Clin Psychopharmacol Neurosci 2018; 16(3): 290-301  
Brain Functional Magnetic Resonance Imaging Cue-reactivity Can Predict Baclofen Response in Alcohol Use Disorders
Bharath Holla1, Sheshachala Karthik1, Jitendriya Biswal1, Biju Viswanath1, Deepak Jayarajan1, Rose Dawn Bharath2, Ganesan Venkatasubramanian1, Vivek Benegal1
Departments of 1Psychiatry and 2Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
Correspondence to: Rose Dawn Bharath, DM
Department of Neuroimaging and Interventional Radiology, Cognitive Neurosciences Centre, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
Tel: +91-80-2699-5424/5454
E-mail: drrosedawn@yahoo.com
ORCID: https://orcid.org/0000-0002-7464-4250
Received: May 4, 2017; Revised: July 11, 2017; Accepted: July 17, 2017; Published online: August 31, 2018.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: 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 cue-reactivity task before beginning medication with baclofen and 2 weeks later. Twelve additional inpatients with AUD, who did not receive any anticraving 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 pre-frontal 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.
Conclusion: 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 (IC) prolonged the time to first alcohol drink.
Keywords: Baclofen; Functional magnetic resonance imaging; Cue-reactivity; Relapse prediction.


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