Altered motor cortex excitability to magnetic stimulation in alcohol withdrawal syndrome.
BACKGROUND
Alcohol addiction is a complex brain disease caused by alterations in crucial neurotransmitter systems, including gamma-aminobutyric acid (GABA) and glutamate. These disturbances could be revealed by changes in cortical excitability parameters, as assessed by transcranial magnetic stimulation (TMS). This study was aimed to further investigate the complex pathophysiology of alcohol withdrawal syndrome (AWS).


METHODS
Motor cortex excitability was examined in 13 subjects with AWS in a mild predelirial state, in 12 chronic alcoholics and in 15 age-matched control subjects, using a range of TMS protocols. Central motor conduction time, resting and active motor threshold, duration of the cortical silent period, short latency intracortical inhibition (SICI), and intracortical facilitation (ICF) to paired TMS were examined.


RESULTS
Intracortical facilitation was significantly increased in the AWS patients when compared with the chronic alcoholics and the control subjects. The other TMS parameters did not differ significantly from the controls. Administration of a single oral dose of the glutamatergic antagonist riluzole in a subgroup of 8 patients significantly reduced ICF; motor threshold and SICI were not affected by riluzole.


CONCLUSIONS
Transcranial magnetic stimulation shows a selective increase in intracortical facilitation after ethanol withdrawal. Our findings support the theory that altered glutamatergic receptor function plays an important role in the pathogenesis of human alcohol withdrawal. This study provides further physiological evidence that antiglutamatergic approaches represent an efficacious alternative for treating alcohol withdrawal symptoms.
Nardone
Raffaele
R
Department of Neurology and Neuroscience Institute, Christian Doppler Clinic, Paracelsus Private Medical University, Salzburg, Austria. raffaele.nardone@asbmeran-o.it
Bergmann
Jürgen
J
Kronbichler
Martin
M
Caleri
Francesca
F
Lochner
Piergiorgio
P
Tezzon
Frediano
F
Ladurner
Gunther
G
Golaszewski
Stefan
S
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis / Q000503:physiopathology*; D000431:Ethanol / Q000009:adverse effects*; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000503:physiopathology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods
D000431:Ethanol