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

Early differential diagnosis between Tourette's syndrome and chronic tic disorder is difficult but important because both the outcome and the treatment of these two childhood-onset diseases are distinct. We assessed the sensitivity and specificity of brain single-photon emission tomography (SPET) perfusion imaging in distinguishing the two diseases, and characterized their different cerebral perfusion patterns. Twenty-seven children with Tourette's syndrome and 11 with chronic tic disorder (mean age 9.5 and 8.6 years, respectively) underwent brain SPET with technetium-99m hexamethylpropylene amine oxime (HMPAO). Visual interpretation and semiquantitative analysis of SPET images were performed. On visual interpretation, 22 of 27 (82%) of the Tourette's syndrome group had lesions characterized by decreased perfusion. The left hemisphere was more frequently involved. None of the children with chronic tic disorder had a visible abnormality. Semi-quantitative analysis showed that, compared with children with chronic tic disorder, children with Tourette's syndrome had significantly lower perfusion in the left lateral temporal area and asymmetric perfusion in the dorsolateral frontal, lateral and medial temporal areas. In conclusion, using the visual approach, brain SPET perfusion imaging is sensitive and specific in differentiating Tourette's syndrome and chronic tic disorder. The perfusion difference between the two groups, demonstrated by semi-quantitative analysis, may be related more to the co-morbidity in Tourette's syndrome than to tics per se.

Topics: Adolescent; Aging; Cerebrovascular Circulation; Child; Chronic Disease; Female; Humans; Male; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tic Disorders; Tomography, Emission-Computed, Single-Photon; Tourette Syndrome

Both decreased and increased perfusion and metabolism have been described with PET and SPECT in different areas of the brain in patients with Gilles de la Tourette's syndrome. The aim of this study was to define the regional cerebral perfusion pattern in drug-free patients and the changes in perfusion with the usual neuroleptic treatment.. A group of 13 normal control subjects and 15 unmedicated Gilles de la Tourette's syndrome patients were studied with 99mTc-HMPAO brain SPECT. Thirteen of the initial group of patients were retested on neuroleptic treatment. A semiquantitative analysis of the images was performed.. Decreased perfusion in orbital and anterior medial regions of both frontal lobes as well as in both temporal lobes was observed in the nontreated group compared with control subjects. With treatment, a perfusion increase in these frontal regions and in the left medial temporal cortex was observed.. Neuroleptic treatment could decrease the hyperactivity of the dopaminergic system leading to improvement of the clinical symptoms and reperfusion of some previously hypoperfused regions.

Topics: Adolescent; Adult; Antipsychotic Agents; Brain; Cerebrovascular Circulation; Child; Child, Preschool; Female; Humans; Male; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tourette Syndrome

Our study involved performing brain perfusion SPECT scans on Tourette's subjects to observe any common perfusion abnormalities involving the cerebral cortex or subcortical structures.. Six patients with Tourette's syndrome and nine normal control subjects underwent a brain SPECT study with 99mTc-HMPAO. Regions of interest were generated over the cerebral cortex, basal ganglia, thalamus and cerebellum to evaluate any relative perfusion abnormalities or asymmetry in the Tourette's subjects.. Five of the six Tourette's subjects demonstrated a significant decrease in right basal ganglia activity which was not present in any of the normal control subjects.. Our study suggests an etiology for Tourette's syndrome involving the right basal ganglia. Furthermore, brain SPECT may be useful in the evaluation of these patients if it proves to be sufficiently sensitive and specific in larger study populations.

Topics: Adult; Basal Ganglia; Brain; Female; Functional Laterality; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tourette Syndrome

Gilles de la Tourette's syndrome (GTS) is a familial neuropsychiatric disorder characterized by tics and obsessive-compulsive behaviours (OCB). Previous HMPAO SPET studies of subjects with GTS have shown hypoperfusion of striatal and frontal areas. Studies of patients with primary obsessive-compulsive disorder have shown, in contrast, hyperperfusion of similar areas.. Twenty subjects from five families affected by GTS, including individuals with OCB but no tics, were examined using HMPAO SPET.. There were abnormalities of regional cerebral perfusion in individuals with GTS, OCB and tics. Hypoperfusion was in striatal, frontal and temporal areas. There was no hyperperfusion.. Regional cerebral blood flow patterns in individuals with OCB in families affected by GTS are comparable to their relatives with GTS and differ from individuals with primary OCD in the absence of a family history of tic disorders.

Topics: Adolescent; Adult; Cerebrovascular Circulation; Child; Compulsive Behavior; Corpus Striatum; Family Health; Female; Frontal Lobe; Humans; Male; Middle Aged; Obsessive Behavior; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Temporal Lobe; Tic Disorders; Tomography, Emission-Computed, Single-Photon; Tourette Syndrome

Functional brain imaging with technetium-99m d,l-hexamethyl propyleneamine oxime (HMPAO) Single Photon Emission Tomography (SPET) allows us to explore the cerebral pathophysiology of Gilles de la Tourette's Syndrome (GTS).. Fifty patients and 20 controls were examined. Patients were rated for tic severity and mood. Scans were analysed quantitatively using internal ratios to the occipital cortex.. Patients different from controls on measures of relative blood flow to the left caudate, anterior cingulate cortex and the left dorsolateral prefrontal cortex. Severity of tics was related to hypoperfusion of the left caudate and cingulate and a left medial temporal region. Hypoperfusion in the left dorsolateral prefrontal region was related to mood.. The areas found to be hypoperfused in this study are consistent with known functions of fronto-striatal circuits. A wide range of perfusion patterns is seen, however, and no characteristic patterns for behavioural subgroups has been documented with this technique.

Topics: Adolescent; Adult; Aged; Brain; Brain Mapping; Caudate Nucleus; Child; Depressive Disorder; Dominance, Cerebral; Female; Gyrus Cinguli; Humans; Male; Middle Aged; Organotechnetium Compounds; Oximes; Prefrontal Cortex; Regional Blood Flow; Technetium Tc 99m Exametazime; Temporal Lobe; Tomography, Emission-Computed, Single-Photon; Tourette Syndrome

Topics: Basal Ganglia; Brain; Child; Female; Humans; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tourette Syndrome

Case reports, numerous brain imaging studies, and certain disease states suggest that the orbital frontal cortex and the striatum are dysfunctional in obsessive-compulsive disorder (OCD). Interest has also grown recently concerning the genetic, neuroanatomic, and clinical links between OCD, chronic motor tics, and Gilles de la Tourette Syndrome (GTS). To test the hypothesis of possible orbito-frontal/basal ganglia dysfunction in GTS, similar to OCD, we studied 20 unmedicated GTS subjects, 10 of whom also had comorbid OCD (GTS/OCD), and 8 control subjects. The subjects were examined with high-resolution single photon emission computed tomography (SPECT) and the labeled regional cerebral blood flow (rCBF) ligand technetium-99m-d,l-hexamethyl-propylene amine oxime (99Tcm-HMPAO). As a group, GTS subjects showed significantly elevated right frontal/visual cortex activity (mean = 0.879, SD = 0.107) compared with control subjects (mean = 0.798, SD = 0.049). A subanalysis comparing simple GTS versus GTS with comorbid OCD failed to reveal significant differences in regional flow.

Topics: Adult; Basal Ganglia; Dominance, Cerebral; Female; Frontal Lobe; Humans; Male; Obsessive-Compulsive Disorder; Organotechnetium Compounds; Oximes; Regional Blood Flow; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tourette Syndrome