technetium-tc-99m-bicisate and Tourette-Syndrome

We report the case of an adult male patient with Tourette syndrome, self-injurious behavior and depression, refractory to conventional treatment, and whose symptoms remitted after electroconvulsive therapy. Serial Technetium 99m-Ethyl-Cysteinate-Dimer single photon emission tomographies were applied, before, during, and after electroconvulsive therapy. The neural substrates of this treatment process were further analyzed by woxel-wise subtracted single photon emission tomography images.

Topics: Adult; Brain; Brain Mapping; Brief Psychiatric Rating Scale; Cerebral Cortex; Combined Modality Therapy; Cysteine; Depressive Disorder; Electroconvulsive Therapy; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Neurologic Examination; Organotechnetium Compounds; Psychotropic Drugs; Regional Blood Flow; Self-Injurious Behavior; Subtraction Technique; Tomography, Emission-Computed, Single-Photon; Tourette Syndrome

We undertook this study to assess the patterns of regional cerebral perfusion (RCP) with SPECT using Technetium- 99m-ethyl cysteinate dimer (Tc-99m-ECD) in children with Tourette's Syndrome (TS), and to compare these with the patterns in a group of normal controls. The study sample consisted of 38 children (7 to 14 years) who met the ICD-10 and DSM/IV criteria for Tourette's Syndrome, and a control group of 18 children (9 to 14 years). The Children's Depression Inventory and Maudsley Obsessional-Compulsive Questionnaire were used for assessment, and the severity of motor and vocal tics were assessed using the Goetz Rating Scale. The RCP values were significantly lower in the TS group in left caudate, cingulum, right cerebellum, left dorsolateral prefrontal, and the left orbital frontal region. A positive correlation was found between the severity of vocal tics and blood flow of mid-cerebellum, right dorsolateral prefrontal and left dorsolateral prefrontal regions. Although no depressive or obsessive patients were included in the study, the depression and obsession scores were found to be negatively correlated with all RCP values, especially in the temporal regions. Further studies are needed to explore the relationship between the hypoperfusion of certain brain areas and the underlying neurophysiology and neurobiology of patients with TS. Additional disturbances such as obsessive-compulsive symptoms and depressive symptoms should also be assessed

Topics: Adolescent; Brain; Cerebrovascular Circulation; Child; Cysteine; Female; Humans; Male; Organotechnetium Compounds; Tomography, Emission-Computed, Single-Photon; Tourette Syndrome