Brain fMRI Cue-Reactivity Can Predict Baclofen Response in Alcohol Use Disorders
Bharath Holla 1, Sheshachala Karthik 1, Jitendriya Biswal 1, Biju Viswanath 1, Deepak Jayarajan 1, Rose Dawn Bharath 2*, Ganesan Venkatasubramanian 1, Vivek Benegal 1
1Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India, 2Department Neuroimaging and Interventional Radiology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
Received: May 3, 2017; Revised: July 11, 2017; Accepted: July 17, 2017; Published online: July 17, 2017.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Objectives:
Baclofen is a promising treatment for Alcohol Use Disorders (AUD), although its clinical response in humans is mixed. The present study aimed at investigating the impact of baclofen treatment on cue-induced brain activation pattern and its relationship with relapse outcomes.
Methods:
Twenty-three inpatients with AUD underwent a functional magnetic resonance imaging (fMRI) cue-reactivity task before beginning medication with baclofen and 2 weeks later. Twelve additional in-patients with AUD, who did not receive any anti-craving medications, formed the control group. All subjects were prospectively followed up for 90 days post-discharge or until lapse to first alcohol use.
Results:
Whole-brain linear mixed effects analysis revealed a significant group-by-time interaction with greater activation of the bilateral dorsolateral prefrontal cortex and right anterior cingulate cortex (ACC) following baclofen treatment in comparison with the control group. Further, cox regression analysis revealed that increased activation of ACC and deactivation of insular cortex (IC) was associated with longer time to first alcohol use only in the baclofen treatment group but not in the control group.
Conclusions:
This study provides preliminary evidence for the neural predictors of baclofen treatment response in AUD. Baclofen treatment in AUD was associated with changes in cue-reactivity at critical brain regions within the incentive-salience network. Importantly, baclofen treatment-related specific activation of regions involved in cognitive control (ACC) and deactivation of regions involved in reward anticipation (insula) prolonged the time to first alcohol drink.
Keywords: Baclofen, fMRI Cue-Reactivity, Relapse Prediction, iRISA


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