Voxel-Based Morphometry-from Hype to Hope. A Study on Hippocampal Atrophy in Mesial Temporal Lobe Epilepsy.

BACKGROUND AND PURPOSE: Automated volumetry of the hippocampus is considered useful to assist the diagnosis of hippocampal sclerosis in temporal lobe epilepsy. However, voxel-based morphometry is rarely used for individual subjects because of high rates of false-positives. We investigated whether an approach with high dimensional warping to the template and nonparametric statistics would be useful to detect hippocampal atrophy in patients with hippocampal sclerosis. MATERIALS AND METHODS: We performed single-subject voxel-based morphometry with nonparametric statistics within the framework of Statistical Parametric Mapping to compare MRI from 26 well-characterized patients with temporal lobe epilepsy individually against a group of 110 healthy controls. The following statistical threshold was used: P < .05 corrected for multiple comparisons with family-wise error over the region of interest right and left hippocampus. RESULTS: The sensitivity for the detection of atrophy related to hippocampal sclerosis was 0.92 (95% CI, 0.67-0.99) for the right hippocampus and 0.60 (0.31-0.83) for the left, and the specificity for volume changes was 0.98 (0.93-0.99). All clusters of decreased hippocampal volumes were correctly lateralized to the seizure focus. Hippocampal volume decrease was in accordance with neuronal cell loss on histology reports. CONCLUSIONS: Nonparametric voxel-based morphometry is sensitive and specific for hippocampal atrophy in patients with mesial temporal lobe epilepsy and may be useful in clinical practice.

[Medical students and community health care centers: preparing the future]. / Etudiants en médecine et centres médico-sociaux: préparer l'avenir.

Since 2011, second year medical students from Lausanne University follow a single day course in the community health care centers of the Canton of Vaud. They discover the medico-social network and attend to patients' visits at home. They experience the importance of the information transmission and the partnership between informal caregivers, professional caregivers, general practitioner and hospital units. The goal of this course is to help the future physicians to collaborate with the community health care centers teams. This will be particularly important in the future with an aging and more dependant population.

Quality of sleep, fatigue and daytime sleepiness in migraine - a controlled study.

The objective of this study was to evaluate whether the quality of sleep and the degree of fatigue and daytime sleepiness are related to migraine. We investigated 489 subjects comprising 97 patients with eight or more, 77 patients with five to seven and 196 patients with one to four migraine days per month, and 119 migraine-free controls with fewer than six headache days per year. The patients were recruited via articles in newspapers not stressing the subject of the study. All participants underwent a semistructured interview and completed the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale (ESS) and the Self-rating Depression Scale and the Self-rating Anxiety Scale. For statistical analysis we used two way manovas, post hoc univariate two-way anovas and Hochberg's GT2 tests as well as three-way mixed design anovas. The PSQI total score was highest in patients with frequent migraine (5.9 +/- 4.3) and lowest in controls (4.3 +/- 2.5, P = 0.04). Four subscores of the PSQI showed similar statistically significant differences. The FSS and ESS scores did not differ in the four study groups. Analysing depression and anxiety revealed a significant impact on PSQI, FSS and ESS, but did not demonstrate interactions with migraine, thus suggesting that the impact of migraine is similar in patients without and with psychiatric comorbidity. In conclusion, the quality of sleep is decreased in patients with migraine, whereas fatigue and daytime sleepiness do not differ from healthy controls. The decreased quality of sleep in migraineurs is also a consequence of migraine itself and cannot be explained exclusively by comorbidity with depression or anxiety.

Network atrophy in temporal lobe epilepsy: a voxel-based morphometry study.

BACKGROUND: Recent evidence suggests that temporal lobe epilepsy affects a neuronal network rather than a single circumscribed structure within the temporal lobe. Thus, in mesial temporal lobe epilepsy (mTLE) with hippocampal sclerosis gray matter abnormalities have been found beyond the hippocampus in extrahippocampal regions by means of voxel-based morphometry (VBM). On the contrary, in cryptogenic or MRI-negative TLE (cTLE) no consistent gray matter abnormalities in VBM studies have been reported. METHODS: We used optimized VBM with modulation to detect gray matter abnormalities compared to healthy controls in patients with mTLE and cTLE. Twenty-two patients with mTLE (right/left TLE 13:9), 17 patients with cTLE (right/left TLE 7:10), and 12 healthy controls were enrolled in the study. RESULTS: In mTLE we found decreased gray matter volume (GMV) beyond the hippocampus in the ipsilateral thalamus. GMV decrease was more widespread in patients with left-sided seizure focus including the left parahippocampal and superior temporal gyrus, frontal regions, cerebellum, and the right cingulum. In cTLE, decreased GMV was observed in the frontal and orbitofrontal cortex, the cerebellum, neocortical temporal regions, and in the right parahippocampal cortex. Again, patients with left-sided seizure focus had a more widespread and extensive GMV decrease including regions such as the right and left cingulum. CONCLUSION: We found evidence for distinct neuronal network damage in mesial temporal lobe epilepsy (mTLE) and cryptogenic TLE (cTLE) which is more widespread in patients with left-sided seizure focus. Atrophy of the cingulum was a common feature in left- but not in right-sided mTLE and cTLE.

Metabolic changes in the normal ageing brain: consistent findings from short and long echo time proton spectroscopy.

OBJECTIVES: Sixty three healthy subjects were measured to assess dependence of brain metabolites on age using short- and long echo time spectroscopy in different brain regions. MATERIAL AND METHODS: Younger and elderly humans were measured with long echo time (TE=135ms) 3D-MR-spectroscopic imaging (MRSI) (10 subjects) and with ultra-short echo (TE=11ms) time 2D-MRSI (7 subjects). In addition, results from single voxel (1)H-spectroscopy (TE=20ms) of two cohorts of 46 healthy subjects were retrospectively correlated with age. RESULTS: 3D-MR SI revealed reduced NAA/Cr in the older group in the frontal lobe (-22%; p<0.01), parietal lobe (-28%; p<0.01) and semiovale (-9%; p<0.01) compared to the younger group. Cho/Cr was elevated in the semiovale (+35%; p<0.01) and in the n. lentiformis (+42%; p<0.01) in the older group. NAA/Cho was reduced in all regions measured, except the thalamus, in the older group compared to the younger group (from -21 to -49%; p<0.01). 2D-MRSI revealed decreased total NAA (-3.1% per decade; p<0.01) and NAA/Cr (-3.8% per decade; p<0.01), increased total Cho (+3.6% per decade; p<0.01) and Cho/Cr (+4.6% per decade; p<0.01) and increased total myo-Inositol (mI, +4.7% per decade; p<0.01) and mI/Cr (+5.4% per decade; p<0.01) and decreased NAA/Cho (-8% per decade; p<0.01) in semiovale WM. Results from single voxel spectroscopy revealed a significantly negative correlation of NAA/Cho in frontal (-13% per decade; p<0.01) and in temporal lobe (-7.4% per decade; p<0.01) as well as increased total Cr (10% per decade; p<0.01) in frontal lobe. Other results from single voxel measurements were not significant, but trends were comparable to that from multivoxel spectroscopy. CONCLUSION: Age-related changes measured with long echo time and short echo time 1H-MRS were comparable and cannot, therefore, be caused by different T2 relaxation times in young and old subjects, as suggested previously.

[Tourette's syndrome - a review]. / Das Tourette-Syndrom Eine Ubersicht.

Tourette's syndrome (TS) is a neuropsychiatric disorder characterised by the occurrence of chronic motor and vocal tics that usually begin in childhood. A prevalence of 4-5/10.000 individuals is estimated. Tourette's syndrome patients frequently show comorbidity with other psychiatric disorders such as obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), anxiety, and affective disorders. Some forms of OCD seem to share a common genetic etiology with TS and to be a facultative part of the TS phenotypic spectrum. Based on MRI, positron emission tomography (PET), and single photon emission computed tomography (SPECT), data alterations in the cortico-striato-pallido-thalamo-cortical functional systems have been discussed. Within these systems, dopaminergic neurotransmission is thought to play an important role in the pathophysiology of TS. Autoimmunological mechanisms seem to be important in some subtypes of TS and OCD that are triggered or exacerbated by infections with hemolytic streptococci. In these cases, immune modulatory therapy proved to be efficient. To date, there is no established treatment regimen for TS. The medications used most frequently are antipsychotics.

Study of family history in seasonal affective disorder.

OBJECTIVE: In our investigation we assessed the risk of morbidity for psychiatric disorders among the first-degree relatives of patients with seasonal affective disorders (SAD) and compared it with a control group of patients suffering from nonseasonal mood disorders (NSMD). METHODS: Over a period of 12 months (June 1994 to May 1995) we recruited patients consecutively admitted to our psychiatric university outpatient clinic in a prospective study. All patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, revised 4th edition. A total of 344 patients presented themselves with a diagnosis of affective disorder. Out of these, 36 were diagnosed as having SAD. From the same group of 344 patients, we selected a matched control group of 36 patients suffering from NSMD. The experimental and control groups were matched according to sex, age, severity of illness and number of siblings. RESULTS: There was no significant difference concerning the lifetime prevalences for psychiatric disorders among the fist-degree relatives in both groups (SAD = 16.5% and NSMD = 19%). CONCLUSION: It seems that there is no difference in familiarity for psychiatric disorders between SAD and NSMD.

Fluoxetine treatment in patients with recurrent brief depression.

Recurrent brief depression (RBD) fulfills DSM-IV criteria for major depression except duration. Depressive episodes last at least 2 days but less than 2 weeks occurring at least once a month for 12 consecutive months without association to the menstrual cycle. RBD has a high prevalence in the general population (approximately 10%). At present, there are few double-blind controlled studies indicating that selective serotonine reuptake inhibitors (SSRIs) might not be effective in treatment of RBD. However, most of those studies include patients with a history of frequent suicide attempts and depressive episodes lasting shorter 2 weeks. It has previously been shown that fluoxetine was effective in patients with RBD in an open-label study. The objective of our study was to reinvestigate these contradictory results concerning the effectiveness of fluoxetine in patients with RBD. Seventeen patients with RBD according to DSM-IV and ICD-10 diagnostic criteria, who had no history of major depression were treated with a dosage of 20-40 mg fluoxetine daily. Patients had to keep a diary in order to document psychopathological symptoms according to DSM-IV. We also used the 21-item Hamilton Depression Rating Scale (HAM-D), the Beck Depression Inventory (BDI) and the Clinical Global Impressions (CGI). Duration of the study was 8 weeks. The diaries of nine patients were observed for a clinical observation period of 20 weeks after the end of the study with continued fluoxetine treatment. Two patients who initially fulfilled diagnostic criteria for RBD suffered from depressive episodes that lasted longer than 2 weeks. Therefore, their data had to be excluded from primary analysis. In the remaining 15 patients, we showed statistically significant improvement of depressive episodes measured by patient's diary, HIAM-D, BDI and CGI that persisted over the clinical observation period. Frequency of depressive episodes showed a significant decrease during fluoxetine treatment. Duration and severity of the single depressive episodes also decreased but did not reach statistical significance. In accordance with previous studies, fluoxetine could be a treatment option for patients with RBD. Treatment of RBD with SSRIs has been discussed controversially in the literature. Our study shows the effectiveness of fluoxetine in this depressive disorder. To confirm these preliminary results, a double-blind controlled study is necessary.

No change in striatal dopamine re-uptake site density in psychotropic drug naive and in currently treated Tourette's disorder patients: a [(123)I]-beta-CIT SPECt-study.

BACKGROUND: There is evidence that Tourette's disorder (TD) is associated with abnormalities in the dopaminergic system involving the dopamine transporter (DAT). Data from [(123)I]-beta-CIT single photon emission computed tomography (SPECT) studies and postmortem findings concerning DAT densities in TD patients are not conclusive. The objective of our study was to measure DAT densities with [(123)I]-beta-CIT binding in TD patients who were either psychotropic drug naive or currently treated with antipsychotics (AP) and healthy controls. METHOD: Altogether 20 TD patients were investigated. A total of 15 patients were psychotropic drug naive and five were currently treated with AP. Ten psychotropic drug naive patients were compared with ten age and sex matched healthy subjects. Five currently treated patients were compared with five age and sex matched psychotropic drug naive TD patients. The investigation was carried out using [(123)I]-beta-CIT (2-beta-carbomethoxy-3-beta(4-iodophenyl)-tropane and SPECT. Regions of interest (ROI) were drawn over the striatum and the cerebellum. RESULTS: The DAT densities measured by the striatal/cerebellar (S/C) binding ratio did not differ between drug naive TD patients and the controls. The difference between currently AP treated and psychotropic drug naive TD patients did not reach the level of significance. There was no correlation between the ratio and severity of tics and illness. CONCLUSION: Our study with psychotropic drug naive TD patients contributed to clarify the inconsistent results concerning the DAT.