A Lesion Network Mapping Study of the Cerebellar Lesion-related Impulsivity and Compulsivity
Yicheng Lin1, Yi-Hsuan Liu3, Chi-Ying R. Lin4, Luciana Salama6, Vero Navarrine6, Santiago Volmaro8, Li-Hung Chang1, Ching-Po Lin2, Hernan Chaves9, Maria Eugenia Sarandria10, Zoe Ziperovich8, Adrián Mateo Kim8, Florencia Yorio11, Ramiro Salas5, Alejandro Muggeri11, Virginia Pujol Lereis12, Blanca Diez11, Sebastián F. Ameriso12, Ming-Kai Pan13, Andrés Pablo Varani7, Sheng-Han Kuo14, Malco Rossi10
1Institute of Neuroscience, National Yang Ming Chiao Tung University, 2National Yang Ming Chiao Tung University, 3Neurology, Columbia University, 4Department of Neurology, Baylor College of Medicine, 5Baylor College of Medicine, 6Facultad de Medicina, 7Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO Houssay), Facultad de Medicina, Departamento de Ciencias Fisiológicas. Grupo de Neurociencias de Sistemas, Universidad de Buenos Aires, 8Universidad de Buenos Aires, 9Departamento de Diagnóstico por Imágenes, Fleni, Buenos Aires, 10FLENI, 11Departamento de Neurooncología, Fleni, Buenos Aires, 12Centro Integral de Neurología Vascular, Departamento de Neurología, Fleni, Buenos Aires, 13Cerebellar Research Center, National Taiwan University Hospital, 14Department of Neurology, Columbia University Irving Medical Center and the New York Presbyterian Hospital
Objective:
Emerging evidence positions that cerebellar lesions cause impulsivity and compulsivity. However, whether these lesions alone trigger these behaviors or their connections with other brain areas are responsible remains unclear. Our study dives into these compelling questions to uncover the cerebellum and it's cerebello-cerebral connectivity related impulsive and compulsive symptoms.
Background:
The cerebellum functions as a critical hub within brain networks governing motor, cognitive-affective, and reward processes. The evolutionarily expanded posterior cerebellum supports cognitive operations. Recent evidence reveals that impulsivity and compulsivity are clinical features in cerebellar ataxia patients. These findings establish the cerebellum's previously underrecognized role in regulating impulsive and compulsive behaviors.
Design/Methods:
We conducted a cross-sectional, observational lesion-symptom network mapping (LNM) study involving 36 patients with focal cerebellar lesions. Participants underwent comprehensive evaluations using validated instruments, including the Scale for the Assessment and Rating of Ataxia (SARA), the Cerebellar Cognitive Affective Syndrome Scale (CCAS), and the Cerebellar Impulsivity-Compulsivity Assessment (CIA). LNM utilized human connectome data (n=1,000) to delineate cerebello-cerebral connectivity profiles, which compared between patients exhibiting high versus low levels CIA to elucidate the neural underpinnings of these behavioral traits.
Results:
We showed that lesions associated with higher CIA scores were predominantly localized to the right cerebellar hemisphere, with significant involvement of lobule VI, Crus I-II. LNM results demonstrated that patients with elevated CIA scores displayed enhanced connectivity between the right cerebellar hemisphere and left frontal cortical regions, including the inferior/medial frontal gyrus, caudate nucleus, and angular gyrus. Conversely, these patients exhibited reduced connectivity between the right and left cerebellar hemispheres, specifically involving lobules III–V, Crus I–II, and lobules VII–IX.
Conclusions:
The observed cerebello-cerebral connectivity patterns delineate critical neural circuits implicated in the manifestation of impulsive and compulsive behaviors following focal cerebellar injury. Our findings suggest that targeting fronto-cerebellar connectivity through neuromodulation strategies could represent a therapeutic approach for mitigating impulsivity and compulsivity.
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