This manuscript is dedicated to Dr. Robert E. Anderson, who played an essential part in acquiring the data described here, and passed away during the preparation of this article.
Reduced fMRI activity predicts relapse in patients recovering from stimulant dependence
Version of Record online: 27 SEP 2012
Copyright © 2012 Wiley Periodicals, Inc.
Human Brain Mapping
Volume 35, Issue 2, pages 414–428, February 2014
How to Cite
Clark, V. P., Beatty, G. K., Anderson, R. E., Kodituwakku, P., Phillips, J. P., Lane, T. D.R., Kiehl, K. A. and Calhoun, V. D. (2014), Reduced fMRI activity predicts relapse in patients recovering from stimulant dependence. Hum. Brain Mapp., 35: 414–428. doi: 10.1002/hbm.22184
- Issue online: 13 JAN 2014
- Version of Record online: 27 SEP 2012
- Manuscript Accepted: 30 JUL 2012
- Manuscript Revised: 22 JUL 2012
- Manuscript Received: 3 APR 2012
- National Institute of Drug Abuse and NIH. Grant Number: R01DA012852
- NCRR. Grant Number: 5M01RR000997, subproject 8353 (to V.P.C.)
- drug dependence;
Relapse presents a significant problem for patients recovering from stimulant dependence. Here we examined the hypothesis that patterns of brain function obtained at an early stage of abstinence differentiates patients who later relapse versus those who remain abstinent. Forty-five recently abstinent stimulant-dependent patients were tested using a randomized event-related functional MRI (ER-fMRI) design that was developed in order to replicate a previous ERP study of relapse using a selective attention task, and were then monitored until 6 months of verified abstinence or stimulant use occurred. SPM revealed smaller absolute blood oxygen level-dependent (BOLD) response amplitude in bilateral ventral posterior cingulate and right insular cortex in 23 patients positive for relapse to stimulant use compared with 22 who remained abstinent. ER-fMRI, psychiatric, neuropsychological, demographic, personal and family history of drug use were compared in order to form predictive models. ER-fMRI was found to predict abstinence with higher accuracy than any other single measure obtained in this study. Logistic regression using fMRI amplitude in right posterior cingulate and insular cortex predicted abstinence with 77.8% accuracy, which increased to 89.9% accuracy when history of mania was included. Using 10-fold cross-validation, Bayesian logistic regression and multilayer perceptron algorithms provided the highest accuracy of 84.4%. These results, combined with previous studies, suggest that the functional organization of paralimbic brain regions including ventral anterior and posterior cingulate and right insula are related to patients' ability to maintain abstinence. Novel therapies designed to target these paralimbic regions identified using ER-fMRI may improve treatment outcome. Hum Brain Mapp 35:414–428, 2014. © 2012 Wiley Periodicals, Inc.