Yonsei Med J.  2009 Jun;50(3):441-444. 10.3349/ymj.2009.50.3.441.

Changes of Functional MRI Findings in a Patient Whose Pathological Gambling Improved with Fluvoxamine

• Chung SK
• You IH
• Cho GH
• Chung GH
• Shin YC
• Kim DJ
• Choi SW

• KMID: 1758575
• DOI: http://doi.org/10.3349/ymj.2009.50.3.441

Abstract

Legalized gambling is a growing industry, and is probably a factor in the presently increasing prevalence of pathological gambling. We present a case of a 36-year-old pathological gambler who was treated with fluvoxamine, a selective serotonin reuptake inhibitor, and who was assessed by functional MRI before and after drug administration. During activation periods, the pathological gambler was shown cards as stimuli, and fMRI results in several brain regions showed differential effects before and after medication and a maintenance period. This case demonstrates that the treatment response to fluvoxamine in a pathological gambler was observed not only by subjective self-report, but also by objective fMRI results. Therefore, fMRI may be a useful tool in the diagnosis and prediction of treatment response in patients afflicted with pathological gambling.

Keyword

Fluvoxamine; functional MRI; pathological gambling

MeSH Terms

Adult
Behavior, Addictive/*drug therapy
Fluvoxamine/*therapeutic use
*Gambling
Humans
Magnetic Resonance Imaging
Male
Serotonin Uptake Inhibitors/*therapeutic use
Treatment Outcome

Figure

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  Fig. 1 fMRI before fluvoxamine administration. This figure shows the difference between the activation and resting conditions. The brain is generally activated, especially in both parietal regions and the occipital, and frontal regions.

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  Fig. 2 fMRI one week after fluvoxamine administration. The figure shows the difference between the activation and resting conditions. There is no activated region in the occipital and temporal areas. There were activated regions in both frontal (right: Brodmann's areas 6, 5, and 4; left: Brodmann's areas 6, 4) and both parietal (right: Brodmann's area 7; left: Brodmann's areas 7, 19) lobes.

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  Fig. 3 fMRI six weeks after fluvoxamine administration. The figure shows the difference between the activation and resting conditions. There were activated regions in the left frontal (Brodmann's area 6), right parietal (Brodmann's areas 7, 40), and left parietal (Brodmann's areas 7, 19, and 40) lobes.

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  Fig. 4 fMRI six months after fluvoxamine administration. The figure shows the difference between the activation and resting conditions. The previously activated regions were generally decreased. There were small activated regions in the right frontal lobe (Brodmann's area 6), left occipital lobe (Brodmann's areas 18, 19), right limbic area (Brodmann's area 24), and left limbic area (Brodmann's area 31).

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