Uptake of 99mTc-exametazime shown by single photon emission computed tomography before and after lithium withdrawal in bipolar patients: associations with mania.
BACKGROUND
Early manic relapse following lithium discontinuation offers an important opportunity to investigate the relationship between symptoms, effects of treatment and regional brain activation in bipolar affective disorder.


METHODS
Fourteen stable bipolar patients on lithium were examined with neuropsychological measures, clinical ratings and single photon emission computed tomography (SPECT) before and after acute double-blind withdrawal of lithium. Brain perfusion maps were spatially transformed into standard stereotactic space and compared pixel-by-pixel. A parametric analysis was used to examine the change in brain perfusion on lithium withdrawal, and the relationship between symptom severity and brain perfusion separately both between and within subjects.


RESULTS
Lithium withdrawal was associated with an important redistribution of brain perfusion, with increases in inferior posterior regions and decreases in limbic areas, particularly anterior cingulate cortex. Seven of the 14 patients developed manic symptoms during the placebo phase, correlating with relative increases in perfusion of superior anterior cingulate and possibly left orbito-frontal cortex.


CONCLUSIONS
The important effect of lithium withdrawal on brain perfusion implies that after withdrawal of lithium, the brain develops an abnormal state of activity in limbic cortex. The structures involved did not co-localise with those apparently modulated by manic symptoms.
Goodwin
G M
GM
Warneford Hospital, Oxford.
Cavanagh
J T
JT
Glabus
M F
MF
Kehoe
R F
RF
O'Carroll
R E
RE
Ebmeier
K P
KP
D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010091:Oximes; D013375:Substance Withdrawal Syndrome / Q000000981:diagnostic imaging*; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D018692:Antimanic Agents; D015609:Organotechnetium Compounds; D010091:Oximes; D016651:Lithium Carbonate; D019690:Technetium Tc 99m Exametazime