Effect of long term baclofen treatment on recognition memory and novelty detection

Cognitive Dysfunction in Persons with Chronic Spinal Cord Injuries

Cognitive dysfunction (CD) is pervasive in individuals who have chronic spinal cord injuries (SCI). Although classically associated with concomitant traumatic brain injuries, many other causes have been proposed, including premorbid neuropsychological conditions, mood disorders, substance abuse, polypharmacy, chronic pain and fatigue, sleep apnea, autonomic dysregulation, post-intensive care unit syndrome, cortical reorganizations, and neuroinflammation. The consequences of CD are likely widespread, affecting rehabilitation and function. CD in those with SCI should be recognized, and potentially treated, in order to provide the best patient care.

Cognitive effects of labeled addictolytic medications

INTRODUCTION

Alcohol, tobacco, and illegal drug usage is pervasive throughout the world, and abuse of these substances is a major contributor to the global disease burden. Many pharmacotherapies have been developed over the last 50years to target addictive disorders. While the efficacy of these pharmacotherapies is largely recognized, their cognitive impact is less known. However, all substance abuse disorders are known to promote cognitive disorders like executive dysfunction and memory impairment. These impairments are critical for the maintenance of addictive behaviors and impede cognitive behavioral therapies that are regularly administered in association with pharmacotherapies. It is also unknown if addictolytic medications have an impact on preexisting cognitive disorders, and if this impact is modulated by the indication of prescription, i.e. abstinence, reduction or substitution, or by the specific action of the medication.

METHOD

We reviewed the cognitive effects of labeled medications for tobacco addiction (varenicline, bupropion, nicotine patch and nicotine gums), alcohol addiction (naltrexone, nalmefene, baclofen, disulfiram, sodium oxybate, acamprosate), and opioid addiction (methadone, buprenorphine) in human studies. Studies were selected following MOOSE guidelines for systematic reviews of observational studies, using the keywords [Cognition] and [Cognitive disorders] and [treatment] for each medication.

RESULTS

971 articles were screened and 77 studies met the inclusion criteria and were reported in this review (for alcohol abuse, n=21, for tobacco n=22, for opioid n=34. However, very few comparative clinical trials have explored the chronic effects of addictolytic medications on cognition in addictive behaviors, and there are no clinical trials on the cognitive impact of nalmefene in patients suffering from alcohol use disorders.

DISCUSSION

Although some medications seem to enhance cognition in patients suffering from cognitive disorders, others could promote cognitive impairments, and our work highlights a lack of literature on this subject. In conclusion, more comparative clinical trials are needed to better understand the cognitive impact of addictolytic medications.

Influence of intrathecal baclofen on the level of consciousness and mental functions after extremely severe traumatic brain injury: brief report

BACKGROUND

Whenever oral treatment or botulinum toxin injections fail to control severe spasticity, a trial with intrathecal baclofen is recommended no earlier than 1 year after brain injury. When irreversible contractures are to be avoided, such a trial might be done earlier. Some have briefly reported cognitive modifications with this treatment.

METHODS

During the trial period, intrathecal baclofen is continuously infused by a portable external pump through an intrathecal catheter. The daily dose is adjusted according to the clinical response. If the expected response is obtained by reduction of spasticity, a programmable pump is then implanted. Throughout the procedure, close neuropsychological follow-up is pursued.

RESULTS

Two persons with extremely severe brain injury and spasticity received a programmable pump less than 10 months after trauma. Unexpectedly, one emerged from the minimally conscious state and the other from post-traumatic amnesia.

CONCLUSIONS

Intrathecal baclofen should be considered within the first year after brain injury whenever spasticity does not respond to medication. ITB lessens the degree of spasticity which in turn facilitates care and, thus, has the potential to limit contractures. After severe brain injury, this treatment might trigger recovery from altered states of consciousness, improve cognition and facilitate rehabilitation.

Relationship between intrathecal baclofen and the central nervous system

The GABA(B) receptor agonists display a number of pharmacological effects including central muscle relaxation, decreased self-administration of cocaine and narcotic drugs, antinociception, cognitive impairment as well as enhancement of synaptic plasticity. The main relationships between intrathecal or intracerebral baclofen and the Central Nervous System (CNS) are reviewed with particular attention to actions on pain, epilepsy and basal ganglia regulation. Since baclofen may be involved in synaptic plasticity and the development of neuronal pathways, the main issues of this field are reviewed with particular attention to the effects of baclofen on the developing brain. The role of baclofen in the regulation of movement has not been clearly understood, but recent findings support its important involvement in globus pallidus and subthalamic nucleus. The neuroprotective action of baclofen in cerebral ischemia is a matter of debate. The effects of baclofen in cognition and attention are another important issue because patients with chronic intrathecal baclofen (ITB) administration often present with impairment of cognitive functions. Drug craving and its improvement after baclofen administration is also reviewed. Finally, the clinically interesting results on the regulation of food intake and blood pressure are highlighted. The preliminary experience on the effects in cortical neuron viability at different concentrations of ITB is reported.

Neotic preferences in laboratory rodents: Issues, assessment and substrates

Neotic preference refers to the extent to which animals prefer stimuli of differing novelty value. Degree of novelty is determined by within- and between-trials habituation and amount of temporal (novelty) and spatial change (complexity) in stimulation which in turn will determine the amount of curiosity-based approach (neophilia) or fear-based avoidance (neophobia) of novel stimuli. Tests of genuine neotic preferences enable direct assessments of responsiveness to temporal and spatial changes and include measurements of novel versus familiar locations (such as novelty-related location preferences), responsiveness to stimulus complexity (such as object exploration) and learning for exploratory rewards (such as light-contingent bar-pressing). Effects of brain lesions and peripherally administered drugs have implicated several brain areas and neurotransmitters that subserve memory, fear and reward in neotic preferences namely the hippocampus and ACh (memory), the amygdala, GABA and 5-HT (fear), and the mesolimbic DA reward system. However, more attention should be paid to the complexity of interactions between different brain and neurotransmitter systems and improvements in methodology before conclusions should be drawn about the neurobiological basis of neotic preferences.

GABAB receptor antagonism abolishes the learning impairments in rats with chronic atypical absence seizures

Chronic atypical absence seizures are a component of the Lennox-Gastaut syndrome, a disorder invariably associated with severe cognitive impairment in children. However, the cause of this intellectual delay remains unclear. The AY9944 model of chronic atypical absence seizures in rats reliably reproduces the electrographic, behavioral, pharmacological and cognitive features of clinical atypical absence. Using this model, we tested the hypothesis that the cognitive impairment associated with this disorder involves a gamma-aminobutyric acid B (GABA(B)) receptor-mediated mechanism. Therefore, we examined the effect of a specific, high affinity GABA(B) receptor antagonist, CGP35348, on the atypical absence seizures, the working memory deficits, and the altered long-term potentiation that we have observed in the AY9944 model. CGP35348 blocked atypical absence seizures, restored long-term potentiation to normal level, and reversed the cognitive deficit in the AY9944-treated animals. However, dose-response studies showed that lower doses of CGP35348 that failed to influence atypical absence seizure activity, completely reversed the spatial working memory deficit. These data suggest that GABA(B) receptor-mediated mechanisms are responsible for the cognitive dysfunction in the AY9944 model of chronic atypical absence seizures and further, that their cognitive impairment is independent of the seizure activity. The data raise the possibility that GABA(B) receptor antagonists may have therapeutic potential for the treatment of cognitive impairment in epilepsy syndromes where atypical absence seizures are a component.

GABA(B) receptor alterations as indicators of physiological and pharmacological function

Given the widespread distribution of GABA(B) receptors throughout the central nervous system, and within certain peripheral organs, it is likely their selective pharmacological manipulation could be of benefit in the treatment of a variety of disorders. Studies aimed at defining the clinical potential of GABA(B) receptor agonists and antagonists have included gene deletion experiments, examination of changes in receptor binding, subunit expression and function in diseased tissue, as well as after the chronic administration of drugs. The results indicate that a functional GABA(B) receptor requires the combination of GABA(B(1)) and GABA(B(2)) subunits, that receptor function does not always correlate with subunit expression and receptor binding, and that GABA(B) receptor modifications may be associated with the clinical response to antidepressants, mood stabilizers, and GABA(B) receptor agonists and antagonists. Moreover, changes in GABA(B) binding or expression suggest this receptor may be involved in mediating symptoms associated with chronic pain, epilepsy and schizophrenia. This, together with results from other types of studies, indicates the potential therapeutic value of developing drugs capable of selectively activating, inhibiting, or modulating GABA(B) receptor function.

The GABA(B) receptor antagonist CGP36742 attenuates the baclofen- and scopolamine-induced deficit in Morris water maze task in rats

Effects of CGP36742 (3-aminopropyl-n-butylphosphinic acid), an orally active GABA(B) receptor antagonist, on the baclofen- and scopolamine-induced deficit of place learning in the Morris water maze task were examined in rats. Rats were given four training trials per day with the submerged platform at a fixed location in the maze for 4 days. On day 4, the rats were required to swim in the pool without the platform after the fourth training trial (probe test). Intraperitoneal injection of baclofen (4 mg/kg) or scopolamine (0.3 mg/kg) significantly increased the escape latency to reach the platform and decreased the duration in the quadrant where the platform had been originally located. Increased latency in the training trials and decreased duration in the probe test induced by baclofen or scopolamine were significantly attenuated by oral administration of CGP36742 at doses of 10 and 30 mg/kg. In the rotarod test, CGP36742 at a dose of 100 mg/kg but not at doses of 10 or 30 mg/kg antagonized the baclofen-induced motor incoordination. Thus, there was dissociation between the effective doses of CGP36742 in the learning task and those in the sensory motor test. These results suggest the possible involvement of cholinergic systems as well as GABA(B) receptor systems in the CGP36742 action.