title: Brain hypermetabolism in amyotrophic lateral sclerosis: a FDG PET study in ALS of spinal and bulbar onset.
abstract: OBJECTIVE
  To identify the neurobiological traits of amyotrophic lateral sclerosis (ALS) and to elucidate functional differences between ALS of spinal and bulbar onset. We hypothesized that glucose metabolism distribution might vary between groups.
  
  
  METHODS
  The study groups comprised 32 patients with ALS of either bulbar (n = 13) or spinal (n = 19) onset and 22 subjects as controls. They were investigated by [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (FDG PET), comparing the patient groups with each other and with the controls by statistical parametric mapping.
  
  
  RESULTS
  Highly significant relative increases in glucose metabolism distribution were found in the group comprising all 32 ALS patients as compared with the controls in the bilateral amygdalae, midbrain, pons and cerebellum. Relative hypermetabolism was also found in patients with spinal onset as compared with the controls in the right midbrain. In patients with bulbar onset compared with the controls and with patients with spinal onset, large relatively hypometabolic areas were found in the bilateral frontal cortex, right insula, anterior cingulate, precuneus and inferior parietal lobe. Patients with spinal onset had significantly higher scores in a neuropsychological test assessing verbal fluency compared with patients with bulbar onset.
  
  
  CONCLUSIONS
  This large FDG PET investigation provided unprecedented evidence of relatively increased metabolism in the amygdalae, midbrain and pons in ALS patients as compared with control subjects, possibly due to local activation of astrocytes and microglia. Highly significant relative decreases in metabolism were found in large frontal and parietal regions in the bulbar onset patients as compared with the spinal onset patients and the controls, suggesting a differential metabolic and neuropsychological state between the two conditions.
authors.affiliation: Positron Emission Tomography Center IRMET S.p.A, Turin, Italy.
authors.forename: Angelina
authors.initials: A
authors.lastname: Cistaro
authors.forename: Maria Consuelo
authors.initials: MC
authors.lastname: Valentini
authors.forename: Adriano
authors.initials: A
authors.lastname: Chiò
authors.forename: Flavio
authors.initials: F
authors.lastname: Nobili
authors.forename: Andrea
authors.initials: A
authors.lastname: Calvo
authors.forename: Cristina
authors.initials: C
authors.lastname: Moglia
authors.forename: Anna
authors.initials: A
authors.lastname: Montuschi
authors.forename: Silvia
authors.initials: S
authors.lastname: Morbelli
authors.forename: Dario
authors.initials: D
authors.lastname: Salmaso
authors.forename: Piercarlo
authors.initials: P
authors.lastname: Fania
authors.forename: Giovanna
authors.initials: G
authors.lastname: Carrara
authors.forename: Marco
authors.initials: M
authors.lastname: Pagani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D001921:Brain / Q000378:metabolism*; D001931:Brain Mapping / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000494:pharmacology*; D005947:Glucose / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D049268:Positron-Emission Tomography / Q000379:methods*; D013131:Spine / Q000378:metabolism
chemical_list: D019788:Fluorodeoxyglucose F18; D005947:Glucose
references.citation: J Neurol Sci. 1997 May 1;148(1):95-100
references.pmid: 9125395
references.citation: Neurology. 1992 May;42(5):1004-8
references.pmid: 1579222
references.citation: Neurology. 1993 Aug;43(8):1569-73
references.pmid: 8351013
references.citation: Brain. 1996 Dec;119 ( Pt 6):2105-20
references.pmid: 9010014
references.citation: Curr Alzheimer Res. 2010 Jun;7(4):287-94
references.pmid: 19939228
references.citation: Arch Neurol. 2008 May;65(5):636-41
references.pmid: 18474740
references.citation: J Neurol. 2007 Aug;254(8):1033-6
references.pmid: 17294065
references.citation: Amyotroph Lateral Scler Other Motor Neuron Disord. 2000 Dec;1(5):293-9
references.pmid: 11464847
references.citation: Amyotroph Lateral Scler. 2009 Jun;10(3):131-46
references.pmid: 19462523
references.citation: Glia. 2007 Sep;55(12):1238-50
references.pmid: 17659529
references.citation: J Neurol Neurosurg Psychiatry. 1995 May;58(5):541-7
references.pmid: 7745399
references.citation: Neuroimage. 2009 Apr 1;45(2):249-57
references.pmid: 18718541
references.citation: Eur Neurol. 1989;29(2):115-20
references.pmid: 2785038
references.citation: J Neurol Sci. 2001 Apr 1;185(2):95-100
references.pmid: 11311289
references.citation: J Nucl Med. 2009 Jun;50(6):982-90
references.pmid: 19443600
references.citation: J Neurol. 2005 Mar;252(3):321-31
references.pmid: 15739047
references.citation: Neuropsychologia. 2000;38(6):734-47
references.pmid: 10689049
references.citation: J Neurol Sci. 1995 May;129 Suppl:44-6
references.pmid: 7595618
references.citation: Neuroradiology. 1998 May;40(5):298-302
references.pmid: 9638670
references.citation: Trends Neurosci. 2005 Mar;28(3):117-9
references.pmid: 15749163
references.citation: Neurology. 2009 Feb 24;72(8):725-31
references.pmid: 19237701
references.citation: Br J Psychiatry. 2010 Jun;196(6):474-9
references.pmid: 20513859
references.citation: Brain. 2000 Nov;123 ( Pt 11):2289-96
references.pmid: 11050028
references.citation: J Neural Transm Gen Sect. 1992;89(1-2):111-22
references.pmid: 1418862
references.citation: J Neurol Sci. 1993 May;116(1):52-8
references.pmid: 8509805
references.citation: J Comput Assist Tomogr. 1988 Jul-Aug;12(4):630-6
references.pmid: 3260610
references.citation: Acta Neurol Scand. 1990 Feb;81(2):141-3
references.pmid: 2327234
references.citation: Ann Neurol. 1987 Nov;22(5):580-6
references.pmid: 3501273
references.citation: J Alzheimers Dis. 2010;22(3):993-1003
references.pmid: 20858977
references.citation: J Neurotrauma. 2010 Aug;27(8):1463-75
references.pmid: 20504160
references.citation: Acta Neurol Scand. 1992 Feb;85(2):81-9
references.pmid: 1574993
references.citation: J Neurol Neurosurg Psychiatry. 1997 May;62(5):464-72
references.pmid: 9153602
references.citation: Brain Res. 2000 Dec 15;886(1-2):108-112
references.pmid: 11119692
references.citation: Soc Cogn Affect Neurosci. 2009 Dec;4(4):417-22
references.pmid: 20042432
references.citation: Brain. 1981 Jun;104(2):217-47
references.pmid: 7016254
references.citation: Eur J Nucl Med Mol Imaging. 2011 Feb;38(2):343-51
references.pmid: 20844871
references.citation: Eur J Nucl Med Mol Imaging. 2008 Jul;35(7):1357-66
references.pmid: 18418593
references.citation: Brain. 1993 Dec;116 ( Pt 6):1399-423
references.pmid: 8293278
references.citation: Amyotroph Lateral Scler Other Motor Neuron Disord. 2003 Sep;4(3):171-6
references.pmid: 14527871
references.citation: Arch Neurol. 2010 Jan;67(1):122-5
references.pmid: 20065142
references.citation: Synapse. 2011 Mar;65(3):207-14
references.pmid: 20665726
references.citation: Nat Neurosci. 2008 Mar;11(3):251-3
references.pmid: 18246065