Erken ve geç başlangıçlı alkol bağımlılarında bölgesel beyin kan akımının değerlendirilmesi: SPECT çalışması

Öz

Amaç: Alkol bağımlılığının beynin yapısı ve işlevselliği üzerinde olumsuz etkileri vardır. Alkole başlangıç yaşı, alkol bağımlılarının gruplandırılmasında önemli bir parametredir. Bu çalışmanın amacı erken (EB) ve geç başlangıçlı (GB) alkol bağımlılarında bölgesel beyin kan akımı (b-BKA) değerlerlerinin farkılılık gösterip göstermediğini karşılaştırmaktır.

Yöntemler: DSM-IV ölçütlerine gore alkol bağımlılğı tanısı olan 33 erkek hasta ve 13 sağlıklı control çalışmaya alınmıştır. Kortikal serebral kan akımının bölgesel değerleri yüksek çözünürlüklü Tc-99m-HMPA tek foton emisyon bilgisayarlı tomografi kullanılarak değerlendirilmiştir. Alkolik olgular sorunlu alkol başlangıç yaşına göre iki gruba ayrılmıştır. 

Bulgular:  Üç grup karşılaştırıldığında alt frontal, alt temporal, alt sol oksipital ve orta sol frontal bölgelerde b-BKA farklılıkları saptanmıştır (p<0.05). GB grupta control grubuna göre her iki alt frontal ve temporal bölgede azalmış b-BKA değerleri bulunmuştur (p<0.005). GB grup EB grupla karşılaştırıldığında, alt frontal ve temporal, alt sol oksipital ve orta sol frontal bölgelerde anlamlı derecede azalmış b-BKA değerleri göstermiştir (p<0.05). 

Sonuç: Bulgularımız erken ayıklık dönemindeki EB ve GB alkol bağımlılarında b-BKA’nda farklılıklar olduğunu ortaya koymuştur. Bu bulgular daha önceki çalışmalarda da belirtildiği üzere frontal lobun alkolizmin nörobiyolojisinde kilit role sahip olduğuna işaret etmektedir. Uzun sureli ayıklık döneminden sonra ölçümlerin tekrarlanması alkol bağımlısı gruplar arasındaki farklılıkların ortaya konmasında yararlı olacaktır. 

Anahtar Kelimeler

• Alkolizm,SPECT,Serebral kan akımı

Assessment of regional cerebral blood flow in patients with early and late onset alcohol dependence: SPECT study

Abstract

Aim: Alcohol dependence has negative effects on the structure and functionality of the brain. The age of onset of alcohol is an important parameter in the grouping of alcoholics. The aim of this study is to compare whether regional cerebral blood flow (r-CBF) values differ between early (EO) versus late onset (LO) alcoholic patients.

Methods: A total of 33 male patients with alcohol dependence as per DSM-IV criteria and 13 healthy controls were enrolled for the study. Regional measures of cortical cerebral blood flow were assessed using a high resolution Tc-99m-HMPAO single photon emission computed tomography (SPECT). Alcoholic subjects were divided into two groups according to onset of problematic alcohol drinking age. 

Results: When three groups were compared, r-CBF differences were obtained in inferior frontal, inferior temporal, inferior left occipital and middle left frontal regions. Decreased r-CBF values were found in LO group when they compared to controls in both lower frontal and temporal regions (p<0.05). LO group showed significant reduced r-CBF values in regions of inferior frontal and temporal, inferior left occipital and middle left frontal when compared with EO. 

Conclusion: Our findings revealed that, there were differences in r-CBF values in EO and LO alcoholics at early abstinence period. These findings suggest that frontal lobes have a key role in alcoholism neurobiology, as noted in previous studies. Repeating the measurements after a long-term abstinence will be useful in revealing differences among the alcoholic groups. 

Keywords

• Alcoholism,SPECT,Cerebral blood flow

References

1. 1. Oscar-Berman M, Marinkovic K. Alcohol: Effects on neurobehavioral functions and the brain alcoholism and the brain: An overview. Neuropsychol Rev. 2007;17:239–57.
2. 2. Soyka M, Dresel S, Horak M, Ruther T, Tatsch K. PET and SPECT findings in alcohol hallucinosis: Case report and super-brief review of the pathophysiology of this syndrome. World J.Biol.Psychiatry. 2000;1:215-18.
3. 3. Demir B, Ulug B, Lay EE, Erbas B. Regional cerebral blood flow and neuropsychological functioning in early and late onset alcoholism. Psychiatry Res. 2002;115:115-25.
4. 4. Suzuki Y, Oishi M, Mizutani T, Sato Y. Regional cerebral blood flow measured by the resting and vascular reserve (RVR) method in chronic alcoholics. Alcohol Clin.Exp Res. 2002;26:95-9.
5. 5. Kubota M, Nakazaki S, Hirai S, Saeki N, Yamaura A, Kusaka T. Alcohol consumption and frontal lobe shrinkage: Study of 1432 non-alcoholic subjects. J Neurol Neurosurg Psychiatry. 2001;71:104-6.
6. 6. Nicolas JM, Catafau AM, Estruch R, Lomeña FJ, Salamero M, Herranz R, et al. Regional cerebral blood flow-SPECT in chronic alcoholism: relation to neuropsychological testing. J Nucl Med. 1993;34:1452-9.
7. 7. Tutus A, Kugu N, Sofuoglu S, Nardali M, Kugu N, Karaaslan F, et al. Transient frontal hypoperfusion in Tc-99m hexamethylpropyleneamineoxime single photon emission computed tomography imaging during alcohol withdrawal. Biol Psychiatry. 1998;43:923-8.
8. 8. Noel X, Sferrazza R, Van Der LM, Paternot J, Verhas M, Hanak C, et al. Contribution of frontal cerebral blood flow measured by (99m) Tc-Bicisate spect and executive function deficits to predicting treatment outcome in alcohol-dependent patients. Alcohol Alcohol. 2002;37:347-54.

9. 9. Pach D, Hubalewskava DA, Szurkowska Kamenczak A, Targosz D, Gawlikowski T, Huszno B, et al. Evaluation of regional cerebral blood flow using 99m Tc-ECD SPECT in ethanol alcohol dependent patients: pilot study. Przegl Lek. 2007;64(4-5):204-7.
10. 10. Fortier CB, Leritz EC, Salat DH, Lindemer E, Maksimovskiy AL, Shepel J, et al. Widespread effects of alcohol on white matter microstructure. Alcohol Clin Exp Res. 2014;38(12):2925-33.
11. 11. Squeglia LM, Jacobus J, Tapert SF. The effect of alcohol use on human adolescent brain structures and systems. Handb Clin Neurol. 2014;125:501-10.
12. 12. Daglish MR, Nutt DJ. Brain imaging studies in human addicts. Eur Neuropsychopharmacol. 2003;13:453-8.
13. 13. Dupont RM, Rourke SB, Grant I, Lehr PP, Reed RJ, Challakere K, et al. Single photon emission computed tomography with iodoamphetamine-123 and neuropsychological studies in long-term abstinent alcoholics. Psychiatry Res. 1996;67:99-111.
14. 14. Ebstein EE, Labovie E, McCrady B, Jensen NK, Hayaki J. A multi-site study of alcohol subtypes: classification and overlap of unidimensional and multi-dimensional typologies. Addiction. 2002;97:1041-53.
15. 15. Cloninger CR, Bohman M, Sigvardsson S. Inheritance of alcohol abuse. Cross-fostering analysis of adopted men. Arch Gen Psychiatry. 1981;38(8):861-8.
16. 16. Johnson BA, Cloninger CR, Roache JD, Bordnick PS, Ruiz P. Age of onset as a discriminator between alcoholic subtypes in a treatment-seeking outpatient population. Am J Addict. 2000;9:17-27.
17. 17. Buydens-Brachey M, Branchey M, Noumair D. Age of alcoholism onset. Relationship to psychopathology. Arch Gen Psychiatry. 1989;4:225-30.
18. 18. Von Knorring L, Palm V, Anderson H. Relationship between treatment outcome and subtypes of alcoholism in men. J Stud Alcohol. 1985;46:388-91.
19. 19. Selzer M. The Michigan alcoholism screening test: The quest for new diagnostic instrument. Am J Psychiatry. 1971;127:1653-8.
20. 20. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62.
21. 21. Hamilton M. The assessment of anxiety states by rating. British J of Med Psychol. 1959;32:50-5.
22. 22. Chiu NT, Chang YC, Lee BF, Huang CC, Wang ST. Differences in 99mTc-HMPAO brain SPET perfusion imaging between Tourette's syndrome and chronic tic disorder in children. Eur J Nucl Med. 2001;28:183-90.
23. 23. Rubin RT, Villanueva-Meyer J, Ananth J, Trajmar PG, Mena I. Regional xenon 133 cerebral blood flow and cerebral technetium 99m HMPAO uptake in unmedicated patients with obsessive-compulsive disorder and matched normal control subjects. Determination by high-resolution single-photon emission computed tomography. Arch Gen Psychiatry. 1992;49:695-702.
24. 24. Yazici KM, Kapucu O, Erbas B,Varoglu E, Gülec C, Bekdik CF. Assessment of changes in regional cerebral blood flow in patients with major depression using the 99mTc-HMPAO single photon emission tomography method. Eur J Nucl Med. 1992;19:1038-43.
25. 25. Moselhy HF, Georgiou G, Kahn A. Frontal lobe changes in alcoholism: A review of the literature. Alcohol Alcohol. 2001;36:357-68.
26. 26. Clark CP, Brown GG, Eyler LT, Drummond SP, Braun DR, Tapert SF. Decreased perfusion in young alcohol-dependent women as compared with age-matched controls. Am J Drug Alcohol Abuse. 2007;33(1):13-9.
27. 27. Gansler DA, Harris GJ, Oscar-Berman M, Streeter C, Lewis RF, Ahmed I, et al. Hypoperfusion of inferior frontal brain regions in abstinent alcoholics: A pilot SPECT study. J.Stud.Alcohol. 2000;61:32-7.
28. 28. Harris GJ, Oscar-Berman M, Gansler A, Streeter C, Lewis RF, Ahmed I, et al. Hypoperfusion of the cerebellum and aging effects on cerebral cortex blood flow in abstinent alcoholics: A SPECT study. Alcohol Clin.Exp.Res. 1999;23:1219-27.
29. 29. Gazdzinski S, Durazzo TC, Meyerhoff DJ. Temporal dynamics of whole brain tissue volume changes during recovery from alcohol dependence. Drug Alcohol Depend. 2005;78(3):263-73.
30. 30. Gazdzinski S, Durazzo DC, Mon A, Yeh PH, Meyerhoff DJ. Cerebral white matter recovery in abstinent alcoholics-a multimodality magnetic resonance study. Brain. 2010;133:1043-53.
31. 31. Durazzo TC, Gazdzinski S, Mon A, Meyerhoff DJ. Cortical perfusion in alcohol dependent individuals during short-term abstinence: Relationships to resumption of hazardous drinking following treatment. Alcohol. 2010;44(3):201-10.