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Gallet Q, Bouteloup V, Locatelli M, Habert MO, Chupin M, Campion JY, Michels PE, Delrieu J, Lebouvier T, Balageas AC, Surget A, Belzung C, Arlicot N, Ribeiro MJS, Gissot V, El-Hage W, Camus V, Gohier B, Desmidt T. Cerebral Metabolic Signature of Chronic Benzodiazepine Use in Nondemented Older Adults: An FDG-PET Study in the MEMENTO Cohort. Am J Geriatr Psychiatry 2024; 32:665-677. [PMID: 37973486 DOI: 10.1016/j.jagp.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE We sought to examine the association between chronic Benzodiazepine (BZD) use and brain metabolism obtained from 2-deoxy-2-fluoro-D-glucose (FDG) positron emission tomography (PET) in the MEMENTO clinical cohort of nondemented older adults with an isolated memory complaint or mild cognitive impairment at baseline. METHODS Our analysis focused on 3 levels: (1) the global mean brain standardized uptake value (SUVR), (2) the Alzheimer's disease (AD)-specific regions of interest (ROIs), and (3) the ratio of total SUVR on the brain and different anatomical ROIs. Cerebral metabolism was obtained from 2-deoxy-2-fluoro-D-glucose-FDG-PET and compared between chronic BZD users and nonusers using multiple linear regressions adjusted for age, sex, education, APOE ε 4 copy number, cognitive and neuropsychiatric assessments, history of major depressive episodes and antidepressant use. RESULTS We found that the SUVR was significantly higher in chronic BZD users (n = 192) than in nonusers (n = 1,122) in the whole brain (beta = 0.03; p = 0.038) and in the right amygdala (beta = 0.32; p = 0.012). Trends were observed for the half-lives of BZDs (short- and long-acting BZDs) (p = 0.051) and Z-drug hypnotic treatments (p = 0.060) on the SUVR of the right amygdala. We found no significant association in the other ROIs. CONCLUSION Our study is the first to find a greater global metabolism in chronic BZD users and a specific greater metabolism in the right amygdala. Because the acute administration of BZDs tends to reduce brain metabolism, these findings may correspond to a compensatory mechanism while the brain adapts with global metabolism upregulation, with a specific focus on the right amygdala.
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Affiliation(s)
- Quentin Gallet
- Department of Psychiatry, University Hospital, Angers, France
| | - Vincent Bouteloup
- Centre Inserm U1219 Bordeaux Population Health, CIC1401-EC, Institut de Santé Publique, d'Epidémiologie et de Développement, Université de Bordeaux, CHU de Bordeaux, Pôle Santé Publique, Bordeaux, France
| | - Maxime Locatelli
- CATI, US52-UAR2031, CEA, ICM, Sorbonne Université, CNRS, INSERM, APHP, Ile de France, France; Paris Brain Institute - Institut du Cerveau (ICM), CNRS UMR 7225, INSERM, U 1127, Sorbonne Université F-75013, Paris, France; Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, F-75006, Paris, France
| | - Marie-Odile Habert
- CATI, US52-UAR2031, CEA, ICM, Sorbonne Université, CNRS, INSERM, APHP, Ile de France, France; Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, F-75006, Paris, France; Service de médecine nucléaire, Hôpital Pitié-Salpêtrière, APHP, Paris 75013, France
| | - Marie Chupin
- CATI, US52-UAR2031, CEA, ICM, Sorbonne Université, CNRS, INSERM, APHP, Ile de France, France; Paris Brain Institute - Institut du Cerveau (ICM), CNRS UMR 7225, INSERM, U 1127, Sorbonne Université F-75013, Paris, France
| | | | | | - Julien Delrieu
- Gérontopôle, Department of Geriatrics, CHU Toulouse, Purpan University Hospital, Toulouse, France; UMR1027, Université de Toulouse, UPS, INSERM, Toulouse, France
| | | | | | | | | | - Nicolas Arlicot
- UMR 1253, iBrain, Université de Tours, INSERM, Tours, France; CIC 1415, Université de Tours, INSERM, Tours, France
| | - Maria-Joao Santiago Ribeiro
- CHU de Tours, Tours, France; UMR 1253, iBrain, Université de Tours, INSERM, Tours, France; CIC 1415, Université de Tours, INSERM, Tours, France
| | - Valérie Gissot
- CHU de Tours, Tours, France; UMR 1253, iBrain, Université de Tours, INSERM, Tours, France
| | - Wissam El-Hage
- CHU de Tours, Tours, France; UMR 1253, iBrain, Université de Tours, INSERM, Tours, France; CIC 1415, Université de Tours, INSERM, Tours, France
| | - Vincent Camus
- CHU de Tours, Tours, France; UMR 1253, iBrain, Université de Tours, INSERM, Tours, France
| | - Bénédicte Gohier
- Department of Psychiatry, University Hospital, Angers, France; Université d'Angers, Université de Nantes, LPPL, SFR CONFLUENCES, F-49000 Angers, France
| | - Thomas Desmidt
- CHU de Tours, Tours, France; UMR 1253, iBrain, Université de Tours, INSERM, Tours, France.
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Pifarré P, Simó M, Gispert JD, Plaza P, Fernández A, Pujol J. Diazepam and Jacobson's Progressive Relaxation Show Similar Attenuating Short-Term Effects on Stress-Related Brain Glucose Consumption. Eur Psychiatry 2020; 30:187-92. [DOI: 10.1016/j.eurpsy.2014.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 03/10/2014] [Accepted: 03/16/2014] [Indexed: 10/25/2022] Open
Abstract
AbstractA non-pharmacological method to reduce anxiety is “progressive relaxation” (PR). The aim of the method is to reduce mental stress and associated mental processes by means of progressive suppression of muscle tension. The study was addressed to evaluate changes in brain glucose metabolism induced by PR in patients under a stressing state generated by a diagnostic medical intervention. The effect of PR was compared to a dose of sublingual diazepam, with the prediction that both interventions would be associated with a reduction in brain metabolism. Eighty-four oncological patients were assessed with 18F-fluorodeoxyglucose-positron emission tomography. Maps of brain glucose distribution from 28 patients receiving PR were compared with maps from 28 patients receiving sublingual diazepam and with 28 patients with no treatment intervention. Compared to reference control subjects, the PR and diazepam groups showed a statistically significant, bilateral and generalized cortical hypometabolism. Regions showing the most prominent changes were the prefrontal cortex and anterior cingulate cortex. No significant differences were identified in the direct comparison between relaxation technique and sublingual diazepam. Our findings suggest that relaxation induced by a physical/psychological procedure can be as effective as a reference anxiolytic in reducing brain activity during a stressful state.
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Clergue-Duval V, Questel F, Azuar J, Paquet C, Cognat E, Amami J, Queneau M, Dereux A, Barré T, Bellivier F, Farid K, Vorspan F. Brain 18FDG-PET pattern in patients with alcohol-related cognitive impairment. Eur J Nucl Med Mol Imaging 2019; 47:281-291. [DOI: 10.1007/s00259-019-04487-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
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Niccolini F, Pagano G, Fusar-Poli P, Wood A, Mrzljak L, Sampaio C, Politis M. Striatal molecular alterations in HD gene carriers: a systematic review and meta-analysis of PET studies. J Neurol Neurosurg Psychiatry 2018; 89:185-196. [PMID: 28889093 DOI: 10.1136/jnnp-2017-316633] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/31/2017] [Accepted: 08/23/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Over the past years, positron emission tomography (PET) imaging studies have investigated striatal molecular changes in premanifest and manifest Huntington's disease (HD) gene expansion carriers (HDGECs), but they have yielded inconsistent results. OBJECTIVE To systematically examine the evidence of striatal molecular alterations in manifest and premanifest HDGECs as measured by PET imaging studies. METHODS MEDLINE, ISI Web of Science, Cochrane Library and Scopus databases were searched for articles published until 7 June 2017 that included PET studies in manifest and premanifest HDGECs. Meta-analyses were conducted with random effect models, and heterogeneity was addressed with I2 index, controlling for publication bias and quality of study. The primary outcome was the standardised mean difference (SMD) of PET uptakes in the whole striatum, caudate and putamen in manifest and premanifest HDGECs compared with healthy controls (HCs). RESULTS Twenty-four out of 63 PET studies in premanifest (n=158) and manifest (n=191) HDGECs and HCs (n=333) were included in the meta-analysis. Premanifest and manifest HDGECs showed significant decreases in dopamine D2 receptors in caudate (SMD=-1.233, 95% CI -1.753 to -0.713, p<0.0001; SMD=-5.792, 95% CI -7.695 to -3.890, p<0.0001) and putamen (SMD=-1.479, 95% CI -1.965 to -0.992, p<0.0001; SMD=-5.053, 95% CI -6.558 to -3.549, p<0.0001), in glucose metabolism in caudate (SMD=-0.758, 95% CI -1.139 to -0.376, p<0.0001; SMD=-3.738, 95% CI -4.880 to -2.597, p<0.0001) and putamen (SMD=-2.462, 95% CI -4.208 to -0.717, p=0.006; SMD=-1.650, 95% CI -2.842 to -0.458, p<0.001) and in striatal PDE10A binding (SMD=-1.663, 95% CI -2.603 to -0.723, p=0.001; SMD=-2.445, 95% CI -3.371 to -1.519, p<0.001). CONCLUSIONS PET imaging has the potential to detect striatal molecular changes even at the early premanifest stage of HD, which are relevant to the neuropathological mechanisms underlying the development of the disease.
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Affiliation(s)
- Flavia Niccolini
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gennaro Pagano
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Andrew Wood
- CHDI Management/CHDI Foundation, Princeton, New Jersey, USA
| | | | | | - Marios Politis
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Silva-Rodríguez J, García-Varela L, López-Arias E, Domínguez-Prado I, Cortés J, Pardo-Montero J, Fernández-Ferreiro A, Ruibal Á, Sobrino T, Aguiar P. Impact of benzodiazepines on brain FDG-PET quantification after single-dose and chronic administration in rats. Nucl Med Biol 2016; 43:827-834. [DOI: 10.1016/j.nucmedbio.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/02/2016] [Accepted: 09/07/2016] [Indexed: 02/08/2023]
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Abstract
Neurologic applications were at the forefront of PET imaging when the technique was developed in the mid-1970s. Although oncologic indications have become prominent in terms of number of studies performed worldwide, neurology remains a major field in which functional imaging provides unique information, both for clinical and research purposes. The evaluation of glucose metabolism using FDG remains the most frequent exploration, but in recent years, alternative radiotracers have been developed, including fluorinated amino acid analogues for primary brain tumor imaging and fluorinated compounds for assessing the amyloid deposits in patients with suspected Alzheimer disease. As the brain is enclosed in the skull, which presents fixed landmarks, it is relatively easy to coregister images obtained with various cross-sectional imaging methods, either functional or anatomical, with a relatively high accuracy and robustness. Nevertheless, PET in neurology has fully benefited from the advent of hybrid imaging. Attenuation and scatter correction is now much faster and equally accurate, using CT as compared with the traditional transmission scan using an external radioactive source. The perfect coregistration with the CT data, which is now systematically performed, also provides its own set of valuable information, for instance regarding cerebral atrophy. However, hybrid imaging in neurology comes with pitfalls and limitations, in addition to those that are well known, for example, blood glucose levels or psychotropic drugs that greatly affect the physiological FDG uptake. Movements of the patient's head, either during the PET acquisition or between the PET and the CT acquisitions will generate artifacts that may be very subtle yet lead to erroneous interpretation of the study. Similarly, quantitative analysis, such as voxel-based analyses, may prove very helpful in improving the diagnostic accuracy and the reproducibility of the reading, but a wide variety of artifacts may also be introduced, and should therefore be identified and corrected.
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Affiliation(s)
- Eric Salmon
- Division of Nuclear Medicine, Department of Medical Physics, Cyclotron Research Center, University Hospital of Liège, University of Liège, Liège, Belgium
| | - Claire Bernard Ir
- Division of Nuclear Medicine, Department of Medical Physics, Cyclotron Research Center, University Hospital of Liège, University of Liège, Liège, Belgium
| | - Roland Hustinx
- Division of Nuclear Medicine, Department of Medical Physics, Cyclotron Research Center, University Hospital of Liège, University of Liège, Liège, Belgium.
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Eisenmenger LB, Huo EJ, Hoffman JM, Minoshima S, Matesan MC, Lewis DH, Lopresti BJ, Mathis CA, Okonkwo DO, Mountz JM. Advances in PET Imaging of Degenerative, Cerebrovascular, and Traumatic Causes of Dementia. Semin Nucl Med 2016; 46:57-87. [DOI: 10.1053/j.semnuclmed.2015.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Spatial-temporal patterns of electrocorticographic spectral changes during midazolam sedation. Clin Neurophysiol 2015; 127:1223-1232. [PMID: 26613652 DOI: 10.1016/j.clinph.2015.10.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/15/2015] [Accepted: 10/20/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To better understand 'when' and 'where' wideband electrophysiological signals are altered by sedation. METHODS We generated animation movies showing electrocorticography (ECoG) amplitudes at eight spectral frequency bands across 1.0-116 Hz, every 0.1s, on three-dimensional surface images of 10 children who underwent epilepsy surgery. We measured the onset, intensity, and variance of each band amplitude change at given nonepileptic regions separately from those at affected regions. We also determined the presence of differential ECoG changes depending on the brain anatomy. RESULTS Within 20s following injection of midazolam, beta (16-31.5 Hz) and sigma (12-15.5 Hz) activities began to be multifocally augmented with increased variance in amplitude at each site. Beta-sigma augmentation was most prominent within the association neocortex. Augmentation of low-delta activity (1.0-1.5 Hz) was relatively modest and confined to the somatosensory-motor region. Conversely, injection of midazolam induced attenuation of theta (4.0-7.5 Hz) and high-gamma (64-116 Hz) activities. CONCLUSIONS Our observations support the notion that augmentation beta-sigma and delta activities reflects cortical deactivation or inactivation, whereas theta and high-gamma activities contribute to maintenance of consciousness. The effects of midazolam on the dynamics of cortical oscillations differed across regions. SIGNIFICANCE Sedation, at least partially, reflects a multi-local phenomenon at the cortical level rather than global brain alteration homogeneously driven by the common central control structure.
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Brown RKJ, Bohnen NI, Wong KK, Minoshima S, Frey KA. Brain PET in Suspected Dementia: Patterns of Altered FDG Metabolism. Radiographics 2014; 34:684-701. [DOI: 10.1148/rg.343135065] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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10
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Young Choi M, Soo Lee D, Hwang JM, Gyu Choi D, Lee KM, Park K, Suk Yu Y, Chung H. Investigation of visual cortex in children with cortical visual impairment: positron emission tomography. Neuroophthalmology 2009. [DOI: 10.1076/noph.25.3.103.7129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Berman SM, Voytek B, Mandelkern MA, Hassid BD, Isaacson A, Monterosso J, Miotto K, Ling W, London ED. Changes in cerebral glucose metabolism during early abstinence from chronic methamphetamine abuse. Mol Psychiatry 2008; 13:897-908. [PMID: 17938635 PMCID: PMC2786221 DOI: 10.1038/sj.mp.4002107] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2007] [Revised: 08/02/2007] [Accepted: 08/26/2007] [Indexed: 11/09/2022]
Abstract
Changes in brain function during the initial weeks of abstinence from chronic methamphetamine abuse may substantially affect clinical outcome, but are not well understood. We used positron emission tomography with [F-18]fluorodeoxyglucose (FDG) to quantify regional cerebral glucose metabolism, an index of brain function, during performance of a vigilance task. A total of 10 methamphetamine-dependent subjects were tested after 5-9 days of abstinence, and after 4 additional weeks of supervised abstinence. A total of 12 healthy control subjects were tested at corresponding times. Global glucose metabolism increased between tests (P=0.01), more in methamphetamine-dependent (10.9%, P=0.02) than control subjects (1.9%, NS). Glucose metabolism did not change in subcortical regions of methamphetamine-dependent subjects, but increased in neocortex, with maximal increase (>20%) in parietal regions. Changes in reaction time and self-reports of negative affect varied more in methamphetamine-dependent than in control subjects, and correlated both with the increase in parietal glucose metabolism, and decrease in relative activity (after scaling to the global mean) in some regions. A robust relationship between change in self-reports of depressive symptoms and relative activity in the ventral striatum may have great relevance to treatment success because of the role of this region in drug abuse-related behaviors. Shifts in cortical-subcortical metabolic balance either reflect new processes that occur during early abstinence, or the unmasking of effects of chronic methamphetamine abuse that are obscured by suppression of cortical glucose metabolism that continues for at least 5-9 days after cessation of methamphetamine self-administration.
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Affiliation(s)
- S M Berman
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90024-1759, USA
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Fujisawa T, Yokoyama A, Muramatsu M, Kimura Y, Kurozumi A, Kobayashi I, Sano H, Totsuka Y, Fukushima K. Fitting complete dentures after multiple tooth extraction in a patient with severe dementia. SPECIAL CARE IN DENTISTRY 2007; 27:187-90. [PMID: 17990477 DOI: 10.1111/j.1754-4505.2007.tb00344.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Complete dentures were constructed after tooth extraction for a 71-year-old uncommunicative patient with Alzheimer's disease. Although she had never previously used them, her husband requested the fitting of complete maxillary and mandibular dentures. Thirteen teeth were extracted under local anesthesia and intravenous sedation (IVS), followed by impression-making under IVS. Denture fabrication and adjustment were carried out under mild physical restraint. A tissue conditioner was applied to the fitting surface of the denture base followed by regular denture adjustments. The time required for the patient to eat a meal decreased from 90 minutes without dentures to 30 minutes with dentures due to an improvement in swallowing. Important factors in the successful fitting and use of dentures in this patient were the use of IVS to control behavior during treatment, the treatment plan focused on painless denture use, and oral care by the patient's husband.
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Affiliation(s)
- Toshiaki Fujisawa
- Supporting Unit for Regional Oral Care and Cure, Hokkaido University Hospital Center for Dental Clinics, Japan.
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Luat AF, Asano E, Juhász C, Chandana SR, Shah A, Sood S, Chugani HT. Relationship between brain glucose metabolism positron emission tomography (PET) and electroencephalography (EEG) in children with continuous spike-and-wave activity during slow-wave sleep. J Child Neurol 2005; 20:682-90. [PMID: 16225816 DOI: 10.1177/08830738050200081001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We studied the relationship between brain glucose metabolism patterns and objectively measured interictal epileptiform abnormalities in six children with intractable epilepsy and continuous spike-and-wave activity during slow-wave sleep. Five of the six patients showed lateralized positron emission tomographic (PET) findings, with the hemisphere showing a relative increase in glucose metabolism concordant with the presumed origin of the generalized interictal spike activity delineated by quantitative electroencephalographic (EEG) analysis. One of these five patients achieved seizure freedom following cortical resection involving the areas of unilateral multifocal hypermetabolism, and another patient has been approved for cortical resection. The results in the present study add further support to the hypothesis that the generalized spike-waves in most cases of continuous spike-and-wave activity during slow-wave sleep are the result of secondary bilateral synchrony. Resective surgery can be effective in selected patients with uncontrolled seizures associated with continuous spike-and-wave activity during slow-wave sleep provided that there is concordance between focal abnormalities on PET and EEG.
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Affiliation(s)
- Aimee F Luat
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA
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Lange C, Kracht L, Herholz K, Sachsse U, Irle E. Reduced glucose metabolism in temporo-parietal cortices of women with borderline personality disorder. Psychiatry Res 2005; 139:115-26. [PMID: 15978784 DOI: 10.1016/j.pscychresns.2005.05.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2005] [Revised: 04/26/2005] [Accepted: 05/05/2005] [Indexed: 01/18/2023]
Abstract
Individuals with borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) often experience dissociative symptoms. Evidence is increasing that stress-related hyperglutamatergic states may contribute to dissociative symptoms and neurodegeneration in temporo-parietal cortical areas. Seventeen young women with BPD who had been exposed to severe childhood physical/sexual abuse and presented with pronounced dissociative symptoms underwent (18)fluoro-2-deoxyglucose positron emission tomography (FDG-PET). Nine healthy, matched volunteers served as comparison subjects. Borderline subjects displayed reduced FDG uptake (as analyzed by SPM) in the right temporal pole/anterior fusiform gyrus and in the left precuneus and posterior cingulate cortex. Impaired memory performance among borderline subjects was significantly correlated with metabolic activity in ventromedial and lateral temporal cortices. Our results demonstrate regional hypometabolism in temporal and medial parietal cortical regions known to be involved in episodic memory consolidation and retrieval. Currently, the precuneus/posterior cingulate cortex is modeled as part of a network of tonically active brain regions that continuously gather information about the world around and within us. Decreased resting metabolic rate of these regions may reflect dissociative symptoms and possibly also identity disturbances and interpersonal difficulties of individuals with BPD.
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Affiliation(s)
- Claudia Lange
- Department of Psychiatry and Psychotherapy, University of Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
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Lanctôt KL, Herrmann N, Mazzotta P, Khan LR, Ingber N. GABAergic function in Alzheimer's disease: evidence for dysfunction and potential as a therapeutic target for the treatment of behavioural and psychological symptoms of dementia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2004; 49:439-53. [PMID: 15362248 DOI: 10.1177/070674370404900705] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer's disease (AD) is characterized by disruptions in multiple major neurotransmitters. While many studies have attempted to establish whether GABA is disrupted in AD patients, findings have varied. We review evidence for disruptions in GABA among patients with AD and suggest that the variable findings reflect subtypes of the disease that are possibly manifested clinically by differing behavioural symptoms. GABA, the major inhibitory neurotransmitter, has long been a target for anxiolytics, hypnotic sedatives, and anticonvulsants. We review the clinical use of GABAergic agents in treating persons with AD symptoms. While newer generation GABAergic medications are now available, they have yet to be evaluated among patients with AD.
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Affiliation(s)
- Krista L Lanctôt
- Department of Psychiatry, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario.
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Juengling FD, Kassubek J, Martens-Le Bouar H, Reinhardt MJ, Krause T, Nitzsche EU, Moser E, Korinthenberg R. Cerebral regional hypometabolism caused by propofol-induced sedation in children with severe myoclonic epilepsy: a study using fluorodeoxyglucose positron emission tomography and statistical parametric mapping. Neurosci Lett 2002; 335:79-82. [PMID: 12459503 DOI: 10.1016/s0304-3940(02)01060-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cerebral positron emission tomography (PET) in children often requires sedation. This study evaluated sedation-associated effects on cerebral glucose metabolism in 30 children with severe myoclonic epilepsy as investigated by cerebral (18)F-fluorodeoxyglucose (FDG)-PET. Prior to the PET acquisition, 24 children underwent propofol sedation. Pixel-based t-statistics were calculated using statistical parametric mapping (SPM99) for comparisons of the patients' PET scans with both a healthy adult control group and an age-matched child intra-group control. In both analyses, statistically significant hypometabolic areas were found in the medial parieto-occipital cortex bilaterally, including the lingual gyrus, cuneus, posterior cingulate and middle occipital gyrus in all sedated children. All these localizations correlated in a covariate analysis with the injected dose of propofol (P<0.01, corrected). The bilateral parieto-occipital hypometabolism is likely to be a sedation-specific effect and should be taken into account when evaluating cerebral FDG-PET scans in sedated children.
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Affiliation(s)
- Freimut D Juengling
- Department of Radiology, Division of Nuclear Medicine, University Hospital Freiburg, Hugstetterstr. 55, D-79106, Freiburg, Germany.
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O'Dell DM, Gibson CJ, Wilson MS, DeFord SM, Hamm RJ. Positive and negative modulation of the GABA(A) receptor and outcome after traumatic brain injury in rats. Brain Res 2000; 861:325-32. [PMID: 10760494 DOI: 10.1016/s0006-8993(00)02055-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Glutamate-mediated excitotoxicity has been shown to contribute to cellular dysfunction following traumatic brain injury (TBI). Increasing inhibitory function through stimulation of gamma-aminobutyric acid (GABA(A)) receptors may attenuate excitotoxic effects and improve outcome. The present experiment examined the effects of diazepam, a positive modulator at the GABA(A) receptor, on survival and cognitive performance in traumatically brain-injured animals. In experiment 1, 15 min prior to central fluid percussion brain injury, rats (n=8 per group) were injected (i.p.) with saline or diazepam (5 mg/kg or 10 mg/kg). Additional rats (n=8) were surgically prepared but not injured (sham-injury). Rats pre-treated with the 5 mg/kg dose of diazepam had significantly lower mortality (0%) than injured, saline-treated rats (53%). Also, diazepam-treated (5 mg/kg) rats had significantly shorter latencies to reach the goal platform in the Morris water maze test performed 11-15 days post-injury. In experiment 2, at 15 min post-injury, rats were given either saline (n=5) or 5 mg/kg diazepam (n=6). Rats treated with diazepam did not differ in mortality from injured rats treated with vehicle. However, rats treated with diazepam at 15 min post-injury had significantly shorter latencies to reach the goal platform in the Morris water maze than injured, vehicle-treated rats. In experiment 3, the post-injury administration of bicuculline (1.5 mg/kg, n=8), a GABA(A) antagonist, increased Morris water maze goal latencies compared to injured animals treated with saline (n=8). These results suggest that enhancing inhibitory function during the acute post-injury period produces beneficial effects on both survival and outcome following experimental TBI.
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Affiliation(s)
- D M O'Dell
- Department of Psychology, Virginia Commonwealth University, P.O. Box 842018, Richmond, VA 23284-2018, USA.
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Robinson RO, Ferrie CD, Capra M, Maisey MN. Positron emission tomography and the central nervous system. Arch Dis Child 1999; 81:263-70. [PMID: 10451403 PMCID: PMC1718058 DOI: 10.1136/adc.81.3.263] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R O Robinson
- Department of Paediatric Neurology, Guy's Hospital, St Thomas Street, London SE1 9RT, UK
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Abbott NJ, Chugani DC, Zaharchuk G, Rosen BR, Lo EH. Delivery of imaging agents into brain. Adv Drug Deliv Rev 1999; 37:253-77. [PMID: 10837739 DOI: 10.1016/s0169-409x(98)00097-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Delivery of diagnostic agents to the central nervous system (CNS) poses several challenges as a result of the special features of CNS blood vessels and tissue fluids. Diffusion barriers exist between blood and neural tissue, in the endothelium of parenchymal vessels (blood-brain barrier, BBB), and in the epithelia of the choroid plexuses and arachnoid membrane (blood-CSF barriers), which severely restrict penetration of several diagnostic imaging agents. The anatomy of large vessels can be imaged using bolus injection of X-ray contrast agents to identify sites of malformation or occlusion, and blood flow measured using MRI and CT, while new techniques permit analysis of capillary perfusion and blood volume. Absolute quantities can be derived, although relative measures in different CNS regions may be as useful in diagnosis. Local blood flow, blood volume, and their ratio (mean transit time) can be measured with high speed tomographic imaging using MRI and CT. Intravascular contrast agents for MRI are based on high magnetic susceptibility agents such as gadolinium, dysprosium and iron. Steady-state imaging using agents that cross the BBB including (123)I- and (99m)Tc-labelled lipophilic agents with SPECT, gives a 'snapshot' of perfusion at the time of injection. Cerebral perfusion can also be measured with PET, using H(2)(15)O, (11)C- or (15)O-butanol, and (18)F-fluoromethane, and cerebral blood volume measured with C(15)O. Recent advances in MRI permit the non-invasive 'labelling' of endogenous water protons in flowing blood, with subsequent detection as a measure of blood flow. Imaging the BBB most commonly involves detecting disruptions of the barrier, allowing contrast agents to leak out of the vascular system. Gd-DTPA is useful in imaging leaky vessels as in some cerebral tumors, while the shortening of T(1) by MR contrast agents can be used to detect more subtle changes in BBB permeability to water as in cerebral ischemia. Techniques for imaging the dynamic activity of the brain parenchyma mainly involve PET, using a variety of radiopharmaceuticals to image glucose transport and metabolism, neurotransmitter binding and uptake, protein synthesis and DNA dynamics. PET methods permit detailed analysis of regional function by comparing resting and task-related images, important in improving understanding of both normal and pathological brain function.
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Affiliation(s)
- N J Abbott
- Physiology, Biomedical Division, King's College, Strand, London WC2R 2LS, UK.
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Affiliation(s)
- S J Gatley
- Medical Department, Brookhaven National Laboratory, Upton, New York 11973, USA.
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21
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Streeter CC, Ciraulo DA, Harris GJ, Kaufman MJ, Lewis RF, Knapp CM, Ciraulo AM, Maas LC, Ungeheuer M, Szulewski S, Renshaw PF. Functional magnetic resonance imaging of alprazolam-induced changes in humans with familial alcoholism. Psychiatry Res 1998; 82:69-82. [PMID: 9754450 DOI: 10.1016/s0925-4927(98)00009-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study sought to identify whether subjects with a family history (FH + ) of alcoholism had changes in regional cerebral blood volume (rCBV) after an alprazolam challenge which distinguished them from subjects without a family history (FH -) of alcoholism using functional MRI (fMRI). Twelve FH + and eight FH - subjects were challenged with 1 mg of alprazolam or placebo in a double-blind crossover design. FMRI scans were obtained at baseline, 1 and 2 h after the challenge using the dynamic susceptibility contrast method with gadolinium. Mood scales, the Tufts Addiction Research Center Inventory-Morphine Benzedrine Group Scale and the drug liking scale, were administered every 30 min to assess drug effects. Global analysis of CBV showed a treatment by time decrease on alprazolam relative to placebo, but no effect by family history. The FH + group showed rCBV decreases at 1 h in the left caudate and left inferior prefrontal region, while the FH - group showed rCBV decreases at 2 h in the right inferior prefrontal region and anterior cingulate in response to alprazolam relative to placebo. FH + subjects reported more mood enhancement with alprazolam. This fMRI technique detected global and regional CBV changes induced by alprazolam. The location and rate of alprazolam-induced rCBV changes differed between FH + and FH - subjects. These changes may be related to the increased mood enhancement found in subjects genetically predisposed to alcoholism.
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Affiliation(s)
- C C Streeter
- Department of Psychiatry/116A, Outpatient Clinic, Boston National Institute on Drug Abuse/Veterans Administration Medication Development Research Unit, MA 02114, USA.
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Abstract
Considering the mechanisms responsible for age- and Alzheimer's disease (AD)-related neuronal degeneration, little attention was paid to the opposing relationships between the energy-rich phosphates, mainly the availability of the adenosine triphosphate (ATP), and the activity of the glutamic acid decarboxylase (GAD), the rate-limiting enzyme synthesizing the gamma-amino butyric acid (GABA). Here, it is postulated that in all neuronal phenotypes the declining ATP-mediated negative control of GABA synthesis gradually declines and results in age- and AD-related increases of GABA synthesis. The Ca2+-independent carrier-mediated GABA release interferes with Ca2+-dependent exocytotic release of all transmitter-modulators, because the interstitial (ambient) GABA acts on axonal preterminal and terminal varicosities endowed with depolarizing GABA(A)-benzodiazepine receptors; this makes GABA the "executor" of virtually all age- and AD-related neurodegenerative processes. Such a role of GABA is diametrically opposite to that in the perinatal phase, when the carrier-mediated GABA release, acting on GABA(A)/chloride ionophore receptors, positively controls chemotactic migration of neuronal precursor cells, has trophic actions and initiates synaptogenesis, thereby enabling retrograde axonal transport of target produced factors that trigger differentiation of neuronal phenotypes. However, with advancing age, and prematurely in AD, the declining mitochondrial ATP synthesis unleashes GABA synthesis, and its carrier-mediated release blocks Ca2+-dependent exocytotic release of all transmitter-modulators, leading to dystrophy of chronically depolarized axon terminals and block of retrograde transport of target-produced trophins, causing "starvation" and death of neuronal somata. The above scenario is consistent with the following observations: 1) a 10-month daily administration to aging rats of the GABA-chloride ionophore antagonist, pentylenetetrazol, or of the BDZ antagonist, flumazenil (FL), each forestalls the age-related decline in cognitive functions and losses of hippocampal neurons; 2) the brains of aging rats, relative to young animals, and the postmortem brains of AD patients, relative to age-matched controls, show up to two-fold increases in GABA synthesis; 3) the aging humans and those showing symptoms of AD, as well as the aging nonhuman primates and rodents--all show in the forebrain dystrophic axonal varicosities, losses of transmitter vesicles, and swollen mitochondria. These markers, currently regarded as the earliest signs of aging and AD, can be reproduced in vitro cell cultures by 1 microM GABA; the development of these markers can be prevented by substituting Cl- with SO4(2-); 4) the extrasynaptic GABA suppresses the membrane Na+, K+-ATPase and ion pumping, while the resulting depolarization of soma-dendrites relieves the "protective" voltage-dependent Mg2+ control of the N-methyl-D-aspartate (NMDA) channels, thereby enabling Ca2+-dependent persistent toxic actions of the excitatory amino acids (EAA); and 5) in whole-cell patch-clamp recording from neurons of aging rats, relative to young rats, the application of 3 microM GABA, causes twofold increases in the whole-cell membrane Cl- conductances and a loss of the physiologically important neuronal ability to desensitize to repeated GABA applications. These age-related alterations in neuronal membrane functions are amplified by 150% in the presence of agonists of BDZ recognition sites located on GABA receptor. The GABA deafferentation hypothesis also accounts for the age- and AD-related degeneration in the forebrain ascending cholinergic, glutamatergic, and the ascending mesencephalic monoaminergic system, despite that the latter, to foster the distribution-utilization of locally produced trophins, evolved syncytium-like connectivities among neuronal somata, axon collaterals, and dendrites, to bidirectionally transport trophins. (ABSTRACT TRUNCATED)
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Affiliation(s)
- T J Marczynski
- Department of Pharmacology, College of Medicine, University of Illinois, Chicago 60612, USA.
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23
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Ferrie CD, Marsden PK, Maisey MN, Robinson RO. Cortical and subcortical glucose metabolism in childhood epileptic encephalopathies. J Neurol Neurosurg Psychiatry 1997; 63:181-7. [PMID: 9285456 PMCID: PMC2169669 DOI: 10.1136/jnnp.63.2.181] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Nearly one third of children with cryptogenic epileptic encephalopathies have been reported to have focal cortical defects on 18fluorodeoxyglucose (FDG) PET. As diffuse cortical dysfunction and involvement of subcortical structures, particularly the thalami, is postulated to underlie the propensity to seizures in these conditions, the aim was to determine the frequency of bilateral and diffuse cortical metabolic defects and of subcortical metabolic abnormalities in the same patients. METHODS The interictal uptake of FDG was studied in 32 children with epileptic encephalopathies. Using a semiquantitative technique, the ratio of uptake in cortical regions and subcortical structures to that in the cerebellum was compared with that of age matched historical controls. Uptake more than 2 SD above ("hypermetabolic") or below ("hypometabolic") that of age matched controls was considered abnormal. RESULTS Diffusely abnormal cortical up-take (nearly always hypometabolic) occurred in almost two thirds of patients; in all but two of the remaining patients at least one cortical region showed significantly decreased uptake bilaterally. When analysed as age cohorts, the mean cortical:cerebellar FDG uptake was significantly lower than that of controls in all cortical regions (P<0.005). Ninety per cent of patients had evidence of relative thalamic hypometabolism and in each age group there was a significant reduction in relative thalamic FDG uptake compared with that of controls (P<0.005). In nine out of 11 patients with unilateral cortical hypometabolic defects thalamic FDG up-take was lower ipsilateral to the cortical abnormality. CONCLUSIONS Diffuse cortical dysfunction is common in the epileptic encephalopathies and may reflect the underlying cause of the condition or arise as a consequence of uncontrolled seizures. Altered thalamic glucose metabolism is further evidence of subcortical involvement in these conditions.
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Affiliation(s)
- C D Ferrie
- Department of Paediatric Neurology, The General Infirmary at Leeds, UK
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Gaillard WD, Zeffiro T, Fazilat S, DeCarli C, Theodore WH. Effect of valproate on cerebral metabolism and blood flow: an 18F-2-deoxyglucose and 15O water positron emission tomography study. Epilepsia 1996; 37:515-21. [PMID: 8641226 DOI: 10.1111/j.1528-1157.1996.tb00602.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We compared the effect of valproate (VPA) on cerebral metabolic rate for glucose (CMRGlc) and cerebral blood flow (CBF), measured with 18F-2-deoxyglucose (18FDG) and 15O water positron emission tomography (PET), in 10 normal volunteers. Mean VPA dose was 17.7 mg/kg, and mean VPA level was 82.1 mg/L (+/-16.5) for 4 weeks. VPA reduced global CMRGlc by 9.4% (9.60 +/- 0.76 vs. 8.59 +/- 1.02 mg Glc/min/100 g, p < 0.05) and regionally in all anatomic areas (p < 0.05 for 11 of 26 areas). VPA diminished global CBF by 14.9% (56.55 +/- 6.70 vs. 47.48 +/- 4.42 ml/min/100 g, p < 0.002) and regionally in all anatomic areas (p < 0.05 for 12 of 26 areas). No significant correlation was noted between VPA level and either global CMRGlc or CBF. The effect of VPA on global CMRGlc is similar to that of carbamazepine (CBZ) and phenytoin but less than that of phenobarbital, valium, or combination therapy with VPA and CBZ. VPA reduced regional CBF (rCBF) but not CMRGlc in the thalamus, an effect that may be associated with VPA's mechanism of action against generalized seizures.
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Affiliation(s)
- W D Gaillard
- Epilepsy Research Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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25
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Marczynski TJ. GABAergic deafferentation hypothesis of brain aging and Alzheimer's disease; pharmacologic profile of the benzodiazepine antagonist, flumazenil. Rev Neurosci 1995; 6:221-58. [PMID: 8717636 DOI: 10.1515/revneuro.1995.6.3.221] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent experiments have shown that: 1) A chronic 10 month daily administration to rats of the benzodiazepine (BDZ) receptor antagonist, flumazenil (FL; 4 mg/kg in drinking water), from the age of 13 through 22 months, significantly retarded the age-related loss of cognitive functions, as ascertained by the radial arm maze tests conducted two months after FL withdrawal. 2) An equal number of 8 rats died in the control and FL-treated group before the behavioral tests were completed and the animals were sacrificed; the life span of the FL-treated 8 rats equaled 24.0 (+/- 0.6 SEM) months, while that of the control 8 rats equaled 22.3 months (+/- 0.7 SEM), and the group difference was marginally significant (p = 0.04 Mann-Whitney test). 3) In rats sacrificed 3 months after FL withdrawal and behavioral testing, the protective action of FL, relative to age-matched controls, was revealed by a significant reduction in the age-related loss of neurons in the hippocampal formation. 4) In the time period of 3 months between the drug withdrawal and sacrificing of the animals, stress experienced by the aging rats during behavioral testing, related to excessive daily handling of the animals and partial food deprivation to motivate them to perform in the radial arm maze, apparently had excitotoxic effects on the hippocampal neurons, as indexed by the presence of 30% neurons in a state of moderate pyknosis found both in the FL group and the age-matched controls. In the 6 months "young" control group, the number of pyknotic neurons equaled only 3.5%. It was concluded that the drug withdrawal and stress of behavioral testing unleashed the previously FL-controlled age-related degeneration. On the basis of these results and the literature, showing that the tone of the GABAergic system increases with age, and particularly in Alzheimer's disease (AD), the hypothesis of brain aging was formulated. It postulates that in mammals, with growing age, and prematurely in humans with AD, the increasing tone of the BDZ/GABAergic system interferes with antero- and retrograde axonal transport through a chronic depolarizing block of preterminal axon varicosities of the ascending aminergic and cholinergic/peptidergic systems, which are indispensable for normal metabolic/trophic glial-neuronal relationships. Such a state leads to discrete anatomic deafferentation of forebrain systems, and particularly of the neocortex, where block of the anterograde axonal transport results in induction of the cortical mRNA responsible for synthesis of the beta-amyloid precursor protein (beta APP). The simultaneous block of retrograde transport from chronically depolarized preterminal axon varicosities may account for toxic accumulation in cortex of the nerve growth factor (NGF) and other trophins, without which the basal forebrain cholinergic neurons degenerate. The general pharmacologic profile of FL has been discussed on the basis of FL administration to animals and healthy and diseased humans. This profile shows that FL: 1) increases brain metabolic functions; 2) reduces emotional responses, thereby stabilizing the functions of the autonomic system in both humans and animals challenged by adverse environmental stimuli; 3) improves cognitive and coordinated motor functions in both humans and animals; 4) uniquely combines anxiolytic, vigilance and cognitive enhancing, i.e. nootropic, properties, which may, in part, stem from FL-induced emotional imperturbability (ataraxy); 5) facilitates habituation of healthy humans and animals to novel but inconsequential environmental stimuli, and promotes non-aggressive interactions among animals; 6) in single i.v. doses, and administered chronically to humans, FL has antiepileptic actions in the Lennox-Gastaut syndrome and other forms of epilepsy characterized by "spike-and-dome" EEG patterns; these actions are likely to depend on FL's disinhibition of the serotonin system; 7) administered in single i.v...
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Affiliation(s)
- T J Marczynski
- Department of Pharmacology, University of Illinois, Chicago 60612 USA
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26
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Kumlien E, Bergström M, Lilja A, Andersson J, Szekeres V, Westerberg CE, Westerberg G, Antoni G, Långström B. Positron emission tomography with [11C]deuterium-deprenyl in temporal lobe epilepsy. Epilepsia 1995; 36:712-21. [PMID: 7555990 DOI: 10.1111/j.1528-1157.1995.tb01051.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We performed positron emission tomography (PET) with [11C]deuterium-deprenyl in 9 patients with temporal lobe epilepsy (TLE) undergoing evaluation for possible epilepsy surgery. Seven patients had unilateral and 2 had bilateral mesiotemporal epileptic foci based on the preoperative investigation including ictal EEG discharges and PET with 2-[18F]fluoro-2-deoxyglucose (FDG). Deprenyl is an irreversible inhibitor of monoamine oxidase type B (MAO-B) with a very high affinity for the enzyme. In the brain, MAO-B is preferentially located in astrocytes, and a previous in vitro study showed increased binding of the ligand in sclerotic hippocampi. Dynamically acquired N-[methyl-11C]-a,a-di-deutero-L-deprenyl distribution in PET images were analyzed graphically, and the focus regions were assessed visually on the PET images. In addition, the accumulation rate and distribution volume of the tracer relative to the cerebellar cortex were measured in standardized homologous temporal regions by semiquantitative methods. Uptake of [11C]deuterium-deprenyl was significantly increased in the epileptogenic temporal lobes, both apparently and semiquantitatively. By calculating mean interlobar ratios, we identified the temporal lobe containing the epileptic focus in six unilateral cases. One case was ambiguous but was not falsely localized. The two bilateral cases were correctly identified as such. Our results suggest that PET with [11C]deuterium-deprenyl might be a useful method for identification of epileptogenic temporal lobes.
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Affiliation(s)
- E Kumlien
- Department of Neurology, University Hospital, Uppsala, Sweden
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27
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Matthew E, Andreason P, Pettigrew K, Carson RE, Herscovitch P, Cohen R, King C, Johanson CE, Greenblatt DJ, Paul SM. Benzodiazepine receptors mediate regional blood flow changes in the living human brain. Proc Natl Acad Sci U S A 1995; 92:2775-9. [PMID: 7708722 PMCID: PMC42301 DOI: 10.1073/pnas.92.7.2775] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
We studied the effects of a high-affinity gamma-aminobutyric acid (GABA)-benzodiazepine-receptor agonist (lorazepam) and an antagonist (flumazenil) in humans, using H2(15)O positron-emission tomography. Administration of lorazepam to healthy volunteers caused time- and dose-dependent reductions in regional cerebral blood flow and self-reported alterations in behavioral/mood parameters. Flumazenil administration reversed these changes. These observations indicated that benzodiazepine-induced effects on regional cerebral blood flow and mood/behavior are mediated at some level through GABA-benzodiazepine receptors, although the specific mechanism remains unclear. The approach described here provides a method for quantifying GABA-benzodiazepine-receptor-mediated neurotransmission in the living human brain and may be useful for studying the role of these receptors in a variety of neuropsychiatric disorders.
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Affiliation(s)
- E Matthew
- Clinical Neuroscience Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
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28
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Newlin DB. A comparison of drug conditioning and craving for alcohol and cocaine. RECENT DEVELOPMENTS IN ALCOHOLISM : AN OFFICIAL PUBLICATION OF THE AMERICAN MEDICAL SOCIETY ON ALCOHOLISM, THE RESEARCH SOCIETY ON ALCOHOLISM, AND THE NATIONAL COUNCIL ON ALCOHOLISM 1992; 10:147-64. [PMID: 1589599 DOI: 10.1007/978-1-4899-1648-8_8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Craving is a potentially important concept that is difficult to define and study in the laboratory. Although alcohol and cocaine are very different pharmacologically, this discussion emphasizes common factors in addiction to these drugs, such as the tendency of alcoholics and cocaine abusers to crave these substances. I review commonalities in drug conditioning and cue reactivity to alcohol and cocaine. Both drugs support Pavlovian conditioning when they are presented as unconditioned stimuli, whether studied in rodents or humans. In addition, both drugs are craved when abusers are presented with stimuli associated with these drugs. Finally, I propose a theoretical definition of craving based on autoshaping and sign-tracking phenomena that suggests a common mechanism of addiction to these drugs. This model defines craving as a reflection of sign tracking to internal and external stimuli that have in the past reliably predicted presentation of these drugs.
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Affiliation(s)
- D B Newlin
- Addiction Research Center, National Institute on Drug Abuse, Baltimore, Maryland 21224-2735
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29
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Abstract
We studied the effects of valproate (VPA) on local cerebral glucose metabolism (LCMRglc) in eight patients with partial seizure disorders and two with primary generalized epilepsy. Each patient had two positron-emission tomography (PET) scans with 18F-2-deoxyglucose (FDG), with, and without, VPA (mean level 52 mg/dl, range 30-127 mg/dl). Patients continued carbamazepine (CBZ) for both scans: serum concentrations were not significantly changed by VPA (CBZ range 5.4-12 mg/dl). Seven patients had the "without-VPA" scan first. Mean interval between PET scans was 75 days. Global CMRglc was decreased by 22% by addition of VPA (7.2 +/- 1.8 mg/100 g/min without VPA, 5.6 +/- 1.1 g/min with VPA, p less than 0.05, corrected). Thirteen regions of interest (ROIs) were analyzed in each hemisphere in each PET scan. Metabolic rates were significantly lower in 15 of 26 ROIs with VPA (p less than 0.05, corrected). VPA depresses cerebral metabolism to a greater degree than do CBZ and phenytoin (PHT) but less than does phenobarbital (PB). The metabolic effect may be related to the mechanism of action and have neuropsychological implications.
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Affiliation(s)
- D B Leiderman
- Clinical Epilepsy Section, NINDS, National Institutes of Health, Bethesda, Maryland 20892
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30
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Fueki N, Iinuma K, Kojima A, Yanai K, Haginoya K, Tada K, Ido T, Ito M. Reduced regional cerebral metabolic rate for glucose at the terminal stage in a case of late infantile neuronal ceroid lipofuscinosis. J Child Neurol 1990; 5:98-100. [PMID: 2345285 DOI: 10.1177/088307389000500205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Regional cerebral metabolic rate for glucose was determined for six different areas of the gray matter in an 8-year-old girl with late infantile neuronal ceroid lipofuscinosis. In all regions, the rates were almost half of the control values. The regional cerebral metabolic rate for glucose was relatively preserved in the striatal region and severely reduced in the frontal cortex.
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Affiliation(s)
- N Fueki
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
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31
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Laurie DJ, Pratt JA. Local cerebral glucose utilization following subacute and chronic diazepam pretreatment: differential tolerance. Brain Res 1989; 504:101-11. [PMID: 2598004 DOI: 10.1016/0006-8993(89)91603-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Local cerebral glucose utilization (LCGU) was determined in parallel groups of conscious rats receiving diazepam (0.3 mg/kg i.v.) either acutely or following subacute (5 mg/kg i.p. daily for 3 days) or chronic (5 mg/kg i.p. daily for 28 days) diazepam pretreatment, using 2-deoxyglucose quantitative autoradiography. Acute administration of diazepam reduced LCGU in 44 of the 66 structures examined compared to vehicle-treated controls. These included limbic, cortical and extrapyramidal structures, and areas associated with sensory processing. These data are consistent with many brain regions being functionally involved in the diverse acute pharmacological effects of diazepam and with the widespread distribution of benzodiazepine receptors throughout the neuroaxis. Following subacute treatment, when animals were tolerant to the sedative effects of diazepam, glucose use remained depressed in the majority of areas studied. However, in the locus coeruleus, dorsal tegmental nucleus and most structures associated with auditory processing, tolerance to the depressant effect of diazepam upon glucose use had occurred suggesting the importance of these structures in the sedative effect of diazepam. The most striking feature of the patterns of LCGU after chronic diazepam treatment was that tolerance had occurred in the mammillary body and subiculum. However, glucose use remained depressed in hippocampal layers and in structures that provide input to the hippocampus (e.g. raphe nuclei). These data suggest that the outflow of neuronal activity from the hippocampus to the mammillary body via the subiculum is restored after chronic treatment, and may implicate these pathways in the anxiolytic action of diazepam. Overall, it would appear that different neuroanatomical substrates underlie the various pharmacological effects of diazepam and that there may be regional differences in tolerance mechanisms.
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Affiliation(s)
- D J Laurie
- Department of Physiology and Pharmacology, University of Strathclyde, Glasgow, U.K
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32
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Theodore WH, Bromfield E, Onorati L. The effect of carbamazepine on cerebral glucose metabolism. Ann Neurol 1989; 25:516-20. [PMID: 2774494 DOI: 10.1002/ana.410250519] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We used positron emission tomography with 18F-2-deoxy-D-glucose to study the effect of carbamazepine on local cerebral metabolic rate for glucose (lCMRGlc) in 9 patients with complex partial seizures. Twenty regions of interest were evaluated. Seven control patients had serial scans without a drug change. Metabolic rates were significantly (p less than 0.05) lower in patients on carbamazepine in 6 of 20 regions of interest (3 left cerebral hemisphere, 3 right). Mean lCMRGlc was 7.4 +/- 2.0 mg/min/100 in patients on carbamazepine and 8.8 +/- 2.5 in patients off carbamazepine (p less than 0.00005; cutoff level for 180 comparisons: 0.00027). The mean (+/- SEM) difference in lCMRGlc between scans was 12 +/- 2%. No significant changes in lCMRGlc on serial scans were detected in any of the 20 regions for the control group. The mean (+/- SEM) variation for control regions of interest was 1 +/- 1%. This study showed that carbamazepine depresses cerebral glucose metabolism as much as phenytoin does, but much less than phenobarbital does. The difference in effect on lCMRGlc may be related to drug mechanisms of action, as well as to effects on memory, learning, mood, and behavior.
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Affiliation(s)
- W H Theodore
- Clinical Epilepsy Section, National Institutes of Health, Bethesda, MD 20892
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Abstract
Using PET with [18-F]-2-deoxyglucose (FDG), we studied the effects of antiepileptic drugs on cerebral glucose metabolism. Serial scans were performed before and after the test drug was added to or removed from the patient's regimen. At least 3 weeks elapsed after achieving steady-state plasma levels when drugs were added, or after plasma levels were undetectable when drugs were tapered, before repeat scans were obtained. Only a single drug was changed between scans. In the phenobarbital (PB) study, the "on-drug" scan was performed first in each case. In this instance, a mean of 14 weeks elapsed between the time blood levels were undetectable and repeat scanning in order to avoid the possibility of withdrawal effects. Scanning in each group was performed 30 min after injection of 5 mCi of FDG, with EEG monitoring to exclude ictal activity. Regional glucose metabolic rates were calculated in 8 to 20 regions of interest. PB reduced LCMRglu in seven of eight regions studied, with a mean reduction over all regions of 37 +/- 3%. Phenytoin (PHT) reduced LCMRglu in only two of 10 regions (mean = 13%). We studied the effect of PHT on cerebellar metabolism in 42 patients using unpaired scans. Cerebellar LCMRglu was lower when patients were taking PHT at the time of scan, as well as in those who were taking PHT for 5 years or more, but the differences were not significant. There was a weak inverse correlation between PHT serum level and cerebellar LCMRglu in patients taking the drug at the time of scan (r = -0.36; 0.05 less than p less than 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- W H Theodore
- Clinical Epilepsy Section, National Institutes of Health, Bethesda, Maryland 20892
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