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Abstinence Restores the Alcoholic Brain

New evidence correlates short-term recovery of brain structure, metabolism, and function in abstinent alcoholics.

Bartsch and colleagues used automated structural brain imaging, proton MR spectroscopy, and neuropsychological testing to assess whether abstinence in alcoholics leads to brain repair. Within a few days after alcohol withdrawal and 6 to 7 weeks later, they evaluated 15 patients with DSM-IV–defined primary alcohol dependence. A group of 10 normal subjects served as controls. Notably, the alcoholics did not smoke heavily, and none required medication to treat symptoms of alcohol withdrawal.

From the first to the second evaluation, alcoholics exhibited a nearly 2% increase in total brain volume (compared with no change among controls), with region-specific increases in the superior cerebellar vermis, the perimesencephalic and periventricular regions, and the frontomesial and fronto-orbital edges. Increased brain volume correlated significantly with increases in cerebellar and frontomesial levels of choline, but not with N-acetylaspartate (NAA) levels. In contrast, improved performance on a test of attention was significantly associated with increases in frontomesial NAA levels. Measures of brain water levels did not change over time.

Comment: Although longitudinal studies have demonstrated short-term recovery of brain structure, metabolism, and function in abstinent alcoholics, this is the first to combine all three measures. The metabolic data suggest that increases in brain volume were due to white matter repair rather than to increases in brain hydration. The patient population may have had a less severe form of alcoholism than is typical, because detoxification was not associated with significant symptoms of withdrawal and metabolic measures did not differ at baseline from those in the control population. This study adds to a growing body of evidence that the brain undergoes significant repair during abstinence, particularly in less severe forms of alcoholism. It is noteworthy that volume increases were observed in several brain areas that are selectively affected in Wernicke encephalopathy, a disorder of thiamine deficiency that occurs most commonly in alcoholics. Hence, it remains possible that improved nutrition as well as sobriety contributes to brain repair following abstinence.

— Michael E. Charness, MD

Dr. Charness is Professor of Neurology, Harvard Medical School; Associate Chief, Department of Neurology, Brigham and Women's Hospital; and Chief of Staff, Veterans Affairs Boston Healthcare System.

Published in Journal Watch Neurology March 20, 2007

Citation(s):

Bartsch AJ et al. Manifestations of early brain recovery associated with abstinence from alcoholism. Brain 2007 Jan; 130:36-47.

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