title: Brain dynamic neurochemical changes in dystonic patients: a magnetic resonance spectroscopy study.
abstract: Measurements of the concentrations of γ-aminobutyric acid (GABA) and glutamate in the motor cortices and lentiform nuclei of dystonic patients using single-voxel (1)H magnetic resonance spectroscopy (MRS) have yielded conflicting results so far. This study aimed to investigate dynamic changes in metabolite concentrations after stimulation of the motor cortices in patients with upper limb dystonia. Using single-voxel MRS at 3 T, the concentrations of GABA, glutamate plus glutamine, and N-acetylaspartate were measured bilaterally in the primary sensorimotor cortex, lentiform nucleus, and occipital region before and after 5-Hz transcranial magnetic stimulation (TMS) over the dominant motor cortex. Data obtained from 15 patients with upper limb primary dystonia were compared with data obtained from 14 healthy volunteers. At baseline, there was no group difference in concentration of metabolites in any region. rTMS induced a local (in the stimulated motor cortex) decrease of N-acetylaspartate (P < .006) to the same extent in healthy volunteers and patients. GABA concentrations were modulated differently, however, decreasing mildly in patients and increasing mildly in healthy volunteers (P = .05). There were no remote effects in the lentiform nucleus in either group. The stimulation-induced changes in metabolite concentrations have been interpreted in view of the increased energy demand induced by rTMS. The dynamics of the GABA concentration were specifically impaired in dystonic patients. Whether these changes reflect changes in the extrasynaptic or synaptic GABA component is discussed.
authors.affiliation: Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Marjańska
authors.forename: Stéphane
authors.initials: S
authors.lastname: Lehéricy
authors.forename: Romain
authors.initials: R
authors.lastname: Valabrègue
authors.forename: Traian
authors.initials: T
authors.lastname: Popa
authors.forename: Yulia
authors.initials: Y
authors.lastname: Worbe
authors.forename: Margherita
authors.initials: M
authors.lastname: Russo
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Auerbach
authors.forename: David
authors.initials: D
authors.lastname: Grabli
authors.forename: Cecilia
authors.initials: C
authors.lastname: Bonnet
authors.forename: Cécile
authors.initials: C
authors.lastname: Gallea
authors.forename: Mathieu
authors.initials: M
authors.lastname: Coudert
authors.forename: Lydia
authors.initials: L
authors.lastname: Yahia-Cherif
authors.forename: Marie
authors.initials: M
authors.lastname: Vidailhet
authors.forename: Sabine
authors.initials: S
authors.lastname: Meunier
mesh_terms: D000328:Adult; D000368:Aged; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000032:analysis / Q000378:metabolism; D001923:Brain Chemistry / Q000502:physiology*; D003627:Data Interpretation, Statistical; D004421:Dystonia / Q000378:metabolism*; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D018698:Glutamic Acid / Q000378:metabolism; D005973:Glutamine / Q000378:metabolism; D006801:Humans; D007091:Image Processing, Computer-Assisted; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000378:metabolism; D017072:Neostriatum / Q000378:metabolism; D009434:Neural Pathways / Q000378:metabolism; D013003:Somatosensory Cortex / Q000378:metabolism; D050781:Transcranial Magnetic Stimulation; D034941:Upper Extremity; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000378:metabolism
chemical_list: D005973:Glutamine; D001224:Aspartic Acid; D018698:Glutamic Acid; D005680:gamma-Aminobutyric Acid; C000179:N-acetylaspartate