Manifestations of early brain recovery associated with abstinence from alcoholism

Abstract

Chronic alcohol abuse results in morphological, metabolic, and functional brain damage which may, to some extent, be reversible with early effects upon abstinence. Although morphometric, spectroscopic, and neuropsychological indicators of cerebral regeneration have been described previously, the overall amount and spatial preference of early brain recovery attained by abstinence and its associations with other indicators of regeneration are not well established. We investigated global and local brain volume changes in a longitudinal two-timepoint study with T 1 -weighted MRI at admission and after short-term (6-7 weeks) sobriety follow-up in 15 uncomplicated, recently detoxified alcoholics. Volumetric brain gain was related to metabolic and neuropsychological recovery. On admission and after short-term abstinence, structural image evaluation using normalization of atrophy (SIENA), its voxelwise statistical extension to multiple subjects, proton MR spectroscopy ( 1 H-MRS), and neuropsychological tests were applied. Upon short-term sobriety, 1 H-MRS levels of cerebellar choline and frontomesial N-acetylaspartate (NAA) were significantly augmented. Automatically detected global brain volume gain amounted to nearly two per cent on average and was spatially significant around the superior vermis, perimesencephalic, periventricular and frontal brain edges. It correlated positively with the percentages of cerebellar and frontomesial choline increase, as detected by 1 H-MRS. Moreover, frontomesial NAA gains were associated with improved performance on the d2-test of attention. In 10 ageand gender-matched healthy control subjects, no significant brain volume or metabolite changes were observed. Although cerebral osmotic regulations may occur initially upon sobriety, significant increases of cerebellar choline and frontomesial NAA levels detected at stable brain water integrals and creatine concentrations, serum electrolytes and red blood cell indices in our patient sample suggest that early brain recovery through abstinence does not simply reflect rehydration. Instead, even the adult human brain and particularly its white matter seems to possess genuine capabilities for regrowth. Our findings emphasize metabolic as well as regionally distinct morphological capacities for partial brain recovery from toxic insults of chronic alcoholism and substantiate early measurable benefits of therapeutic sobriety. Further understanding of the precise mechanisms of this recovery may become a valuable model of brain regeneration with relevance for other disorders.Keywords: alcoholism; morphometry; MR spectroscopy; SIENA; voxelwise SIENA statistics Abbreviations:1 H-MRS = proton MR spectroscopy; NAA = N-acetylaspartate; PBVC = percentage brain volume change; SIENA = structural image evaluation using normalization of atrophy

Effects of acute dehydration on brain morphology in healthy humans

“…SIENA has been used in a number of studies investigating changes in brain structure [Bartsch et al, 2007;Mezzapesa et al, 2007;Peters et al, 2006] and is briefly described below. The SIENA program is applied to each participant's pair of images, scanned before and after acute dehydration.…”

“…To allow voxelwise statistical interrogation of the data, the mean displacement images for each participant are dilated (14 times using a 3 3 3 3 3 kernel, nonbinary dilation) and transformed into Montreal Neurological Institute (MNI) space and masked by a standard brain edge image [Bartsch et al, 2007]. The number of dilations performed is the standard number for a SIENA voxelwise analysis and provides a large enough band of flow values around the brain-CSF boundary so that the standard brain edge mask can extract values for each point on the mask.…”

The Whole Spectrum of Alcohol-Related Changes in the CNS: Practical MR and CT Imaging Guidelines for Daily Clinical Use

“…Not only the focal distribution of alcohol in the brain and changes in cellular metabolites such as aspartate but also the regeneration of the brain tissue under oxidative stress in the case of abstinence in chronic abuse can be dynamically detected on magnetic resonance spectroscopy and correlate with clinical recovery [48 -50]. Cerebral regeneration in the case of abstinence is reflected in a focally differentiated increase in the choline and NAA peaks [51].…”

Reversible Alcohol-related Dementia: A Five-year Follow-up Study Using FDG-PET and Neuropsychological Tests

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