[The influence of atypical antipsychotics on brain functioning in schizophrenia. A proton magnetic resonance study]. / Wplyw leków antypsychotycznych atypowych na funkcjonowanie mózgu w schizofrenii w obrazie spektroskopii protonowej rezonansu magnetycznego.

INTRODUCTION: The influence of antipsychotic medication on brain alterations in proton magnetic resonance spectroscopy (1H MRS) in schizophrenia can be the explanation of many discrepancies observed in the previous papers. AIM: The aim of this study was the evaluation of antipsychotic medication effect on the metabolite levels in the brain of schizophrenic patients based on 1H MRS examination. METHODS: The group of 32 patients with a diagnosis of schizophrenia according to DSM-IV and 26 healthy controls were included into the study. The patients were examined twice--once after the period of at least 7 days without neuroleptics (baseline) and for the second time at least 4 weeks after stable doses ofneuroleptics (follow-up). 21 patients were receiving risperidone and 11--olanzapine. Proton resonance spectroscopy was performed on a 1.5 MR scanner. Each volume element (voxel) was localised in the left frontal lobe, in the left temporal lobe and in the left thalamus. Metabolite ratios: N-acetylaspartate (NAA) to creatine (Cr) and unsupressed water signal were analysed. Results. We found the significant increase of the NAA/Cr level in the thalamus in the group of patients treated with risperidone, we didn't observe similar changes in the olanzapine group. CONCLUSIONS: Our results confirm that the neuroleptic drugs, especially atypicals, modify brain metabolism measured by 1H MRS. The pattern of the changes suggest a possible neuroprotective influence of the antipsychototic treatment in schizophrenic patients. The small group of the olanzapine treated patients doses not allow to make any conclusions regarding this type of medication.

Duration of untreated psychosis and proton magnetic resonance spectroscopy (1H-MRS) findings in first-episode schizophrenia.

BACKGROUND: The duration of untreated psychosis (DUP) is a factor associated with the natural course of schizophrenia and an independent predictor of treatment outcome. Recent studies focus on the effects of DUP on the functioning of the nervous system, but the findings are inconsistent. As proton magnetic resonance spectroscopy (1H-MRS) enables the assessment of signals from chemical compounds in vivo, it seems a useful tool to explore this problem. MATERIAL/METHODS: In this study the relationships between DUP and 1H-MRS measurements were investigated. Thirty patients with first-episode schizophrenia and 19 controls were examined. Median DUP was 10 weeks. Voxels were positioned in the following regions of interest: the left frontal lobe, left temporal lobe, and left thalamus. The ratios of N-acetylaspartate (NAA), choline-containing compounds (Cho), myoinositol (mI), and glutamate/glutamine/GABA complex (Glx) to creatine (Cr) and the non-suppressed water signal were determined. RESULTS: There were no significant differences between the whole group of patients and healthy subjects for the analyzed metabolite ratios in any region of interest. No differences were found between the groups of patients with short and long DUP and controls. No significant correlation was observed between DUP and metabolite ratios. CONCLUSIONS: The results of the study may suggest that the relatively short DUP does not influence brain metabolism in first-episode schizophrenia.

Relationship between frontal N-acetylaspartate and cognitive deficits in first-episode schizophrenia.

BACKGROUND: The aim of this study was to evaluate the relationship between N-acetylaspartate (NAA) levels in selected brain regions and cognitive performance in patients with first-episode schizophrenia. MATERIAL/METHODS: Thirty patients (20 male, 10 female; mean age: 22.5 years) with the diagnosis of first-episode schizophrenia and 19 comparable healthy controls were studied. The Wisconsin Card Sorting Test (WCST) was used to assess cognitive functions. MR imaging and MR spectroscopy examinations were performed on a 1.5 T scanner. Voxels of 8 cm3 were positioned in the left frontal lobe, left temporal lobe, and left thalamus. The ratio of NAA to creatine and the ratio of NAA to unsuppressed water signal were analyzed. RESULTS: Patients performed significantly worse than controls on measures of the WCST. In the patient group, NAA levels in the frontal lobe were significantly related to poorer WCST performance. CONCLUSIONS: Cognitive impairment related to dysfunction of the prefrontal cortex in first-episode schizophrenia is associated with NAA level in the frontal lobe.

N-acetylaspartate (NAA) levels in selected areas of the brain in patients with chronic schizophrenia treated with typical and atypical neuroleptics: a proton magnetic resonance spectroscopy (1H MRS) study.

BACKGROUND: NAA, marker of neurons integrity and viability, is one of the most important brain metabolites visible in 1H MRS. In most studies of schizophrenia, the decrease of NAA level was observed in the temporal, frontal lobes and in the thalamus. This finding was observed more often among chronic patients, what suggests the influence of disease duration or the effect of neuroleptic treatment. The aim of the present study was the comparison of NAA levels in brain of schizophrenic patients taking typical and atypical neuroleptics. MATERIAL/METHODS: We analyzed the NAA levels in selected brain areas in 58 schizophrenic patients and 21 healthy controls. 10 patients were treated with typical neuroleptics, 10 patients with clozapine, 17 received olanzapine and 21 - risperidone. 1H MRS was performed on a 1,5 MR scanner with PRESS sequence. Voxels of 2x2x2 cm were localized in the left frontal, left temporal lobe and left thalamus. RESULTS: There were no differences in NAA levels between patients on typical and atypical medications analyzed together and separately (olanzapine, clozapine and risperidone groups). We also did not find any differences between patients taking selected atypical neuroleptics and controls. The NAA level in the thalamus in the group of patients receiving typical antipsychotics was the lowest among all groups and differed significantly from healthy controls. CONCLUSIONS: The results of our study suggest that atypical neuroleptics may have favorable effect on NAA concentration in brain of schizophrenic patients. Decrease in NAA level in patients taking typical medication may be caused by the progression of the disease or by the direct action of these drugs.

Utility of computed tomography and selected MR sequences in the diagnostics of patients with partial epileptic attacks.

BACKGROUND: Epilepsy is a disease which manifests itself with recurrent dysfunction of the brain. Epilepsy thus becomes a serious social problem and it is therefore necessary to introduce more and more up-to-date methods of its diagnostics. MATERIAL/METHODS: Examinations were performed on 85 patients with partial epileptic attacks. The study group included 43 women and 42 men who had suffered from epilepsy for 2 to 40 years. CT and MR examinations were performed in the interparoxysmal period. In MRI, T1-weighted images before and after contrast administration, T2- and PD-weighted images, and FLAIR images were analyzed. RESULTS: Agreement between the location of lesions in CT and EEG was evaluated with the kappa test and amounted to 0.29. Low compatibility was also found between MR and EEG and amounted to 0.33. However, compatibility between the location in CT and MR reached the level of 0.62. The most common abnormalities were asymmetry of the lateral ventricles (most often temporal horns), cortical scars, mesial temporal sclerosis (MTS), and CNS tumors. T1- and T2-weighted images enabled recognition of most of the focuses, but they failed to visualize some of the degenerative lesions in the hippocampus which were recognizable in coronal FLAIR. No statistically significant correlation was found between the patient age, duration of the disease, and type of lesion and its location. CONCLUSIONS: The performed examinations showed that MR is the method of choice in patients with temporal epilepsy. The study protocol should include the FLAIR sequence in the coronal plane, which has high sensitivity in recognizing lesions within the hippocampus.

Antiretroviral therapy and its influence on the stage of brain damage in patients with HIV - 1H MRS evaluation.

BACKGROUND: MR proton spectroscopy (1H MRS) enables early detection of metabolic changes, which occur in the course of AIDS Dementia Complex Syndrome (ADC). The goal of the study was the evaluation of highly active antiretroviral therapy (HAART) and its influence on the character and intensity of metabolic changes in brain 1H MRS spectra in clinically asymptomatic HIV-infected patients as well as search for correlation between the treatment and 1H MR spectroscopy results and immune deficit degree. MATERIAL/METHODS: In the group of 20 HIV+ patients, the examination of the central nervous system (CNS), MR and 1H MRS were conducted twice:before HAART treatment and during the therapy; on average after 6 months (4 -9 months of treatment). RESULTS: The levels of NAA/Cr in the control MRS examination were close to the values observed before treatment. However, statistically significant increase in NAA/Cho ratio (p<0.05) was noticed. The control examination showed statistically decrease of Cho/Cr and mI/Cr ratios, though statistically insignificant (p>0.05). NAA and Cr contents in reference to the signal of non-suppressed water increased insignificantly in the follow-up examination. However, statistically significant decrease in Cho/H(2)O and mI/H(2)O levels (p<0.05) was observed. CONCLUSIONS: The therapy with HAART affects normalization of metabolite levels in the central nervous system in clinically asymptomatic HIV+ patients and diminishes the risk of ADC occurrence. Myoinositol and choline levels estimated in 1H MRS might be the indices for antiretroviral treatment efficacy.

[Clinical and neuropsychological correlates of proton magnetic resonance spectroscopy detected metabolites in brains of first-episode and schizophrenic patients]. / Badania wybranych obszarów mózgu metoda spektroskopii protonowej rezonansu magnetycznego (1H MRS) w aspekcie dysfunkcji poznawczych i obrazu klinicznego u osób ze schizofrenia wczesna i przewlekla--doniesienie wstepne.

OBJECTIVE: This study examined 1H MRS detected metabolite levels (in left frontal, temporal lobes and thalamus) and clinical and cognitive features of patients with first-episode and chronic schizophrenia. METHOD: We studied 31 first-episode patients (group 1) and 17 chronic patients (group 2) with ICD-10 diagnosis of schizophrenia (and 13 healthy subjects). Patients were also assessed by the means of PANSS, CGI, Calgary scales and WCST, TMT, Stroop tests. RESULTS: We did not observe statistically significant differences in metabolite levels between group 1 and 2. We observed only a trend toward higher Cho level in temporal lobe in group 2 and lower NAA level in group 1. When comparing with the control group we observed a significantly higher Cho level in the frontal lobe (group 1,2) (p < 0.05). We observed a trend toward lower NAA levels in the frontal lobe (group 1,2), and lower NAA level in the temporal lobe (group 1). Patients with chronic schizophrenia performed significantly worse in WCST, TMT and Stroop tests (p < 0.05). CONCLUSION: These results suggest, that abnormalities in metabolite levels in frontal and temporal lobes are present at the onset of disease and don't progress over time. The cognitive dysfunction is more prominent in chronic patients.

MR proton spectroscopy in liver examinations of healthy individuals in vivo.

BACKGROUND: Magnetic resonance proton spectroscopy ((1)H MRS) is a non-invasive method that provides in vivo measurement of metabolic concentrations in body tissue. However, relatively little is known about the potential of 1H MR spectroscopy for the quantification of liver metabolites. The aim of this study was to determine the usefulness of (1)H MRS in establishing the metabolic pattern of normal human liver. MATERIAL/METHODS: Proton spectroscopy of the liver, using the Picker system, Edge Eclipse 1.5T, with whole-body coil and PRESS 35 sequence, was conducted in a group of 24 healthy volunteers. In all subjects we also evaluated the thickness of the subcutaneous fat tissue in MR images and body mass index. RESULTS: The presence of lipid resonances, phosphoesters (Pe), glycogen/glucose (Glc), and glutamine/glutamate (Gln) were observed in the spectra. Total lipid concentration, CH3 and (CH2)n of the lipid resonances were higher in the men than in the women, while the metabolite contents in the CH2=CH-CH2 groups of lipids, Pe, Glc and Gln peaks were similar in both genders. We observed statistically significant positive correlation, more apparent in the group of men, between TL concentration and BMI. There was no statistically significant correlation between lipid total concentration and age. CONCLUSIONS: Proton spectroscopy enables the quantitative evaluation of lipid contents in the liver. The correlation between liver triglyceride contents and body mass index shows that the tendency to obesity is also connected with lipid accumulation in the liver.