Manifestations of early brain recovery associated with abstinence from alcoholism
1 University of Würzburg, Department of Neuroradiology, Würzburg Germany 2 University of Applied Police Sciences, Aschersleben Germany 3 University of Oxford, Image Analysis Group/FMRIB Centre Oxford, UK 4 University of Siena, Department of Neurological and Behavioural Sciences Siena, Italy 5 University of Basel, Department of Psychiatry Basel, Switzerland
Correspondence to: Dr Andreas J. Bartsch, Department of Neuroradiology, University of Würzburg, Josef-Schneider-Strasse 11, D-97080 Würzburg, Germany E-mail: bartsch@neuroradiologie.uni-würzburg.de
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 T1-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 (1H-MRS), and neuropsychological tests were applied. Upon short-term sobriety, 1H-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 1H-MRS. Moreover, frontomesial NAA gains were associated with improved performance on the d2-test of attention. In 10 age- and 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.
Key Words: alcoholism; morphometry; MR spectroscopy; SIENA; voxelwise SIENA statistics
Abbreviations: 1H-MRS, proton MR spectroscopy; NAA, N-acetylaspartate; PBVC, percentage brain volume change; SIENA, structural image evaluation using normalization of atrophy
Received May 8, 2006. Revised September 21, 2006. Accepted September 29, 2006.
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