title: Reversal of cerebral glucose hypometabolism on positron emission tomography with electroconvulsive therapy in an elderly patient with a psychotic episode.
abstract: AB, a 74-year-old Caucasian woman, was admitted for acute onset of psychosis, anxiety, and cognitive impairment. Pharmacotherapy was unsuccessful and the patient was referred for electroconvulsive therapy (ECT). Pre-ECT,18F-fluorodeoxyglucose-positron emission tomography (PET)/computed tomography showed extensive frontal, parietal, and temporal cortical hypometabolism suggestive of a neurodegenerative disease. After eight ECT sessions, the psychotic and anxiety symptoms as well as the cognitive impairment resolved. The rapid improvement in symptoms was more suggestive of a psychotic episode rather than dementia. Two days after the ECT course,18F-fluorodeoxyglucose-PET/computed tomography showed improvements in cerebral cortical hypometabolism, especially in the left parietal cortex, left temporal/occipital cortex. and bifrontal regions. At a follow-up visit 2 months after the ECT course, the psychotic episode was still in remission, and18F-fluorodeoxyglucose-PET/computed tomography continued to show improved cerebral cortical hypometabolism in these areas. This case illustrated the effect of ECT in reversing cerebral glucose hypometabolism on PET. The improvement in cerebral glucose hypometabolism may represent the neurophysiological mechanism of ECT in the treatment of a psychotic episode. Improved cerebral glucose hypometabolism was present 2 months post-ECT, which suggests that ECT caused sustained functional neural changes.
authors.affiliation: Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA.|Department of Addiction Psychiatry, UCLA-Kern, Bakersfield, CA, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Hassamal
authors.affiliation: Department of Nuclear Medicine, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Jolles
authors.affiliation: Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Ananda
authors.initials: A
authors.lastname: Pandurangi
mesh_terms: D000368:Aged; D001007:Anxiety / Q000000981:diagnostic imaging / Q000378:metabolism; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000378:metabolism*; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000378:metabolism; D003704:Dementia / Q000000981:diagnostic imaging / Q000378:metabolism; D004565:Electroconvulsive Therapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D049268:Positron-Emission Tomography; D011618:Psychotic Disorders / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy*; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005947:Glucose
keywords: 18F-fluorodeoxyglucose; anxiety disorders; dementia; electroconvulsive therapy; psychotic disorders