Frontotemporal alterations in pediatric bipolar disorder: results of a voxel-based morphometry study.
BACKGROUND
While numerous magnetic resonance imaging (MRI) studies have evaluated adults with bipolar disorder (BPD), few have examined MRI changes in children with BPD.


OBJECTIVE
To determine volume alterations in children with BPD using voxel-based morphometry, an automated MRI analysis method with reduced susceptibility to various biases. A priori regions of interest included amygdala, accumbens, hippocampus, dorsolateral prefrontal cortex (DLPFC), and orbitofrontal cortex.


METHODS
Ongoing study of the pathophysiology of pediatric BPD.


METHODS
Intramural National Institute of Mental Health; approved by the institutional review board. Patients Pediatric subjects with BPD (n = 20) with at least 1 manic or hypomanic episode meeting strict DSM-IV criteria for duration and elevated, expansive mood. Controls (n = 20) and their first-degree relatives lacked psychiatric disorders. Groups were matched for age and sex and did not differ in IQ.


METHODS
With a 1.5-T MRI machine, we collected 1.2-mm axial sections (124 per subject) with an axial 3-dimensional spoiled gradient recalled echo in the steady state sequence. Image analysis was by optimized voxel-based morphometry.


RESULTS
Subjects with BPD had reduced gray matter volume in the left DLPFC. With a less conservative statistical threshold, additional gray matter reductions were found in the left accumbens and left amygdala. No difference was found in the hippocampus or orbitofrontal cortex.


CONCLUSIONS
Our results are consistent with data implicating the prefrontal cortex in emotion regulation, a process that is perturbed in BPD. Reductions in amygdala and accumbens volumes are consistent with neuropsychological data on pediatric BPD. Further study is required to determine the relationship between these findings in children and adults with BPD.
Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD 20892, USA. Dicksted@mail.nih.gov
Daniel P
DP
Dickstein
Michael P
MP
Milham
Allison C
AC
Nugent
Wayne C
WC
Drevets
Dennis S
DS
Charney
Daniel S
DS
Pine
Ellen
E
Leibenluft
D000293:Adolescent; D000367:Age Factors; D000679:Amygdala / Q000473:pathology; D001284:Atrophy; D001714:Bipolar Disorder / Q000175:diagnosis / Q000473:pathology*; D002648:Child; D005260:Female; D005625:Frontal Lobe / Q000473:pathology*; D007839:Functional Laterality; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D009714:Nucleus Accumbens / Q000473:pathology; D017397:Prefrontal Cortex / Q000473:pathology; D011569:Psychiatric Status Rating Scales; D013702:Temporal Lobe / Q000473:pathology*