States (up to 20% of total deaths), and is the cause of about 90% of all lung cancer deaths. Quitting smoke can be quite painful due to the addictive nature of nicotine. However, cardiovascular risks caused by smoking will be cut drastically just one year after quitting, and cancer risk is halved within five years (2).

Several medications used to treat smoke addiction, do not reduce withdrawal symptoms by any mean. They actually work by blocking the reward mechanisms in the brain, eliminating the “pleasant” sensation associated with smoking. Obviously, the estimated success rate is quite low: just 30% after six months. Other prescriptions such as nicotine patches and chewing gums instead provide the body with some nicotine, yet success rates are similarly low.

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The new study showed that up to 70% of the 38 patients who suffered from insular cortex stroke quit smoking after just three months, showing more than double the success chance of smoke cessation medications. All 156 patients enrolled were heavy smokers, and the researchers used magnetic resonance imaging (MRI) and computed tomography (CT) to assess whether they suffered a stroke in the insular cortex or anywhere else. Nicotine withdrawal symptoms can be quite severe, and patients were observed to monitor their craving after smoke cessation. Patients who suffered from insular cortex stroke showed fewer and less severe symptoms and were then followed up for 3 months after the stroke happened.

The main limit of the study was the small number of patients enlisted. However the lead researcher explained that “Much more research is needed in order for us to more fully understand the underlying mechanism and specific role of the insular cortex, but is clear that something is going on in this part of the brain that is influencing addiction.”

Article by Dr. Claudio Butticè, PharmD.

 

REFERENCES

1. Amir Abdolahia, Geoffrey C. Williams, Curtis G. Benesch, et al. “Smoking cessation behaviors three months following acute insular damage from stroke.” Addictive Behaviors Volume 51, December 2015, Pages 24–30

2. Centers for Disease Control and Prevention “Smoking & Tobacco Use” (Accessed September 2015)