title: Abnormal white matter integrity in chronic users of codeine-containing cough syrups: a tract-based spatial statistics study.
abstract: OBJECTIVE
  Codeine-containing cough syrups have become one of the most popular drugs of abuse in young people in the world. Chronic codeine-containing cough syrup abuse is related to impairments in a broad range of cognitive functions. However, the potential brain white matter impairment caused by chronic codeine-containing cough syrup abuse has not been reported previously. Our aim was to investigate abnormalities in the microstructure of brain white matter in chronic users of codeine-containing syrups and to determine whether these WM abnormalities are related to the duration of the use these syrups and clinical impulsivity.
  
  
  METHODS
  Thirty chronic codeine-containing syrup users and 30 matched controls were evaluated. Diffusion tensor imaging was performed by using a single-shot spin-echo-planar sequence. Whole-brain voxelwise analysis of fractional anisotropy was performed by using tract-based spatial statistics to localize abnormal WM regions. The Barratt Impulsiveness Scale 11 was surveyed to assess participants' impulsivity. Volume-of-interest analysis was used to detect changes of diffusivity indices in regions with fractional anisotropy abnormalities. Abnormal fractional anisotropy was extracted and correlated with clinical impulsivity and the duration of codeine-containing syrup use.
  
  
  RESULTS
  Chronic codeine-containing syrup users had significantly lower fractional anisotropy in the inferior fronto-occipital fasciculus of the bilateral temporo-occipital regions, right frontal region, and the right corona radiata WM than controls. There were significant negative correlations among fractional anisotropy values of the right frontal region of the inferior fronto-occipital fasciculus and the right superior corona radiata WM and Barratt Impulsiveness Scale total scores, and between the right frontal region of the inferior fronto-occipital fasciculus and nonplan impulsivity scores in chronic codeine-containing syrup users. There was also a significant negative correlation between fractional anisotropy values of the right frontal region of the inferior fronto-occipital fasciculus and the duration of codeine-containing syrup use in chronic users.
  
  
  CONCLUSIONS
  Chronic codeine-containing syrup abuse may be associated with disruptions in brain WM integrity. These WM microstructural deficits may be linked to higher impulsivity in chronic codeine-containing syrup users.
authors.affiliation: From the Department of Medical Imaging (Y.-w.Q., H.-h.S., G.-h.J.), Guangdong No. 2 Provincial People's Hospital, Guangzhou, China Department of Medical Imaging (Y.-w.Q.), The First Affiliated Hospital of Gannan Medical University, Ganzhou, China qiuyw1201@gmail.com.
authors.forename: Y-W
authors.initials: YW
authors.lastname: Qiu
authors.affiliation: From the Department of Medical Imaging (Y.-w.Q., H.-h.S., G.-h.J.), Guangdong No. 2 Provincial People's Hospital, Guangzhou, China.
authors.forename: H-H
authors.initials: HH
authors.lastname: Su
authors.affiliation: Departments of Medical Imaging and Interventional Radiology (X.-f.L.), Cancer Center, Sun Yat-Sen University, Guangzhou, China.
authors.forename: X-F
authors.initials: XF
authors.lastname: Lv
authors.affiliation: From the Department of Medical Imaging (Y.-w.Q., H.-h.S., G.-h.J.), Guangdong No. 2 Provincial People's Hospital, Guangzhou, China.
authors.forename: G-H
authors.initials: GH
authors.lastname: Jiang
mesh_terms: D000328:Adult; D016880:Anisotropy; D000996:Antitussive Agents / Q000009:adverse effects*; D001921:Brain / Q000187:drug effects / Q000473:pathology*; D001931:Brain Mapping; D003061:Codeine / Q000009:adverse effects*; D003371:Cough / Q000188:drug therapy; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D008297:Male; D004366:Nonprescription Drugs / Q000009:adverse effects; D019966:Substance-Related Disorders / Q000150:complications*; D066127:White Matter / Q000187:drug effects / Q000473:pathology*
chemical_list: D000996:Antitussive Agents; D004366:Nonprescription Drugs; D003061:Codeine
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