Multiple previous alcohol detoxifications are associated with decreased medial temporal and paralimbic function in the postwithdrawal period.
BACKGROUND
Functional neuroimaging studies after alcohol cessation have demonstrated that chronic alcohol use globally reduces neuronal activity for several weeks. Less is known about the effects of previous alcohol use patterns on regional brain activity. Multiple previous alcohol detoxifications are associated with a worse clinical course and increased risk of seizures, perhaps due to sensitization of key brain structures. We performed the following imaging study in alcoholics in the postwithdrawal period to determine if blood flow in medial temporal structures would differ as a function of previous alcohol use (i.e., whether regions were kindled or sensitized due to multiple detoxifications).


METHODS
Fourteen adults meeting DSM-IV criteria for alcohol dependence (mean age 35, 8 SD; 10 men) and participating in a double-blind detoxification medication study underwent a brain perfusion Tc99 m-ECD (Neurolite) single photon emission computed tomography scan on days 7 through 9 (mean 7.6, .5 SD) after their last drink and 2 to 3 days since their last detoxification medication. Seven nonpsychiatrically ill, nonalcohol-dependent healthy adults were scanned as control subjects.


RESULTS
Alcoholics compared with controls had widely reduced relative activity in cortical secondary association areas and relatively increased activity in the medial temporal lobes (p < 0.01). Five alcoholic patients with > or = 2 previous detoxifications were compared with five patients in their first detoxification (age and detoxification medication matched). Multiple detoxification patients had significantly lower relative activity in bilateral anterior temporal poles and medial temporal lobes and in visual cortex (p < 0.01) compared with first episode patients.


CONCLUSIONS
These studies are consistent with other studies comparing alcoholics and controls. They also suggest that on day 7 of detoxification, alcoholic subjects with multiple previous detoxifications have decreased visual cortex, medial temporal lobes, and anterior paralimbic blood flow, compared with those in their first detoxification. Further studies seem warranted to confirm these initial exploratory results.
Department of Psychiatry Alcohol Research Center, Medical University of South Carolina, Charleston 29425, USA. georgem@musc.ed
M S
MS
George
C C
CC
Tenebäck
R J
RJ
Malcolm
J
J
Moore
L E
LE
Stallings
K M
KM
Spicer
R F
RF
Anton
J C
JC
Ballenger
D000328:Adult; D000437:Alcoholism / Q000150:complications* / Q000503:physiopathology; D002492:Central Nervous System Depressants / Q000009:adverse effects*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D004311:Double-Blind Method; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008032:Limbic System / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000009:adverse effects*; D013375:Substance Withdrawal Syndrome / Q000150:complications* / Q000503:physiopathology; D013702:Temporal Lobe / Q000187:drug effects / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon
D002492:Central Nervous System Depressants; D000431:Ethanol