Depression in patients with Huntington disease correlates with alterations of the brain stem raphe depicted by transcranial sonography.
BACKGROUND
Transcranial sonography (TCS) has become a new diagnostic tool in the evaluation of extrapyramidal disorders. Studies of TCS report alterations of the mesencephalic raphe in patients with depression. The aim of this study was to evaluate TCS findings in patients with Huntington disease in correlation with their neurologic and psychiatric status.


METHODS
We recruited patients with genetically confirmed Huntington disease. The neurological and psychiatric status of participants was assessed by independent physicians. Echogenicities were investigated according to examination protocol for extrapyramidal disorders using a Siemens Sonoline Elegra system. The sonography examiner was blinded for clinical data.


RESULTS
We included 39 patients in our study; 21 patients (53.8%) showed symptoms of depression at the time of evaluation and, of those, 15 (71.4%) had hypoechogenic raphe structures. Thirty patients (76.9%) had a history of depressive episodes, 19 (63.3%) of them with hypoechogenic raphe structures. All 9 patients without a history of depressive episodes showed normal echogenicity of raphe structures (sensitivity 63.3%, specificity 100%). Twelve (70.6%) of the 17 patients with Huntington disease who showed psychiatric disturbances prior to the occurrence of motor symptoms exhibited pathological raphe echogenicity (sensitivity 70.6%, specificity 68.2%).


CONCLUSIONS
Most of the patients were taking antichoreatic medication, which particularly influences neurologic status. Thus, a meaningful interpretation of the correlation between TCS findings and neurologic features was limited.


CONCLUSIONS
As a novel finding, a relation between mesencephalic raphe echogenicity and depressive state could be identified in patients with Huntington disease. An alteration of the serotonergic brain stem raphe might be involved in the pathogenesis of depression in these patients.
Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany. christos.krogias@rub.de
Christos
C
Krogias
Katrin
K
Strassburger
Jens
J
Eyding
Ralf
R
Gold
Christine
C
Norra
Georg
G
Juckel
Carsten
C
Saft
Dietmar
D
Ninphius
D000328:Adult; D003866:Depressive Disorder / Q000150:complications* / Q000000981:diagnostic imaging* / Q000523:psychology; D005260:Female; D006801:Humans; D006816:Huntington Disease / Q000150:complications* / Q000000981:diagnostic imaging* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011903:Raphe Nuclei / Q000000981:diagnostic imaging*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D017585:Ultrasonography, Doppler, Transcranial