Multiple previous alcohol detoxifications are associated with decreased medial temporal and paralimbic function in the postwithdrawal period

Background: Functional neuroimaging studies after alcohol cessation have de monstrated that chronic alcohol use globally reduces neuronal activity for several weeks. Less is known about the effects of previous alcohol use patt erns on regional brain activity. Multiple previous alcohol detoxifications are associated with a worse clinical course and increased risk of seizures, perhaps due to sensitization of key brain structures. We performed the fol lowing imaging study in alcoholics in the postwithdrawal period to determin e if blood now in medial temporal structures would differ as a function of previous alcohol use (i.e., whether regions were kindled or sensitized due to multiple detoxifications). Methods: Fourteen adults meeting DSM-IV criteria for alcohol dependence (me an age 35, 8 SD; 10 men) and participating in a double-blind detoxification medication study underwent a brain perfusion Tc99 m-ECD (Neurolite) single photon emission computed tomography scan on days 7 through 9 (mean 7.6, .5 SD) after their last drink and 2 to 3 days since their last detoxification medication. Seven nonpsychiatrically ill, nonalcohol-dependent healthy adu lts were scanned as control subjects. Results: Alcoholics compared with controls had widely reduced relative acti vity in cortical secondary association areas and relatively increased activ ity in the medial temporal lobes (p < 0.01). Five alcoholic patients with g reater than or equal to 2 previous detoxifications were compared with five patients in their first detoxification (age and detoxification medication m atched). Multiple detoxification patients had significantly lower relative activity in bilateral anterior temporal poles and medial temporal lobes and in visual cortex (p < 0.01) compared with first episode patients. Conclusions: These studies are consistent with other studies comparing alco holics and controls. They also suggest that on day 7 of detoxification, alc oholic subjects with multiple previous detoxifications have decreased visua l cortex, medial temporal lobes, and anterior paralimbic blood flow, compar ed with those in their first detoxification. Further studies seem warranted to confirm these initial exploratory results.