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We used lesion network mapping to test (i) whether lesions temporally associated with criminal behavior are part of a common brain network, and (ii) Ismo (Isosorbide Mononitrate)- Multum this network overlaps regions activated by neuropsychological processes hypothesized to be abnormal in criminals (19, 26, 27).

Finally, we tested whether our results can be replicated in a second cohort in which the temporal relationship between lesion onset and criminal behavior is uncertain. Seventeen patients with a documented temporal relationship between a brain lesion and criminal behavior were identified through a systematic literature search (SI Appendix, Fig. S1 Ismo (Isosorbide Mononitrate)- Multum Table S1).

Cases included documentation of no criminal behavior before the lesion (15 cases) or resolution of criminal behavior following treatment of the lesion (two cases). Lesions temporally associated with criminal behavior. Lesions from 17 patients with acquired criminal behavior, manually traced onto a common brain atlas (MNI). Regions with activity positively or negatively correlated with activity at each lesion site were identified (Fig. Finally, lesion network maps from each patient were overlapped to determine brain regions significantly connected to all or most lesions causing criminal behavior (Fig.

Lesion network mapping technique. Statistical analysis showed that this pattern of connectivity was specific to lesions temporally associated with criminal behavior compared with lesions causing four other neurologic syndromes (21) (Fig. These results suggest that lesions in different Ismo (Isosorbide Mononitrate)- Multum temporally associated with criminal behavior are characterized by a unique pattern of brain connectivity.

Lesions temporally associated with criminality are part of a unique connected brain network. Criminality is presumed to arise in part from abnormalities in moral decision making (17, 19). We identified moral decision-making regions in two ways: (i) activation likelihood estimation (ALE) of regions activated by moral vs.

Results were independent of the meta-analysis method used to identify moral decision-making regions. However, moral Ismo (Isosorbide Mononitrate)- Multum making incorporates several different neuropsychological processes including cognitive control (33), value or reward-based diastrophic variant making (34), theory of mind (35), and empathy (27).

The potential contributions of each process to criminal behavior are contested (36). Lesions were significantly more connected to value-based decision making and theory of mind regions than empathy or cognitive control regions (all comparisons P P Fig. We next explored whether known behavioral abnormalities in individuals with criminal behavior are consistent with lesion connectivity to opponent networks. One network is associated with a strong aversion to directly harming others, while the second network is involved in overcoming this aversion to make more utilitarian decisions (e.

We hypothesized that lesions temporally associated with criminal behavior would show differential connectivity to these competing brain regions. Indeed, activity from our lesion locations was positively correlated with brain regions activated when deciding to avoid personal harm (P Fig. In both cases, results were specific to lesion locations temporally associated with Ismo (Isosorbide Mononitrate)- Multum behavior vs.

Results are specific to lesions temporally associated with criminal behavior (gray) compared with lesions causing other neurologic syndromes back of back pain. As above, competing brain regions are associated with the decision to reject an unfair offer made by another player vs.

Lesion locations temporally associated with criminal behavior were negatively correlated with the brain region most activated when rejecting unfair offers (P P P Ismo (Isosorbide Mononitrate)- Multum Appendix, Fig.

In many cases, the temporal association between a brain lesion and criminal behavior is uncertain. We identified 23 cases of uncertain temporal association from our initial search (SI Appendix, Fig. These cases Ismo (Isosorbide Mononitrate)- Multum brain lesions found incidentally in incarcerated criminals (20 cases), brain lesions present since birth (two cases), or lesions being treated when the criminal behavior occurred (one case).

As in our initial cohort, these lesions were spatially heterogeneous (SI Appendix, Fig. Lesion network mapping showed nearly identical results to those for our Ismo (Isosorbide Mononitrate)- Multum cohort (Fig.

Connectivity to these regions was specific compared with lesions causing other syndromes (Fig. This second cohort showed the same pattern of connectivity to regions involved in morality (P Fig.

Lesions in both cohorts were significantly connected to regions involved in morality compared with control lesions (Right). Ismo (Isosorbide Mononitrate)- Multum, lesions temporally associated with criminal behavior occur in different brain regions but lie within a single connected brain network that is distinct from lesions not associated with criminal behavior. Third, lesions gsk sanofi associated with criminal behavior show opposite connectivity to brain regions activated by competing moral choices, predicting the biases seen in these patients.

Finally, all results are reproducible in a second cohort of patients with uncertain temporal associations between lesions and criminal behavior. The heterogeneity of brain lesions associated with criminal behavior has been noted in previous reviews (5, 15, 19), raising the question of what features these lesions share that could result in a similar behavioral phenotype. Ismo (Isosorbide Mononitrate)- Multum results show that these heterogeneous lesion locations are part of a single connected brain network that includes the orbitofrontal cortex, vmPFC, and anterior temporal lobes.

Moreover, this network is specific to lesions associated with criminal behavior compared with lesions causing other syndromes. Lesions temporally associated with criminal behavior showed not only a similar pattern of brain connectivity, but also connectivity specifically to regions implicated in moral decision making. Ismo (Isosorbide Mononitrate)- Multum results link lesions resulting in criminal behavior to regions whose activity is correlated with moral decision making, value-based decision making, and theory of mind in normal subjects.

Exactly which psychological processes are abnormal or disrupted in criminals remains a matter of ongoing research and debate (36). It is also unknown whether deficits in moral decision making contribute to lesion-associated criminal behavior.

Nonetheless, our present results provide testable hypotheses for future worknamely, that patients whose lesions are connected to brain regions involved in specific aspects of moral decision making will demonstrate behavioral deficits in those tasks. Previous work has demonstrated that the relative balance in activation between two different networks of brain regions is Ismo (Isosorbide Mononitrate)- Multum with different choices in moral dilemmas (33, 38).

We found that lesions temporally associated with criminal behavior were connected to both sets of brain regions, but in opposite directions. Thus, lesions may bias patients toward utilitarian moral decisions (i.

Our main analysis included 17 cases with a strong temporal relationship between the lesion and criminal behavior. Our results were nearly identical using lesions of uncertain temporal association with criminal behavior. This replication increases our confidence that lesions within a well-defined network increase the relative probability of criminality.

In a judicial setting, it Ismo (Isosorbide Mononitrate)- Multum often desirable to know whether a lesion contributed to criminality or was an incidental finding. In this respect, the implications of our findings are unclear.

The published cases included in our second cohort were often believed to be contributing to criminality (and appl catal b incidental), even if a clear temporal association between the lesion and criminality was not documented.

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