Functional impairments in patients with borderline personality disorders demonstrated by neurospect HMPAO Tc99 in basal conditions and under frontal activation

RESUMO

We study a sample of 18 patients in basal conditions and 31 patients with diagnosis of Borderline Personality Disorder (DSM-IV Criteria) during cortical activation by means of the Wisconsin card sorting test and assessing function/cerebral blood flow by means of HMPAO Tc 99m NeuroSPECT. The results of changes of cerebral blood flow are shown statistically in a parametric image expressing standard deviations above or below the means of a normative data base for the corresponding age of the patient. We consider only as having significance levels below 2 standard deviations of the normal means . Over this parametric map we project a matrix of Brodmann areas developed by our group in order to precisely localize the areas of abnormality observed. We express our results as percentages of the areas of Brodmann that demonstrates hypoperfusion and we compare the results in a population studied in basal conditions (n=18) and (n=31) during activation by means of the Wisconsin card sorting test. In our results we highlight, in order of importance areas of paradoxical hypoperfusion in conditions of activation versus basal measurements in anterior cyngulate gyrus (Area 24) in both hemispheres. This is followed in importance by Subgenual area (Area 25), area 40 and area 32 in the left hemisphere, and area 28 in the right hemisphere, then followed by area 28 and area 36 in the left hemisphere, area M* and area 44 in both hemispheres, and areas 32, 9 and 46 of Brodmann in the right hemisphere. We concluded that there is a dysfunctional correlation of frontal function in borderline personality disorder. Particularly noticeable is the lack of motivation when there are changes in plans and conduct, lack of pleasure and loss of the meaning of a task during the cortical stimulation. In particular, the Brodmann areas 24, 25 and 32, linked to motivation show a wider involvement when they are exposed to changes in planning and in coping strategies, as it happens during the Wisconsin Test. Areas involved in the executive ability and intelligence also show, but not as noticeable, special change under these circumstances. Both facts can be clinically observed and also in the biography of the Borderline Patient