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Gamma camera imaging in psychiatric disorders. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Manto MU. Cerebellotoxic Agents. HANDBOOK OF THE CEREBELLUM AND CEREBELLAR DISORDERS 2022:2363-2408. [DOI: 10.1007/978-3-030-23810-0_96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Mechanisms of Ethanol-Induced Cerebellar Ataxia: Underpinnings of Neuronal Death in the Cerebellum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168678. [PMID: 34444449 PMCID: PMC8391842 DOI: 10.3390/ijerph18168678] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/10/2021] [Accepted: 08/14/2021] [Indexed: 12/19/2022]
Abstract
Ethanol consumption remains a major concern at a world scale in terms of transient or irreversible neurological consequences, with motor, cognitive, or social consequences. Cerebellum is particularly vulnerable to ethanol, both during development and at the adult stage. In adults, chronic alcoholism elicits, in particular, cerebellar vermis atrophy, the anterior lobe of the cerebellum being highly vulnerable. Alcohol-dependent patients develop gait ataxia and lower limb postural tremor. Prenatal exposure to ethanol causes fetal alcohol spectrum disorder (FASD), characterized by permanent congenital disabilities in both motor and cognitive domains, including deficits in general intelligence, attention, executive function, language, memory, visual perception, and communication/social skills. Children with FASD show volume deficits in the anterior lobules related to sensorimotor functions (Lobules I, II, IV, V, and VI), and lobules related to cognitive functions (Crus II and Lobule VIIB). Various mechanisms underlie ethanol-induced cell death, with oxidative stress and endoplasmic reticulum (ER) stress being the main pro-apoptotic mechanisms in alcohol abuse and FASD. Oxidative and ER stresses are induced by thiamine deficiency, especially in alcohol abuse, and are exacerbated by neuroinflammation, particularly in fetal ethanol exposure. Furthermore, exposure to ethanol during the prenatal period interferes with neurotransmission, neurotrophic factors and retinoic acid-mediated signaling, and reduces the number of microglia, which diminishes expected cerebellar development. We highlight the spectrum of cerebellar damage induced by ethanol, emphasizing physiological-based clinical profiles and biological mechanisms leading to cell death and disorganized development.
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Manto MU. Cerebellotoxic Agents. HANDBOOK OF THE CEREBELLUM AND CEREBELLAR DISORDERS 2021:1-46. [DOI: 10.1007/978-3-319-97911-3_96-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/15/2020] [Indexed: 09/02/2023]
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Manto M, Perrotta G. Toxic-induced cerebellar syndrome: from the fetal period to the elderly. HANDBOOK OF CLINICAL NEUROLOGY 2018; 155:333-352. [DOI: 10.1016/b978-0-444-64189-2.00022-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Single-photon emission computed tomography (SPECT) and positron emission tomography (PET) with different radiotracers enable regional evaluation of blood flow and glucose metabolism, of receptors and transporters of several molecules, and of abnormal deposition of peptides and proteins in the brain. The cerebellum has been used as a reference region for different radiotracers in several disease conditions. Whole-brain voxel-wise analysis is not affected by a priori knowledge bias and should be preferred. SPECT and PET have contributed to establishing the cerebellum role in motion, cognition, and emotion control in physiologic and pathophysiologic conditions. The basic abnormal imaging findings include decreased or increased uptake of flow or metabolism tracers in the cerebellum alone or as part of a network. Decreased uptake is generally observed in primary structural damage of the cerebellum, but can also represent a distant effect of cerebral damage (crossed diaschisis). Increased uptake can be observed in Freidreich ataxia, inflammatory or immune-mediated diseases of the cerebellum, and in status epilepticus. The possibility is also recognized that primary structural damage of the cerebellum might determine distance effects on other brain structures (reversed diaschisis). So far, SPECT and PET have been predominantly used in clinical studies to investigate cerebellar changes in neurologic and psychiatric diseases and in connection with pharmacologic, transcranial magnetic stimulation, deep-brain stimulation, or surgical treatments.
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Volkow ND, Wiers CE, Shokri-Kojori E, Tomasi D, Wang GJ, Baler R. Neurochemical and metabolic effects of acute and chronic alcohol in the human brain: Studies with positron emission tomography. Neuropharmacology 2017; 122:175-188. [PMID: 28108358 DOI: 10.1016/j.neuropharm.2017.01.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/20/2016] [Accepted: 01/14/2017] [Indexed: 02/07/2023]
Abstract
The use of Positron emission tomography (PET) to study the effects of acute and chronic alcohol on the human brain has enhanced our understanding of the mechanisms underlying alcohol's rewarding effects, the neuroadaptations from chronic exposure that contribute to tolerance and withdrawal, and the changes in fronto-striatal circuits that lead to loss of control and enhanced motivation to drink that characterize alcohol use disorders (AUD). These include studies showing that alcohol's reinforcing effects may result not only from its enhancement of dopaminergic, GABAergic and opioid signaling but also from its caloric properties. Studies in those suffering from an AUD have revealed significant alterations in dopamine (DA), GABA, cannabinoids, opioid and serotonin neurotransmission and in brain energy utilization (glucose and acetate metabolism) that are likely to contribute to compulsive alcohol taking, dysphoria/depression, and to alcohol-associated neurotoxicity. Studies have also evaluated the effects of abstinence on recovery of brain metabolism and neurotransmitter function and the potential value of some of these measures to predict clinical outcomes. Finally, PET studies have started to provide insights about the neuronal mechanisms by which certain genes contribute to the vulnerability to AUD. These findings have helped identify new strategies for prevention and treatment of AUD. This article is part of the Special Issue entitled "Alcoholism".
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Affiliation(s)
- Nora D Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, United States; National Institute on Alcohol Abuse and Alcoholism, Laboratory of Neuroimaging, National Institutes of Health, Bethesda, MD 20892, United States.
| | - Corinde E Wiers
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, United States
| | - Ehsan Shokri-Kojori
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, United States
| | - Dardo Tomasi
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, United States
| | - Gene-Jack Wang
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, United States
| | - Ruben Baler
- National Institute on Alcohol Abuse and Alcoholism, Laboratory of Neuroimaging, National Institutes of Health, Bethesda, MD 20892, United States
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Newman EL, Gunner G, Huynh P, Gachette D, Moss S, Smart T, Rudolph U, DeBold JF, Miczek KA. Effects of Gabra2 Point Mutations on Alcohol Intake: Increased Binge-Like and Blunted Chronic Drinking by Mice. Alcohol Clin Exp Res 2016; 40:2445-2455. [PMID: 27717041 PMCID: PMC5073020 DOI: 10.1111/acer.13215] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 08/11/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Alcohol use disorders are associated with single-nucleotide polymorphisms in GABRA2, the gene encoding the GABAA receptor α2-subunit in humans. Deficient GABAergic functioning is linked to impulse control disorders, intermittent explosive disorder, and to drug abuse and dependence, yet it remains unclear whether α2-containing GABAA receptor sensitivity to endogenous ligands is involved in excessive alcohol drinking. METHODS Male wild-type (Wt) C57BL/6J and point-mutated mice rendered insensitive to GABAergic modulation by benzodiazepines (BZD; H101R), allopregnanolone (ALLO) or tetrahydrodeoxycorticosterone (THDOC; Q241M), or high concentrations of ethanol (EtOH) (S270H/L277A) at α2-containing GABAA receptors were assessed for their binge-like, moderate, or escalated chronic drinking using drinking in the dark, continuous access (CA) and intermittent access (IA) to alcohol protocols, respectively. Social approach by mutant and Wt mice in forced alcohol abstinence was compared to approach by EtOH-naïve controls. Social deficits in forced abstinence were treated with allopregnanolone (0, 3.0, 10.0 mg/kg, intraperitoneal [i.p.]) or midazolam (0, 0.56, 1.0 mg/kg, i.p.). RESULTS Mice with BZD-insensitive α2-containing GABAA receptors (H101R) escalated their binge-like drinking. Mutants harboring the Q241M point substitution in Gabra2 showed blunted chronic intake in the CA and IA protocols. S270H/L277A mutants consumed excessive amounts of alcohol but, unlike wild-types, they did not show forced abstinence-induced social deficits. CONCLUSIONS These findings suggest a role for: (i) H101 in species-typical binge-like drinking, (ii) Q241 in escalated chronic drinking, and (iii) S270 and/or L277 in the development of forced abstinence-associated social deficits. Clinical findings report reduced BZD-binding sites in the cortex of dependent patients; the present findings suggest a specific role for BZD-sensitive α2-containing receptors. In addition, amino acid residue 241 in Gabra2 is necessary for positive modulation and activation of GABAA receptors by ALLO and THDOC; we postulate that neurosteroid action on α2-containing receptor may be necessary for escalated chronic EtOH intake.
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Affiliation(s)
| | | | | | | | | | - Trevor Smart
- Dept. of Neuroscience, Physiology and Pharmacology, University College London
| | - Uwe Rudolph
- Laboratory of Genetic Neuropharmacology, McLean Hospital,Dept. of Psychiatry, Harvard Medical School
| | | | - Klaus A. Miczek
- Dept. of Psychology, Tufts University,Dept. of Neuroscience, Tufts University
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Moeller SJ, London ED, Northoff G. Neuroimaging markers of glutamatergic and GABAergic systems in drug addiction: Relationships to resting-state functional connectivity. Neurosci Biobehav Rev 2016; 61:35-52. [PMID: 26657968 PMCID: PMC4731270 DOI: 10.1016/j.neubiorev.2015.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/05/2015] [Accepted: 11/21/2015] [Indexed: 12/29/2022]
Abstract
Drug addiction is characterized by widespread abnormalities in brain function and neurochemistry, including drug-associated effects on concentrations of the excitatory and inhibitory neurotransmitters glutamate and gamma-aminobutyric acid (GABA), respectively. In healthy individuals, these neurotransmitters drive the resting state, a default condition of brain function also disrupted in addiction. Here, our primary goal was to review in vivo magnetic resonance spectroscopy and positron emission tomography studies that examined markers of glutamate and GABA abnormalities in human drug addiction. Addicted individuals tended to show decreases in these markers compared with healthy controls, but findings also varied by individual characteristics (e.g., abstinence length). Interestingly, select corticolimbic brain regions showing glutamatergic and/or GABAergic abnormalities have been similarly implicated in resting-state functional connectivity deficits in drug addiction. Thus, our secondary goals were to provide a brief review of this resting-state literature, and an initial rationale for the hypothesis that abnormalities in glutamatergic and/or GABAergic neurotransmission may underlie resting-state functional deficits in drug addiction. In doing so, we suggest future research directions and possible treatment implications.
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Affiliation(s)
- Scott J Moeller
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Edythe D London
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Departments of Psychiatry and Biobehavioral Sciences, and Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, USA
| | - Georg Northoff
- Brain Imaging and Neuroethics Research Unit, Institute of Mental Health Research, Ottawa, Canada.
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Manto M. Toxic Agents. ESSENTIALS OF CEREBELLUM AND CEREBELLAR DISORDERS 2016:601-611. [DOI: 10.1007/978-3-319-24551-5_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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11
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Hillmer AT, Mason GF, Fucito LM, O'Malley SS, Cosgrove KP. How Imaging Glutamate, γ-Aminobutyric Acid, and Dopamine Can Inform the Clinical Treatment of Alcohol Dependence and Withdrawal. Alcohol Clin Exp Res 2015; 39:2268-82. [PMID: 26510169 DOI: 10.1111/acer.12893] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 08/29/2015] [Indexed: 12/29/2022]
Abstract
Neuroimaging studies have dramatically advanced our understanding of the neurochemical basis of alcohol dependence, a major public health issue. In this paper, we review the research generated from neurochemical specific imaging modalities including magnetic resonance spectroscopy, positron emission tomography, and single-photon emission computed tomography in studies of alcohol dependence and withdrawal. We focus on studies interrogating γ-aminobutyric acid (GABA), glutamate, and dopamine, as these are prominent neurotransmitter systems implicated in alcohol dependence. Highlighted findings include diminished dopaminergic functioning and modulation of the GABA system by tobacco smoking during alcohol withdrawal. Then, we consider how these findings impact the clinical treatment of alcohol dependence and discuss directions for future experiments to address existing gaps in the literature, for example, sex differences and smoking comorbidity. These and other considerations provide opportunities to build upon the current neurochemistry imaging literature of alcohol dependence and withdrawal, which may usher in improved therapeutic and relapse prevention strategies.
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Affiliation(s)
- Ansel T Hillmer
- Departments of Psychiatry and Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Graeme F Mason
- Departments of Psychiatry and Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Lisa M Fucito
- Departments of Psychiatry and Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Stephanie S O'Malley
- Departments of Psychiatry and Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Kelly P Cosgrove
- Departments of Psychiatry and Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut
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Loheswaran G, Barr MS, Rajji TK, Zomorrodi R, Le Foll B, Daskalakis ZJ. Brain Stimulation in Alcohol Use Disorders: Investigational and Therapeutic Tools. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2015; 1:5-13. [PMID: 29560895 DOI: 10.1016/j.bpsc.2015.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/17/2015] [Accepted: 09/18/2015] [Indexed: 01/20/2023]
Abstract
Alcohol use disorders (AUDs) are a major health and social problem worldwide. Brain stimulation holds great promise as an investigational tool to help us understand the pathophysiology of alcohol dependence and as a therapeutic tool to treat AUDs. Numerous studies suggest that glutamatergic, gamma-aminobutyric acidergic, and dopaminergic neurotransmission are altered by alcohol consumption and among patients with AUDs. Alcohol's disruption of neurotransmission is likely to play an important role in its detrimental effects on neuroplasticity, which, in turn, may contribute to the pathophysiology of alcohol dependence. Specifically, aberrant neuroplasticity in the brain reward circuitry is a potential mechanism underlying the pathophysiology of alcohol dependence. The dorsolateral prefrontal cortex (DLPFC), a part of the brain's reward circuitry, is directly accessible to noninvasive brain stimulation and may represent a potential target for the treatment of AUDs. While the literature suggests that impairments in neuroplasticity are likely to be present in the DLPFC and brain reward circuitry in alcohol-dependent patients, this is yet to be directly evaluated in humans. Findings from numerous neuromodulatory brain stimulation studies demonstrate that altering neuroplasticity in the DLPFC in alcohol-dependent patients holds promise as a treatment for alcohol dependence, but the optimal neuromodulatory parameters are yet to be identified. Gaining a better understanding of alcohol dependence vis à vis neuroplasticity in the DLPFC and brain reward circuitry can help us optimize the treatment of alcohol dependence using neuromodulatory brain stimulation in the DLPFC.
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Affiliation(s)
- Genane Loheswaran
- Translational Addiction Research Laboratory, University of Toronto, Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, University of Toronto, Toronto, Ontario, Canada
| | - Mera S Barr
- Temerty Centre for Therapeutic Brain Intervention, University of Toronto, Toronto, Ontario, Canada; Biobehavioural Addictions and Concurrent Disorders Laboratory, University of Toronto, Toronto, Ontario, Canada
| | - Tarek K Rajji
- Temerty Centre for Therapeutic Brain Intervention, University of Toronto, Toronto, Ontario, Canada; Biobehavioural Addictions and Concurrent Disorders Laboratory, University of Toronto, Toronto, Ontario, Canada
| | - Reza Zomorrodi
- Translational Addiction Research Laboratory, University of Toronto, Toronto, Ontario, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, University of Toronto, Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, University of Toronto, Toronto, Ontario, Canada; Biobehavioural Addictions and Concurrent Disorders Laboratory, University of Toronto, Toronto, Ontario, Canada.
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Tobacco smoking interferes with GABAA receptor neuroadaptations during prolonged alcohol withdrawal. Proc Natl Acad Sci U S A 2014; 111:18031-6. [PMID: 25453062 DOI: 10.1073/pnas.1413947111] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Understanding the effects of tobacco smoking on neuroadaptations in GABAA receptor levels over alcohol withdrawal will provide critical insights for the treatment of comorbid alcohol and nicotine dependence. We conducted parallel studies in human subjects and nonhuman primates to investigate the differential effects of tobacco smoking and nicotine on changes in GABAA receptor availability during acute and prolonged alcohol withdrawal. We report that alcohol withdrawal with or without concurrent tobacco smoking/nicotine consumption resulted in significant and robust elevations in GABAA receptor levels over the first week of withdrawal. Over prolonged withdrawal, GABAA receptors returned to control levels in alcohol-dependent nonsmokers, but alcohol-dependent smokers had significant and sustained elevations in GABAA receptors that were associated with craving for alcohol and cigarettes. In nonhuman primates, GABAA receptor levels normalized by 1 mo of abstinence in both groups--that is, those that consumed alcohol alone or the combination of alcohol and nicotine. These data suggest that constituents in tobacco smoke other than nicotine block the recovery of GABAA receptor systems during sustained alcohol abstinence, contributing to alcohol relapse and the perpetuation of smoking.
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Ravan S, Martinez D, Slifstein M, Abi-Dargham A. Molecular imaging in alcohol dependence. HANDBOOK OF CLINICAL NEUROLOGY 2014; 125:293-311. [PMID: 25307582 DOI: 10.1016/b978-0-444-62619-6.00018-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The cellular mechanisms of alcohol's effects in the brain are complex, targeting multiple transmitter systems. Molecular imaging has been used to study the effects of alcohol and alcohol use disorders on these various systems. Studies of dopaminergic indices have provided robust evidence for deficits in D2-mediated transmission in the striatum of chronic recently detoxified alcoholics. Their presence in the at-risk state prior to excessive drinking, and their recovery after long-term sobriety, are unclear and represent an active area of current research. Investigations of the GABAergic system have shown generalized deficits in various brain regions in the chronic abstinence phase. Studies of the opiate system have suggested alterations in some subtypes in discrete brain regions, including the ventral striatum, while studies of serotonin have been negative and those of the cannabinoid system have been inconclusive. Future investigations should target the glutamatergic system, which plays an important role both in the acute intoxicating effects of alcohol as well as in the long-term effects associated with dependence.
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Affiliation(s)
- Shervin Ravan
- Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Diana Martinez
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Mark Slifstein
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Anissa Abi-Dargham
- Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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15
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Laukkanen V, Storvik M, Häkkinen M, Akamine Y, Tupala E, Virkkunen M, Tiihonen J. Decreased GABA(A) benzodiazepine binding site densities in postmortem brains of Cloninger type 1 and 2 alcoholics. Alcohol 2013; 47:103-8. [PMID: 23332316 DOI: 10.1016/j.alcohol.2012.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 12/13/2012] [Accepted: 12/13/2012] [Indexed: 11/25/2022]
Abstract
Ethanol modulates the GABA(A) receptor to cause sedative, anxiolytic and hypnotic effects that are qualitatively similar to benzodiazepines and barbiturates. The aim of this study was to explore if GABA(A) receptor density is altered in post-mortem brains of anxiety-prone Cloninger type 1 and socially hostile type 2 alcoholic subtypes when compared to controls. The GABA(A) binding site density was measured by whole-hemisphere autoradiography with tritium labeled flunitrazepam ([(3)H]flunitrazepam) from 17 alcoholic (nine type 1, eight type 2) and 10 non-alcoholic post-mortem brains, using cold flumazepam as a competitive ligand. A total of eight specific brain areas were examined. Alcoholics displayed a significantly (p < 0.001, bootstrap type generalizing estimating equations model) reduced [(3)H]flunitrazepam binding site density when compared to controls. When localized, type 2 alcoholics displayed a significantly (p ≤ 0.05) reduced [(3)H]flunitrazepam binding site density in the internal globus pallidus, the gyrus dentatus and the hippocampus, whereas type 1 alcoholics differed from controls in the internal globus pallidus and the hippocampus. While previous reports have demonstrated significant alterations in dopaminergic and serotonergic receptors between type 1 and type 2 alcoholics among these same subjects, we observed no statistically significant difference in [(3)H]flunitrazepam binding site densities between the Cloninger type 1 and type 2 alcoholics.
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Manto M. Cerebellotoxic Agents. HANDBOOK OF THE CEREBELLUM AND CEREBELLAR DISORDERS 2013:2079-2117. [DOI: 10.1007/978-94-007-1333-8_96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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17
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Jacob C. Peter Riederer "70th birthday" neurobiological foundations of modern addiction treatment. J Neural Transm (Vienna) 2012; 120:55-64. [PMID: 22903349 DOI: 10.1007/s00702-012-0886-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 07/31/2012] [Indexed: 11/29/2022]
Abstract
Alcohol dependence is caused by complex interactions of multiple susceptibility genes with little effect each and environmental factors. Candidate genes influence metabolism of alcohol, such as alcohol dehydrogenase and aldehyde dehydrogenase, and modulatory transmitter systems, such as the dopaminergic, serotonergic, acetylcholinergic, gamma-aminobutyric acidergic, and various neuropeptidergic systems. Dysfunctional behavioral choices, learning, and memory are involved in the etiology of alcohol dependence. Systematic promotion and maintenance of motivation is a lifetime challenge in the treatment of alcohol use disorders. The second step of treatment management is the discontinuation of alcohol consumption. Withdrawal symptoms can be treated with gamma-aminobutyric acidergic substances such as benzodiazepines. Long-term relapse prevention is another challenge. Multimodal treatment can include naltrexone, a non-selective opioid receptor antagonist, or acamprosate, an N-methyl-D-aspartate receptor modulator, which are first line for pharmacological treatment on the basis of recent Cochrane analyses. Due to the complexity of etiology with both psychological and neurobiological factors, future treatment management of alcoholism may include the combination of individualized disorder-specific psychotherapy and drugs acting on different neuronal pathways, on the basis of individual vulnerability. However, the question remains unsolved whether an individualized approach is feasible and how subgroups should be defined.
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Affiliation(s)
- Christian Jacob
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Fuechsleinstrasse 15, 97080, Wuerzburg, Germany.
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Abstract
Neuroimaging studies have been crucial in understanding changes in the various neurotransmitter systems implicated in addiction in the living human brain. Predominantly reduced striatal dopamine transmission appears to play an important role in psychostimulant, alcohol and heroin addiction, while addiction to cannabis may be mediated primarily by the endocannabinoid system. However, the study of other neurotransmitter systems likely involved in addiction, for example glutamate, has been limited by the number and quality of available radiotracers, and data on changes in these systems in the most common addictions are emerging only now. Further studies are needed to understand fully how the interplay of various neurotransmitter systems contributes to addiction and to ultimately help to develop more effective treatment approaches.
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Affiliation(s)
- Nina B L Urban
- Department of Psychiatry, Division of Substance Abuse, Columbia University, New York, NY 10032, USA.
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Reid AG, Lingford-Hughes AR, Cancela LM, Kalivas PW. Substance abuse disorders. HANDBOOK OF CLINICAL NEUROLOGY 2012; 106:419-31. [PMID: 22608635 DOI: 10.1016/b978-0-444-52002-9.00024-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Mascalchi M, Vella A. Magnetic resonance and nuclear medicine imaging in ataxias. HANDBOOK OF CLINICAL NEUROLOGY 2012; 103:85-110. [PMID: 21827882 DOI: 10.1016/b978-0-444-51892-7.00004-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Imaging techniques including computed tomography (CT), magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET) have been widely applied to the investigation of patients with acute or chronic ataxias. Fundamentally, CT has a role in the emergency evaluation of the patient with acute ataxia to ascertain brainstem or cerebellar hemorrhage and to exclude a mass lesion in the posterior cranial fossa. Conventional MRI is the most frequently performed imaging investigation in patients with ataxia. It can support the diagnosis of acute cerebellitis and Wernicke encephalopathy by revealing T2 signal changes with a typical distribution. In patients with inherited or sporadic chronic ataxia it reveals three fundamental patterns of atrophy of the brainstem, cerebellum, and spinal cord which match the gross neuropathological descriptions. These are represented by olivopontocerebellar atrophy (OPCA), cortical cerebellar atrophy (CCA), and spinal atrophy (SA). A substantial correspondence exists among these patterns of atrophy shown by MRI and the etiological classification of inherited or acquired chronic ataxias. This, along with demonstration of T2 signal changes characteristic of some diseases, makes conventional MRI potentially useful for the diagnostic work-up of the single patient, especially in the case of a sporadic disease. Non-conventional MR techniques including diffusion MR, spectroscopy, and functional MR have been used in patients with acute or chronic ataxia, but their exact role in the evaluation of the single patient is not established yet. They are currently investigated as potential tools to monitor progression of neurodegeneration in chronic ataxia and to serve as "surrogate markers" in clinical trials. Several radiotracers have been utilized in combination with SPECT and PET in patients with ataxia. Perfusion SPECT can reveal cerebellar blood flow abnormalities early in the course of cerebellitis. It has also been utilized to investigate perfusion of the brain in several inherited or sporadic chronic ataxic diseases, contributing to improved understanding of the pathophysiology of these conditions. Recently, perfusion SPECT has been tested as a "surrogate marker" to verify the effects of newly developed therapies in patients with a variety of chronic ataxias. Whole-body FDG-PET is recommended in patients with suspected paraneoplastic cerebellar degeneration to detect the primary malignancy. Brain FDG-PET has provided important information on the pathophysiology of several acquired and inherited conditions. PET and SPECT with radiotracers able to assess the nigrostriatal system or the density of D2 dopamine receptors in the striatum are increasingly used in patients with adult-onset sporadic ataxia for the differential diagnosis between multiple system atrophy in which overt striatal abnormalities are found and idiopathic late-onset cerebellar ataxia in which no abnormality is detected.
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Affiliation(s)
- Mario Mascalchi
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Italy.
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Eyer F, Schreckenberg M, Hecht D, Adorjan K, Schuster T, Felgenhauer N, Pfab R, Strubel T, Zilker T. Carbamazepine and Valproate as Adjuncts in the Treatment of Alcohol Withdrawal Syndrome: A Retrospective Cohort Study. Alcohol Alcohol 2011; 46:177-84. [DOI: 10.1093/alcalc/agr005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cosgrove KP, Esterlis I, Mason GF, Bois F, O'Malley SS, Krystal JH. Neuroimaging insights into the role of cortical GABA systems and the influence of nicotine on the recovery from alcohol dependence. Neuropharmacology 2011; 60:1318-25. [PMID: 21276806 DOI: 10.1016/j.neuropharm.2011.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 01/10/2011] [Accepted: 01/11/2011] [Indexed: 10/18/2022]
Abstract
This paper reviews evidence suggesting that nicotine and tobacco smoke profoundly modulate the effects of alcohol on γ-aminobutyric acid (GABA) neuronal function, specifically at the GABA(A)-benzodiazepine receptor (GABA(A)-BZR). The focus of this paper is on recent neuroimaging evidence in preclinical models as well as clinical experiments. First, we review findings implicating the role of alcohol at the GABA(A)-BZR and discuss the changes in GABA(A)-BZR availability during acute and prolonged alcohol withdrawal. Second, we discuss preclinical evidence that suggests nicotine affects GABA neuronal function indirectly by a primary action at neuronal nicotinic acetylcholine receptors. Third, we show how this evidence converges in studies that examine GABA levels and GABA(A)-BZRs in alcohol-dependent smokers and nonsmokers, suggesting that tobacco smoking attenuates the chemical changes that occur during alcohol withdrawal. Based on a comprehensive review of literature, we hypothesize that tobacco smoking minimizes the changes in GABA levels that typically occur during the acute cycles of drinking in alcohol-dependent individuals. Thus, during alcohol withdrawal, the continued tobacco smoking decreases the severity of the withdrawal-related changes in GABA chemistry. This article is part of a Special Issue entitled 'Trends in neuropharmacology: in memory of Erminio Costa'.
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Affiliation(s)
- Kelly P Cosgrove
- Department of Psychiatry, Yale University School of Medicine and the VACHS, West Haven, CT 06516, USA.
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Abstract
BACKGROUND The treatment of baclofen can rapidly reduce symptoms of severe alcohol withdrawal syndrome (AWS) in alcoholic patients, with a significant reduction in the cost. Baclofen is easily manageable, what's more, no patient treated with baclofen reported euphoria or other pleasant effects caused by the drug and no subject reported any degree of craving for the drug. OBJECTIVES To assess the efficacy and safety of baclofen for patients with alcohol withdrawal syndrome. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (September 2010), MEDLINE (1966 to September 2010), EMBASE (1980 to September 2010), and CINAHL (1982 to September 2010). We also searched the following registers of ongoing trials, e.g. Clinicaltrials.gov, Controlled trials.com, EUDRACT, etc. At the same time, we handsearched the references quoted in the identified trials, contact researchers, pharmaceutical companies and relevant trial authors seeking information about unpublished or incomplete trials. All searches included non-English language literature. SELECTION CRITERIA All randomised controlled clinical trials (RCTs) evaluating baclofen versus placebo or any other treatment for patients with AWS. Uncontrolled, non-randomised or quasi-randomised trials were excluded. Both parallel group and cross-over design were included. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed references retrieved for possible inclusion. All disagreements were resolved by an independent party. Study authors were contacted for additional information. Adverse effects information was collected from the trials. MAIN RESULTS We identified a total of 82 references from all electronic databases searched excluding duplicate. After screening of titles and abstracts, full papers of 7 studies were obtained and assessed for eligibility. Finally, only one study met the inclusion criteria, with 37 participants. AUTHORS' CONCLUSIONS The evidence of recommending baclofen for AWS is insufficient. More well designed RCTs are demanded to further prove its efficacy and safety.
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Affiliation(s)
- Jia Liu
- Department of Geriatric Neurology, Chinese PLA General Hospital, Beijing, China, 100853
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Heitzeg MM, Nigg JT, Yau WYW, Zucker RA, Zubieta JK. Striatal dysfunction marks preexisting risk and medial prefrontal dysfunction is related to problem drinking in children of alcoholics. Biol Psychiatry 2010; 68:287-95. [PMID: 20416863 PMCID: PMC2907458 DOI: 10.1016/j.biopsych.2010.02.020] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 02/18/2010] [Accepted: 02/19/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Parental alcoholism substantially raises risk for offspring alcoholism, an effect thought to be mediated by a dysregulation in impulse control. Adult alcoholics have alterations in the frontostriatal system involved in regulating impulsive responses. However, it remains controversial whether these alterations reflect preexisting traits predisposing to problem alcohol use or are secondary to alcohol involvement. METHODS Sixty-one 16 to 22 year olds were tested using a go/no-go task during functional magnetic resonance imaging. Forty-one were family history positive (FH+), having at least one parent with a diagnosis of alcohol use disorder (AUD), and 20 were family history negative (FH-). Two FH+ subgroups were created to disentangle alcohol involvement from preexisting risk: the FH+ control group (n = 20) had low alcohol problems, differing from the FH- group only by family history. The FH+ problem group (n = 21) had high alcohol problems. RESULTS The ventral caudate deactivated during successful inhibition in the FH- but not the FH+ groups, regardless of problem alcohol involvement. Regression analyses showed that ventral caudate deactivation was related to fewer externalizing problems as well as to family history. Orbital and left medial prefrontal regions were deactivated in both the FH- and FH+ control groups but not the FH+ problem group. Activation in these regions was associated with alcohol and other drug use. CONCLUSIONS These findings suggest a preexisting abnormality in ventral striatal function in youth at risk for AUD, which may lead to inappropriate motivational responding, and suggest that with alcohol use, the prefrontal "control" mechanism loses efficiency, further dysregulating the frontostriatal motivational circuitry.
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Affiliation(s)
- Mary M. Heitzeg
- Department of Psychiatry, The University of Michigan, Ann Arbor, Mi.,Addiction Research Center, The University of Michigan, Ann Arbor, Mi
| | - Joel T. Nigg
- Department of Psychiatry, Oregon Health and Science University, Portland Or
| | - Wai-Ying Wendy Yau
- Department of Psychiatry, The University of Michigan, Ann Arbor, Mi.,Addiction Research Center, The University of Michigan, Ann Arbor, Mi.,Molecular and Behavioral Neuroscience Institute, The University of Michigan, Ann Arbor, Mi
| | - Robert A. Zucker
- Department of Psychiatry, The University of Michigan, Ann Arbor, Mi.,Addiction Research Center, The University of Michigan, Ann Arbor, Mi
| | - Jon-Kar Zubieta
- Department of Psychiatry, The University of Michigan, Ann Arbor, Mi.,Molecular and Behavioral Neuroscience Institute, The University of Michigan, Ann Arbor, Mi
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25
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Liu J, Wang L. Baclofen for alcohol withdrawal. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND Alcohol abuse and dependence represents a most serious health problem worldwide with major social, interpersonal and legal interpolations. Besides benzodiazepines, anticonvulsants are often used for the treatment of alcohol withdrawal symptoms. Anticonvulsants drugs are indicated for the treatment of alcohol withdrawal syndrome, alone or in combination with benzodiazepine treatments. In spite of the wide use, the exact role of the anticonvulsants for the treatment of alcohol withdrawal has not yet bee adequately assessed. OBJECTIVES To evaluate the effectiveness and safety of anticonvulsants in the treatment of alcohol withdrawal. SEARCH STRATEGY We searched Cochrane Drugs and Alcohol Group' Register of Trials (December 2009), PubMed, EMBASE, CINAHL (1966 to December 2009), EconLIT (1969 to December 2009). Parallel searches on web sites of health technology assessment and related agencies, and their databases. SELECTION CRITERIA Randomized controlled trials (RCTs) examining the effectiveness, safety and overall risk-benefit of anticonvulsants in comparison with a placebo or other pharmacological treatment. All patients were included regardless of age, gender, nationality, and outpatient or inpatient therapy. DATA COLLECTION AND ANALYSIS Two authors independently screened and extracted data from studies. MAIN RESULTS Fifty-six studies, with a total of 4076 participants, met the inclusion criteria. Comparing anticonvulsants with placebo, no statistically significant differences for the six outcomes considered.Comparing anticonvulsant versus other drug, 19 outcomes considered, results favour anticonvulsants only in the comparison carbamazepine versus benzodiazepine (oxazepam and lorazepam) for alcohol withdrawal symptoms (CIWA-Ar score): 3 studies, 262 participants, MD -1.04 (-1.89 to -0.20), none of the other comparisons reached statistical significance.Comparing different anticonvulsants no statistically significant differences in the two outcomes considered.Comparing anticonvulsants plus other drugs versus other drugs (3 outcomes considered), results from one study, 72 participants, favour paraldehyde plus chloral hydrate versus chlordiazepoxide, for the severe-life threatening side effects, RR 0.12 (0.03 to 0.44). AUTHORS' CONCLUSIONS Results of this review do not provide sufficient evidence in favour of anticonvulsants for the treatment of AWS. There are some suggestions that carbamazepine may actually be more effective in treating some aspects of alcohol withdrawal when compared to benzodiazepines, the current first-line regimen for alcohol withdrawal syndrome. Anticonvulsants seem to have limited side effects, although adverse effects are not rigorously reported in the analysed trials.
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Affiliation(s)
- Silvia Minozzi
- Department of Epidemiology, ASL RM/E, Via di Santa Costanza, 53, Rome, Italy, 00198
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Kumar S, Porcu P, Werner DF, Matthews DB, Diaz-Granados JL, Helfand RS, Morrow AL. The role of GABA(A) receptors in the acute and chronic effects of ethanol: a decade of progress. Psychopharmacology (Berl) 2009; 205:529-64. [PMID: 19455309 PMCID: PMC2814770 DOI: 10.1007/s00213-009-1562-z] [Citation(s) in RCA: 342] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 04/30/2009] [Indexed: 12/12/2022]
Abstract
The past decade has brought many advances in our understanding of GABA(A) receptor-mediated ethanol action in the central nervous system. We now know that specific GABA(A) receptor subtypes are sensitive to ethanol at doses attained during social drinking while other subtypes respond to ethanol at doses attained by severe intoxication. Furthermore, ethanol increases GABAergic neurotransmission through indirect effects, including the elevation of endogenous GABAergic neuroactive steroids, presynaptic release of GABA, and dephosphorylation of GABA(A) receptors promoting increases in GABA sensitivity. Ethanol's effects on intracellular signaling also influence GABAergic transmission in multiple ways that vary across brain regions and cell types. The effects of chronic ethanol administration are influenced by adaptations in GABA(A) receptor function, expression, trafficking, and subcellular localization that contribute to ethanol tolerance, dependence, and withdrawal hyperexcitability. Adolescents exhibit altered sensitivity to ethanol actions, the tendency for higher drinking and longer lasting GABAergic adaptations to chronic ethanol administration. The elucidation of the mechanisms that underlie adaptations to ethanol exposure are leading to a better understanding of the regulation of inhibitory transmission and new targets for therapies to support recovery from ethanol withdrawal and alcoholism.
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Affiliation(s)
- Sandeep Kumar
- Department of Psychiatry, Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, 3027 Thurston-Bowles Building, CB #7178, Chapel Hill, NC 27599-7178, USA
| | - Patrizia Porcu
- Department of Psychiatry, Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, 3027 Thurston-Bowles Building, CB #7178, Chapel Hill, NC 27599-7178, USA
| | - David F. Werner
- Department of Psychiatry, Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, 3027 Thurston-Bowles Building, CB #7178, Chapel Hill, NC 27599-7178, USA
| | | | | | - Rebecca S. Helfand
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - A. Leslie Morrow
- Department of Psychiatry, Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, 3027 Thurston-Bowles Building, CB #7178, Chapel Hill, NC 27599-7178, USA, Department of Pharmacology, Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, 3027 Thurston-Bowles Building, CB #7178, Chapel Hill, NC 27599-7178, USA
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Taylor C, Nash J, Rich A, Lingford-Hughes A, Nutt D, Potokar J. Assessment of GABAA benzodiazepine receptor (GBzR) sensitivity in patients with alcohol dependence. Alcohol Alcohol 2008; 43:614-8. [PMID: 18586906 DOI: 10.1093/alcalc/agn056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM The aim of this study was to measure GABAA benzodiazepine receptor (GBzR) sensitivity in alcohol-dependent patients and compare with matched non-dependent drinkers. METHODS Nine abstinent alcohol-dependent male patients, age matched with nine male non-dependent social drinkers, received an intravenous infusion of midazolam. Objective (saccadic eye movement slowing) and subjective (visual analogue scales) measurements were recorded at 15-min intervals for 2 h. RESULTS There were no differences in objective or subjective measures. CONCLUSIONS Our hypothesis that patients with alcohol dependence would have less slowing of their eye movements in response to this challenge, reflecting reduced GBzR sensitivity, was not confirmed. The reasons for this could mean that GBzR function returns to normal with abstinence, or that this paradigm is unable to measure the subtle subtype-specific changes in GBzR sensitivity that occur following dependent alcohol use.
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Affiliation(s)
- Claire Taylor
- Psychopharmacology Unit, Dorothy Hodgkin Building, Whitson Street, Bristol BS1 3NY, UK
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Martinez D, Kim JH, Krystal J, Abi-Dargham A. Imaging the neurochemistry of alcohol and substance abuse. Neuroimaging Clin N Am 2008; 17:539-55, x. [PMID: 17983969 DOI: 10.1016/j.nic.2007.07.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Animal models of abuse and dependence have long suggested that chronic drug and alcohol exposure is associated with marked changes in neurochemistry. The development of PET and SPECT imaging now allows investigation of the effects of addiction on the neurochemistry of the human brain. This article reviews the literature of radiochemical imaging in cocaine, alcohol, heroin, methamphetamine, MDMA, and ketamine abuse and dependence.
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Affiliation(s)
- Diana Martinez
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Drive, Box #31, New York, NY 10032, USA.
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Affiliation(s)
- Masahiro Mishina
- Department of Neurological, Nephrological and Rheumatological Science, Graduate School of Medicine, Nippon Medical School
- Neurological Institute, Nippon Medical School Chiba Hokusoh Hospital
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Mechtcheriakov S, Brenneis C, Egger K, Koppelstaetter F, Schocke M, Marksteiner J. A widespread distinct pattern of cerebral atrophy in patients with alcohol addiction revealed by voxel-based morphometry. J Neurol Neurosurg Psychiatry 2007; 78:610-4. [PMID: 17088334 PMCID: PMC2077939 DOI: 10.1136/jnnp.2006.095869] [Citation(s) in RCA: 203] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with alcohol addiction show a number of transient or persistent neurological and psychiatric deficits. The complexity of these brain alterations suggests that several brain areas are involved, although the definition of the brain alteration patterns is not yet accomplished. AIM To determine brain atrophy patterns in patients with alcohol dependence. METHODS Voxel-based morphometry (VBM) of grey matter (GM) and white matter (WM) was performed in 22 patients with alcohol dependence and in 22 healthy controls matched for age and sex. RESULTS In patients with alcohol dependence, VBM of GM revealed a significant decrease in density (p<0.001) in the precentral gyrus, middle frontal gyrus, insular cortex, dorsal hippocampus, anterior thalamus and cerebellum compared with controls. Reduced density of WM was found in the periventricular area, pons and cerebellar pedunculi in patients with alcohol addiction. CONCLUSIONS Our findings provide evidence that alcohol addiction is associated with altered density of GM and WM of specific brain regions. This supports the assumption that alcohol dependence is associated with both local GM dysfunction and altered brain connectivity. Also, VBM is an effective tool for in vivo investigation of cerebral atrophy in patients with alcohol addiction.
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Affiliation(s)
- Sergei Mechtcheriakov
- Department of General Psychiatry, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Weiss E, Marksteiner J. Alcohol-related cognitive disorders with a focus on neuropsychology. ACTA ACUST UNITED AC 2007. [DOI: 10.1515/ijdhd.2007.6.4.337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chen ACH, Porjesz B, Rangaswamy M, Kamarajan C, Tang Y, Jones KA, Chorlian DB, Stimus AT, Begleiter H. Reduced Frontal Lobe Activity in Subjects With High Impulsivity and Alcoholism. Alcohol Clin Exp Res 2007; 31:156-65. [PMID: 17207114 DOI: 10.1111/j.1530-0277.2006.00277.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Impulsivity is an important characteristic of many psychiatric disorders, including substance-related disorders. These disinhibitory disorders have a similar underlying genetic diathesis, with each disorder representing a different expression of the same underlying genetic liability. This study assessed whether there is a relationship between impulsivity and alcohol dependence, and their correlations with P3 (P300) amplitude, a proposed endophenotype of alcoholism. METHODS Healthy control subjects (n=58) and subjects with DSM-IV diagnosis of alcohol dependence (n=57) were assessed with a visual oddball task. Event-Related Potentials (ERPs) were recorded from 61 scalp electrodes and P3 amplitudes measured. Barratt Impulsiveness Scale (BIS), version 11, was used to evaluate impulsivity. Source localization of P3 was computed using low-resolution brain electromagnetic tomography (LORETA). RESULTS Alcoholic subjects manifested reductions in target P3 amplitudes (p<0.0001). Using LORETA, significantly reduced activation was mapped in the cingulate, medial, and superior frontal regions in alcoholic subjects and highly impulsive subjects. Alcoholic subjects had significantly higher scores on the BIS (p<0.0001) than nonalcoholic individuals. There were significant negative correlations between total scores on BIS and P3 amplitude (r=-0.274, p=0.003, on Pz; r=-0.250, p=0.007, on Cz). CONCLUSIONS Our results demonstrate a strong frontal focus of reduced activation during processing of visual targets in alcoholic subjects and individuals with higher impulsivity. The findings suggest that impulsivity may be an important factor that underlies the pathogenesis of alcohol dependence. Studies are underway to examine the relationship between impulsivity and ERPs in offspring of alcoholic subjects, and to identify genes associated with the underlying predisposition involved in disinhibitory disorders.
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Affiliation(s)
- Andrew C H Chen
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
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Abstract
The use of alcohol is widespread in the world, and although there are many regular users, some individuals drink excessively. Understanding the time course of the development and maintenance of alcohol dependence is important in assessing the potential risk/benefit of an intervention and in accurately treating the problem. Most, although not all, literature suggests that alcoholism is a chronic, relapsing disorder and that there is a general progression from less to more severe problems. Understanding the neurobiology that underlies alcohol dependence as it relates to different clinical stages may help in the development of effective targeted pharmacological treatments. Important clinical stages that may be amenable to pharmacological intervention include the transition from alcohol use to heavy drinking particularly in vulnerable individuals, the cessation of heavy drinking in individuals who want to quit, and the prevention of relapse in individuals who have initiated abstinence but may struggle with craving or the desire to resume alcohol use. Neurotransmitter systems implicated in these stages include glutamate, gamma-aminobutyric acid, opioid, and serotonin systems that may act directly or via the indirect modulation of dopamine function. The treatment implications will also be discussed.
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Affiliation(s)
- Ismene L Petrakis
- Department of Psychiatry and School of Medicine, Yale University, New Haven, CT 06510, USA.
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36
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Padmanabhapillai A, Porjesz B, Ranganathan M, Jones KA, Chorlian DB, Tang Y, Kamarajan C, Rangaswamy M, Stimus A, Begleiter H. Suppression of early evoked gamma band response in male alcoholics during a visual oddball task. Int J Psychophysiol 2006; 60:15-26. [PMID: 16019097 DOI: 10.1016/j.ijpsycho.2005.03.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Revised: 02/15/2005] [Accepted: 03/03/2005] [Indexed: 11/15/2022]
Abstract
We investigated the early evoked gamma frequency band activity in alcoholics (n=122) and normal controls (n=72) during a visual oddball task. A time-frequency representation method was applied to EEG data in order to obtain phase-locked gamma band activity (29-45 Hz) and was analyzed within a 0-150 ms time window range. Significant reduction of the gamma band response in the frontal region during target stimulus processing was observed in alcoholic compared to control subjects. In contrast, significantly higher gamma band response for the non-target stimulus was observed in alcoholics compared to controls. It is suggested that the reduction in early evoked frontal gamma band response to targets may be associated with frontal lobe dysfunction commonly observed in alcoholics. This perhaps can be characterized by a deficient top-down processing mechanism.
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Affiliation(s)
- Ajayan Padmanabhapillai
- Department of Psychiatry, Neurodynamics Laboratory, SUNY Health Science Center, Brooklyn, NY, USA
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Lingford-Hughes AR, Wilson SJ, Cunningham VJ, Feeney A, Stevenson B, Brooks DJ, Nutt DJ. GABA-benzodiazepine receptor function in alcohol dependence: a combined 11C-flumazenil PET and pharmacodynamic study. Psychopharmacology (Berl) 2005; 180:595-606. [PMID: 15864554 DOI: 10.1007/s00213-005-2271-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Accepted: 03/20/2005] [Indexed: 11/24/2022]
Abstract
RATIONALE Gamma-aminobutyric acid (GABA)-benzodiazepine receptor function is hypothesised to be reduced in alcohol dependence. OBJECTIVES We used positron emission tomography (PET) with [11C]flumazenil, a non-selective tracer for brain GABA-benzodiazepine (GABA-BDZ) receptor binding, to determine in vivo the relationship between BDZ receptor occupancy by an agonist, midazolam, and its functional effects. METHODS Abstinent male alcohol dependent subjects underwent [11C]flumazenil PET to measure occupancy of BDZ receptors by midazolam whilst recording its pharmacodynamic effects on behavioural and physiological measures. Rate constants describing the exchange of [11C]flumazenil between the plasma and brain compartments were derived from time activity curves. RESULTS A 50% reduction in electroencephalography (EEG)-measured sleep time was seen in the alcohol dependent group despite the same degree of occupancy by midazolam as seen in the control group. The effects of midazolam on other measures of benzodiazepine receptor function, increasing EEG beta1 power and slowing of saccadic eye movements, were similar in the two groups. No differences in midazolam or flumazenil metabolism were found between the groups. CONCLUSIONS In summary, our study suggests that alcohol dependence in man is associated with a reduced EEG sleep response to the benzodiazepine agonist, midazolam, which is not explained by reduced BDZ receptor occupancy, and is consistent with reduced sensitivity in this measure of GABA-BDZ receptor function in alcohol dependence. The lack of change in other functional measures may reflect a differential involvement of particular subtypes of the GABA-BDZ receptor.
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Affiliation(s)
- A R Lingford-Hughes
- Psychopharmacology Unit, University of Bristol, Dorothy Hodgkin Building, Whitson Street, Bristol, BS1 3NY, UK.
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Polycarpou A, Papanikolaou P, Ioannidis JPA, Contopoulos-Ioannidis DG. Anticonvulsants for alcohol withdrawal. Cochrane Database Syst Rev 2005:CD005064. [PMID: 16034965 DOI: 10.1002/14651858.cd005064.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Alcohol withdrawal syndrome is a cluster of symptoms that occurs in alcohol-dependent people after cessation or reduction in alcohol use. This systematic review focuses on the evidence of anticonvulsants' use in the treatment of alcohol withdrawal symptoms. OBJECTIVES To evaluate the effectiveness and safety of anticonvulsants in the treatment of alcohol withdrawal. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004); MEDLINE (1966 to October 2004); EMBASE (1988 to October 2004) and EU-PSI PSI-Tri database with no language and publication restrictions and references of articles. SELECTION CRITERIA All randomized controlled trials examining the effectiveness, safety and overall risk-benefit of an anticonvulsant in comparison with a placebo or other pharmacological treatment or another anticonvulsant were considered. DATA COLLECTION AND ANALYSIS The authors independently assessed trial quality extracted data. MAIN RESULTS Forty-eight studies, involving 3610 people were included. Despite the considerable number of randomized controlled trials, there was a variety of outcomes and of different rating scales that led to a limited quantitative synthesis of data. For the anticonvulsant versus placebo comparison, therapeutic success tended to be more common among the anticonvulsant-treated patients (relative risk (RR) 1.32; 95% confidence interval (CI) 0.92 to 1.91), and anticonvulsant tended to show a protective benefit against seizures (RR 0.57; 95% CI 0.27 to 1.19), but no effect reached formal statistical significance. For the anticonvulsant versus other drug comparison, CIWA-Ar score showed non-significant differences for the anticonvulsants compared to the other drugs at the end of treatment (weighted mean difference (WMD) -0.73; 95% CI -1.76 to 0.31). For the subgroup analysis of carbamazepine versus benzodiazepine, a statistically significant protective effect was found for the anticonvulsant (WMD -1.04; 95% CI -1.89 to -0.20), p = 0.02), but this was based on only 260 randomized participants. There was a non-significant decreased incidence of seizures (RR 0.50; 95% CI 0.18 to 1.34) favouring the patients that were treated with anticonvulsants than other drugs, and side-effects tended to be less common in the anticonvulsant-group (RR 0.56; 95% CI 0.31 to 1.02). AUTHORS' CONCLUSIONS It is not possible to draw definite conclusions about the effectiveness and safety of anticonvulsants in alcohol withdrawal, because of the heterogeneity of the trials both in interventions and the assessment of outcomes. The extremely small mortality rate in all these studies is reassuring, but data on other safety outcomes are sparse and fragmented.
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Affiliation(s)
- A Polycarpou
- Department of Hygiene and Epidemiology, University of Ioannina, School of Medicine, 14 Ch Zoidi Str, Ioannina, Greece, GR45444.
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Porjesz B, Rangaswamy M, Kamarajan C, Jones KA, Padmanabhapillai A, Begleiter H. The utility of neurophysiological markers in the study of alcoholism. Clin Neurophysiol 2005; 116:993-1018. [PMID: 15826840 DOI: 10.1016/j.clinph.2004.12.016] [Citation(s) in RCA: 216] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Revised: 12/09/2004] [Accepted: 12/17/2004] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This review attempts to differentiate neuroelectric measures (electroencephalogram (EEG), event-related potentials (ERPs) and event-related oscillations (EROs)) related to acute and chronic effects of alcohol on the brain from those that reflect underlying deficits related to the predisposition to develop alcoholism and related disorders. The utility of these neuroelectric measures as endophenotypes for psychiatric genetics is evaluated. METHODS This article reviews the main findings of EEG and ERP abnormalities in alcoholics, offspring of alcoholics at high risk to develop alcoholism and the electrophysiological effects of alcohol on high risk compared to low-risk offspring. It highlights findings using EROs, a fast developing tool in examining brain function and cognition. It also reviews evidence of genetic findings related to these electrophysiological measures and their relationship to clinical diagnosis. RESULTS Many of these abnormal neuroelectric measures are under genetic control, may precede the development of alcoholism, and may be markers of a predisposition toward the development of a spectrum of disinhibitory conditions including alcoholism. Genetic loci underlying some neuroelectic measures that involve neurotransmitter systems of the brain have been identified. CONCLUSIONS Quantitative neuroelectric measures (EEG, ERPs, EROs) provide valuable endophenotypes in the study of genetic risk to develop alcoholism and related disorders. SIGNIFICANCE Genetic studies of neuroelectric endophenotypes offer a powerful strategy for identifying susceptibility genes for developing psychiatric disorders, and provide novel insights into etiological factors.
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Affiliation(s)
- Bernice Porjesz
- Neurodynamics Laboratory, Department of Psychiatry, SUNY, Downstate Medical Center, Brooklyn, NY 11203, USA.
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Mason G, Bendszus M, Meyerhoff D, Hetherington H, Schweinsburg B, Ross B, Taylor M, Krystal J. Magnetic resonance spectroscopic studies of alcoholism: from heavy drinking to alcohol dependence and back again. Alcohol Clin Exp Res 2005; 29:150-158. [PMID: 15895489 DOI: 10.1097/01.alc.0000150010.72739.58] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Frankle WG, Slifstein M, Talbot PS, Laruelle M. Neuroreceptor Imaging in Psychiatry: Theory and Applications. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2005; 67:385-440. [PMID: 16291028 DOI: 10.1016/s0074-7742(05)67011-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- W Gordon Frankle
- Departments of Psychiatry, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, New York 10032, USA
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de Mendelssohn A, Kasper S, Tauscher J. [Neuroimaging in substance abuse disorders]. DER NERVENARZT 2004; 75:651-62. [PMID: 15300321 DOI: 10.1007/s00115-003-1565-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of neuroimaging techniques in research on substance abuse disorders has advanced our understanding of the underlying pathophysiological and neuropsychological mechanisms. While initial structural imaging techniques were applied to investigate substance abuse-related cerebral atrophy, the functional techniques of SPECT, PET, and later fMRT and MRS provide a much broader range of possible research in this field. Besides their use in characterizing the pharmacology of abused substances and their relations to the pathophysiology of substance abuse disorders, they have also played an essential role in examining the neuropsychiatric underpinnings of the illness and their manifestation in changes of cerebral metabolism. Here, the influence of these techniques on the developing picture of substance abuse disorders is discussed by examining areas of particular scientific interest and reviewing exemplary findings.
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Affiliation(s)
- A de Mendelssohn
- Klinische Abteilung für Allgemeine Psychiatrie, Universitätsklinik für Psychiatrie Wien
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Abstract
AIM To examine clinically relevant research on the development, course and outcomes of adolescence alcohol use disorders (AUDs). METHODS Observational studies with adolescent samples were selected for inclusion based on systematic assessment of AUDs and clinical relevance. The literature was searched using Medline and Psychinfo. Articles on childhood predictors, characteristics, course, complications and adult outcomes of adolescent AUDs were reviewed. RESULTS The developmental trajectory toward adolescent AUDs begins with the emergence of childhood mental disorders. These problems are transmitted from parent to child in a developmentally specific fashion, reflect psychological dysregulation dimensions and predict adolescent AUDs. While most DSM-IV AUD diagnostic criterion items are valid for adolescents, tolerance and impaired control items are problematic, and some adolescents with significant alcohol problems are not identified by this diagnostic system. Understanding the psychosocial and biomedical complications that accompany AUDs requires attention to factors other than alcohol involvement itself, including childhood maltreatment and comorbid psychopathology. While some adolescents with AUDs manifest chronic alcohol dependence in adulthood, a substantial proportion overcome alcohol problems and transition to abstinence or normative drinking. CONCLUSIONS Developmentally specific phenotypic characteristics define the natural history of adolescent AUDs, inform clinical assessment and provide the developmental context for treatment research. While alcohol consumption may be the primary treatment focus, other important consequences, comorbidities and complications need to be addressed for successful developmental outcomes to result.
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Affiliation(s)
- Duncan B Clark
- University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Viola A, Nicoli F, Denis B, Confort-Gouny S, Le Fur Y, Ranjeva JP, Viout P, Cozzone PJ. High cerebral scyllo-inositol: a new marker of brain metabolism disturbances induced by chronic alcoholism. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2004; 17:47-61. [PMID: 15340856 DOI: 10.1007/s10334-004-0044-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Revised: 06/07/2004] [Accepted: 06/07/2004] [Indexed: 11/25/2022]
Abstract
Cerebral metabolic changes that concur to motor and/or cognitive disorders in actively drinking alcoholics are not well established. We tested the hypothesis that chronic alcoholics exhibit profound alterations in the cerebral metabolism of scyllo-inositol. Brain metabolism was explored in nine actively drinking and 11 recently detoxified chronic alcoholics by in vivo brain (1)H-MRS and in vitro(1)H-MRS of blood serum and cerebrospinal fluid. The cohort was composed of individuals with acute, subacute or chronic encephalopathy or without any clinical encephalopathy. Chronic alcoholism is associated with a hitherto unrecognized accumulation of brain scyllo-inositol. Our results suggest that scyllo-inositol is produced within the central nervous system and shows a diffuse but heterogenous distribution in brain where it can persist several weeks after detoxification. Its highest levels were observed in subjects with a clinically symptomatic alcohol-related encephalopathy. When detected, brain scyllo-inositol takes part in a metabolic encephalopathy since it is associated with reduced N-acetylaspartate and increased creatine. High levels of cerebral scyllo-inositol are correlated with altered glial and neuronal metabolism. Our findings suggest that the accumulation of scyllo-inositol may precede and take part in the development of symptomatic alcoholic metabolic encephalopathy.
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Affiliation(s)
- A Viola
- Centre de Résonance Magnétique, Biologique et Médicale UMR CNRS 6612, Faculté de Médecine, 27 Bd J. Moulin, 13005 Marseille, France.
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Abstract
Addiction provides fertile ground for the application of the tools of functional neuroimaging. They can be divided into studies of neural activity and neurotransmitter function. Using the former, both opiates and stimulants cause a global decrease in brain metabolism. Against this background, acute doses have still been shown to produce relative increases in brain activation in specific regions, e.g., anterior cingulate, thalamus, and amygdala. These are also regions frequently found with cue-exposure paradigms. Our own work on cue-exposure has shown that heroin-related stimuli provoke activation of the anterior cingulate and orbitofrontal regions. Brain metabolism has also been shown to increase in drug withdrawal from alcohol and cocaine. Neurotransmitter studies have shown that in alcohol dependence, GABA(A)-benzodiazepine (GABA-BDZ) receptors are reduced in a number of brain regions and suggest that there may be 'capacity within the system' in some benzodiazepine functions, but tolerance to others, e.g., time asleep. Finally, 11C-Ro15-4513 offers new opportunities for imaging the GABA-BDZ system.
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Affiliation(s)
- Mark R C Daglish
- Psychopharmacology Unit, School of Medical Sciences, University of Bristol, University Walk, Bristol, BS8 1TD, UK.
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Chao LL, Meyerhoff DJ, Cardenas VA, Rothlind JC, Weiner MW. Abnormal CNV in chronic heavy drinkers. Clin Neurophysiol 2003; 114:2081-95. [PMID: 14580606 DOI: 10.1016/s1388-2457(03)00230-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We used the contingent negative variation (CNV), a slow negative shift in the human electroencephalogram, to investigate the effects of heavy chronic alcohol use on frontal lobe function. METHODS Event-related potentials (ERPs) were recorded from 30 heavy drinkers (HD) and 30 age-, sex-, and education-matched light or non-drinkers (LD), using a classical two-stimulus reaction time (RT) paradigm. Structural magnetic resonance images and neuropsychological tests were also administered. RESULTS The amplitude of the late CNV was significantly reduced in HD relative to light drinkers. Moreover, diminished CNV amplitudes in HD appear to be closely related to the amount of recent alcohol consumption. There were no significant differences in neuropsychological measures of frontal lobe function and frontal lobe volume between light and HD. However, in HD, reduced late CNV amplitudes were associated with decreased frontal lobe gray matter volume and poor performance on the Trail Making Test B. In LD but not in HD, late CNV amplitude correlated positively with RT, suggesting that the late CNV reflects some aspect of motor and cognitive preparation. CONCLUSIONS The inverse relationships between frontal lobe gray matter volume, performance on the Trail Making Test B, and late CNV amplitude in HD suggest that the ERP abnormalities observed in the current study may be indices of alcohol-related damage to the frontal lobe. The lack of a significant relationship between CNV amplitude and RT in HD suggests that chronic heavy alcohol use may disrupt response preparation.
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Affiliation(s)
- Linda L Chao
- Magnetic Resonance Unit, 116R San Francisco VA Medical Center, University of California-San Francisco, 4150 Clement Street, San Francisco, CA 94121, USA.
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Ernst M, Kimes AS, Jazbec S. Neuroimaging and mechanisms of drug abuse: interface of molecular imaging and molecular genetics. Neuroimaging Clin N Am 2003; 13:833-49. [PMID: 15024965 DOI: 10.1016/s1052-5149(03)00109-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Whereas ligand studies can inform the end-products of dysregulation of genetic expression, reporter gene imaging can provide the means to understand the genetic origin of these end-products. As with radioligand studies, in vivo direct measurement of gene expression will allow genetic processes to be monitored over time in the same subject, use of a subject as his/her own control in intervention studies (i.e., measurement before and after an intervention), and monitoring the spatial distribution of molecular events in the whole brain. Furthermore, reporter gene imaging, by advancing knowledge of the biologic mechanisms of disease states, has important clinical implications, particularly in the development and monitoring of treatments. We expect PET to play a prominent role in the elucidation of substance abuse mechanisms and contribute significantly to the development of innovative treatment strategies.
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Affiliation(s)
- Monique Ernst
- Mood and Anxiety Disorders Program, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, 15K North Drive, Room 118, MSC 2670, Bethesda, MD 20892-2670, USA.
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Mishina M, Senda M, Kiyosawa M, Ishiwata K, De Volder AG, Nakano H, Toyama H, Oda KI, Kimura Y, Ishii K, Sasaki T, Ohyama M, Komaba Y, Kobayashi S, Kitamura S, Katayama Y. Increased regional cerebral blood flow but normal distribution of GABAA receptor in the visual cortex of subjects with early-onset blindness. Neuroimage 2003; 19:125-31. [PMID: 12781732 DOI: 10.1016/s1053-8119(03)00051-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Before the completion of visual development, visual deprivation impairs synaptic elimination in the visual cortex. The purpose of this study was to determine whether the distribution of central benzodiazepine receptor (BZR) is also altered in the visual cortex in subjects with early-onset blindness. Positron emission tomography was carried out with [(15)O]water and [(11)C]flumazenil on six blind subjects and seven sighted controls at rest. We found that the CBF was significantly higher in the visual cortex for the early-onset blind subjects than for the sighted control subjects. However, there was no significant difference in the BZR distribution in the visual cortex for the subject with early-onset blindness than for the sighted control subjects. These results demonstrated that early visual deprivation does not affect the distribution of GABA(A) receptors in the visual cortex with the sensitivity of our measurements. Synaptic elimination may be independent of visual experience in the GABAergic system of the human visual cortex during visual development.
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Affiliation(s)
- Masahiro Mishina
- Department of Neurology, Neurological Institute, Nippon Medical School Chiba-Hokusoh Hospital, Inba, Japan.
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Volkow ND, Fowler JS, Wang GJ. Positron emission tomography and single-photon emission computed tomography in substance abuse research. Semin Nucl Med 2003; 33:114-28. [PMID: 12756644 DOI: 10.1053/snuc.2003.127300] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Many advances in the conceptualization of addiction as a disease of the brain have come from the application of imaging technologies directly in the human drug abuser. New knowledge has been driven by advances in radiotracer design and chemistry and positron emission tomography (PET) and single-photon emission computed tomography (SPECT) instrumentation and the integration of these scientific tools with the tools of biochemistry, pharmacology, and medicine. This topic cuts across the medical specialties of neurology, psychiatry, oncology, and cardiology because of the high medical, social, and economic toll that drugs of abuse, including the legal drugs, cigarettes and alcohol, take on society. This article highlights recent advances in the use of PET and SPECT imaging to measure the pharmacokinetic and pharmacodynamic effects of drugs of abuse on the human brain.
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Affiliation(s)
- Nora D Volkow
- Brookhaven National Laboratory, Upton, NY 11973, USA
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50
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Abstract
Alcohol and psycho-active substance misuse has far-reaching social, psychological and physical consequences. Advances in neuroimaging technology have allowed neurobiological theories of addiction to become better characterized. We describe the neurobiology of dependence, withdrawal, abstinence and craving states in alcohol, stimulant and opiate misuse. Structural neuroimaging techniques such as CT and MRI with new analytical approaches such as voxel-based morphometry have shown wide-spread changes in stimulant and opiate abuse and atrophy, particularly in the frontal lobes, in alcoholism. Functional neuroimaging techniques such as PET, SPECT and fMRI reveal altered regional cerebral activity by all drugs of abuse. The neurochemistry of addiction, particularly involving dopamine, serotonin, opiate and GABA, has been studied with PET and SPECT and similarities between all drugs of abuse have been found such as reduced dopaminergic markers. The evidence derived from these advances in neuroimaging is likely to herald the emergence of new biological treatments in this important field.
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Affiliation(s)
- A R Lingford-Hughes
- Psychopharmacology Unit, School of Medical Sciences, University of Bristol, UK
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