Jörgen Bergman

Role of the dopaminergic system in chronic pain -- a fluorodopa-PET study.

&NA; Recent data from animal experiments suggest an important role for the basal ganglia in the processing and sensorimotor gating of nociceptive information. However, very little is known about their possible participation in human pain. Because of our previous finding of increased excitability of the blink reflex (a brainstem reflex under dopaminergic inhibitory control) in some burning mouth syndrome (BMS) patients, we have studied the dopaminergic function of the striatum (putamen and caudatus) of BMS patients with positron emission tomography (PET). 6‐[18F]fluorodopa (FDOPA) PET scans were done on ten BMS patients and 14 healthy control subjects. The presynaptic dopaminergic function was significantly decreased in the right putamen (20%, P=0.04) of the BMS patients compared to control subjects. On the left side, the FDOPA uptake was decreased by 17% (P=0.08). The mean FDOPA uptake was not significantly changed in the caudate nucleus of the patients. The finding of decreased striatal FDOPA uptake in the putamen supports our previous neurophysiological observations indicating decreased dopaminergic inhibition in BMS patients. The present result provides direct evidence of the involvement of the nigrostriatal dopaminergic system in pain for the first time in a clinical pain condition.

Rate of progression in Parkinson's disease: A 6-[18F]fluoro-L-dopa PET study

The aim of this study was to investigate the rate of progression in Parkinsons disease (PD) with 6‐[18F]fluoro‐L‐dopa (FDOPA) positron emission tomography (PET). We investigated 21 patients with PD and eight healthy controls. Ten of the patients were de novo at the time of the first PET scan and antiparkinsonian medication was started thereafter, with a favourable response. A FDOPA PET scan was carried out twice at an approximately 5‐year interval. The regions of interest were drawn on individual magnetic resonance imaging (MRI) images, matched with the PET images.

Personality traits and brain dopaminergic function in Parkinson's disease

A distinctive personality type, characterized by introversion, inflexibility, and low novelty seeking, has been suggested to be associated with Parkinsons disease. To test the hypothesis that Parkinsons disease is associated with a specific dopamine-related personality type, the personality structures of 61 unmedicated Parkinsons disease patients and 45 healthy controls were examined. Additionally, in 47 Parkinsons disease patients, the dopaminergic function in the brain was directly measured with 6-[18F]fluoro-l-dopa (18F-dopa) positron emission tomography (PET) with MRI coregistration. The novelty-seeking personality score, supposedly associated with the parkinsonian personality, was slightly lower in the Parkinsons disease group compared with controls, but it did not have a significant relationship with 18F-dopa uptake in any of the brain regions studied (r = −0.12 to 0.11, P > 0.15). The harm-avoidance personality score, associated with anxiety and depression, was clearly increased in patients with Parkinsons disease and it had a paradoxical, highly significant positive correlation with the 18F-dopa uptake in the right caudate nucleus (r = 0.53, P = 0.04, Bonferroni corrected for 220 comparisons). Although the results of this study are not in disagreement with the concept of low-novelty-seeking personality type in Parkinsons disease, the personality type does not seem to be dopamine dependent. The correlation between the personality trait of harm avoidance and 18F-dopa may reflect a specific feedback circuitry of neurotransmitters that is associated with negative emotionality in Parkinsons disease.

Progression in Parkinson's disease: A positron emission tomography study with a dopamine transporter ligand [18F]CFT

We studied the rate of progression of striatal dopamine transporter function in Parkinsons disease (PD). Eight patients with early PD without antiparkinsonian medication and 7 healthy volunteers were investigated with [18F]CFT positron emission tomography (PET). The PET scan was carried out twice at an approximate 2‐year interval. The uptake of [18F]CFT was calculated as a region‐cerebellum:cerebellum ratio at 180 to 210 minutes after injection. At the first PET scan, the [18F]CFT uptake in PD patients in the putamen was 1.45 ± 0.45 (mean ± SD) (42% of the control mean) and 2.43 ± 0.59 in the caudate nucleus (76% of the control mean). The ratios declined by the time of the second PET scan, and the rate of annual decline of the baseline mean in PD patients was 13.1% in the putamen and 12.5% in the caudate nucleus. In controls, the corresponding figures were 2.1% for the putamen and 2.9% for the caudate nucleus. The decline in [18F]CFT uptake was significantly higher in PD patients than in controls. Thus, dopamine transporter ligands such as [18F]CFT seem to be sensitive markers for the rate of progression in PD. Ann Neurol 2000;47:804–808

Fluorine-18-labeled fluorine gas for synthesis of tracer molecules

The aim of this work was to develop a method to produce 18F-labeled fluorine gas ([18F]F2) with high specific radioactivity (SA, radioactivity/mass-ratio). 18F-Labeled methyl fluoride ([18F]CH3F) was synthesized from [18F]F-aq and mixed with carrier F2 in an inert neon matrix. The constituents were atomized in an electric discharge, after which a rearrangement and 18F for 19F exchange took place. [18F]F2 with a specific radioactivity of up to 55 GBq/mumol is available for the labeling synthesis of tracers for positron emission tomography (PET).

The A1 allele of the human D2 dopamine receptor gene is associated with increased activity of striatal L-amino acid decarboxylase in healthy subjects.

The A1 allele of the TaqI restriction fragment length polymorphism (RFLP) of the human dopamine D2 receptor gene (DRD2) is associated with a low density of D2 dopamine receptors in the striatum. Because of the important role of D2 autoreceptors in regulating dopamine synthesis, we aimed to examine whether subjects with the A1 allele have altered presynaptic dopamine function in the brain. We also studied the effects of two other DRD2 polymorphisms, C957 T and −141C Ins/Del, which have been suggested to affect D2 receptor levels in brain. The relationships between the TaqIA RFLP, C957 T and −141C Ins/Del polymorphisms and striatal dopamine synthesis in 33 healthy Finnish volunteers were studied using positron emission tomography and [18F]fluorodopa ([18F]FDOPA), a radiolabelled analog of the dopamine precursor L-DOPA. Heterozygous carriers of the A1 allele (A1/A2; 10 subjects) had significantly higher (18%) [18F]FDOPA uptake in the putamen than subjects without the A1 allele (A2/A2; 23 subjects). C957 T and −141C Ins/Del polymorphisms did not significantly affect [18F]FDOPA Ki values. These results demonstrate that the A1 allele of DRD2 gene is associated with increased striatal activity of aromatic L-amino acid decarboxylase, the final enzyme in the biosynthesis of dopamine and the rate-limiting enzyme for trace amine (e.g. &bgr;-phenylethylamine) synthesis. The finding can be explained by lower D2 receptor expression leading to decreased autoreceptor function, and suggests that dopamine and/or trace amine synthesis rate is increased in the brains of A1 allele carriers.

Decreased striatal dopamine transporter binding in vivo in chronic schizophrenia

We have previously reported that average striatal dopamine transporter (DAT) binding in vivo is unaltered in neuroleptic-naive first-episode schizophrenic patients [Laakso et al., Am. J. Psychiatry 157 (2000) 269]. However, as it has been suggested that some of the brain changes in schizophrenia may vary depending on the illness phase, we studied DAT density in eight stable, medicated chronic schizophrenic patients and eight matched controls using positron emission tomography and [18F]CFT, a marker of dopamine nerve terminals. [18F]CFT binding potentials were significantly lower in chronic schizophrenic patients than in controls, both in the caudate and the putamen (-9 to -16%). Together with the finding of unchanged average striatal DAT levels in first-episode patients and relative insensitivity of striatal [18F]CFT binding to endogenous dopamine and neuroleptic drugs, the result is in line with a relative loss of striatal dopaminergic nerve terminals and/or decreased expression of DAT in a subset of chronic schizophrenic patients.

Myocardial viability: Fluorine-18-deoxyglucose positron emission tomography in prediction of wall motion recovery after revascularization

To assess the value of positron emission tomography (PET) imaging with fluorine-18-deoxyglucose ([18F]FDG) in predicting cardiac wall motion recovery after revascularization, 48 consecutive patients with previous myocardial infarction were studied. The normalized [18F]FDG uptake at rest was assessed semiquantitatively and compared to perfusion at rest as studied by SPECT imaging. Wall motion was analyzed with echocardiography before and after revascularization. Wall motion recovery occurred in 27 (30%) of the revascularized 90 dysfunctional segments. Preserved [18F]FDG uptake (mean +/- 2 SD) was commonly found in dysfunctional segments, but only 54% of these segments recovered after revascularization. Subnormal [18F]FDG uptake identified accurately the segments with no potential to recover (predictive value 100%). By using an optimized threshold value for normalized [18F]FDG uptake, the sensitivity of 85% and specificity of 84% to predict functional recovery were reached simultaneously. However, in the segments with moderately or severely reduced perfusion at rest, the diagnostic accuracy of [18F]FDG uptake for viability was 100%. The results of this study show that the presence of viable tissue indicated by preserved [18F]FDG uptake does not inevitably imply functional recovery after revascularization. However, acceptable diagnostic accuracy for viability might be reached by [18F]FDG alone, providing that appropriate uptake limits are used. The combined evaluation of [18F]FDG uptake and perfusion enables precise assessment of myocardial viability.

Cortical 6-[18F]fluoro-L-dopa uptake and frontal cognitive functions in early Parkinson's disease.

Patients with Parkinsons disease (PD) have already at the early stages of the disease impaired performance especially in tests measuring frontal lobe functions such as attention. The pathophysiological basis of these deficits is unclear. In the present study, 21 non-demented, non-medicated patients at the early stage of PD and 24 healthy controls underwent a positron emission tomography (PET) scan with 6-[18F]fluoro-L-dopa (Fdopa) as the tracer. In addition, the PD patients performed a neuropsychological test battery, including a test measuring sustained attention (VIG) and a test requiring suppressed attention (Stroop). Both voxel-based Statistical Parametric Mapping (SPM) and automated region of interest (ROI) analysis were employed. Compared to controls, the PD patients had decreased Fdopa uptake in the striatum and a large cortical area of increased Fdopa uptake. The reaction time in the VIG test correlated positively with the Fdopa uptake of the dorsolateral prefrontal cortex and the performance in the Stroop test correlated negatively with the Fdopa uptake in an area including the medial frontal cortex and the anterior cingulate. The results show that cortical Fdopa uptake is increased in early non-medicated PD and suggest that the changes in frontal Fdopa uptake are related to cognitive impairments found in early PD.

Usefulness of a dopamine transporter PET ligand [18F]β-CFT in assessing disability in Parkinson's disease

OBJECTIVES The usefulness of a novel dopamine transporter PET ligand, [18F]β-CFT in assessing disability in Parkinsons disease was studied. METHODS Twenty seven patients with Parkinsons disease in different disability stages (of which nine were patients with early disease) and nine healthy controls were studied. The regions of interest were drawn on a magnetic resonance image resliced according to the PET image. RESULTS There was a significant reduction in [18F]β-CFT uptake in the posterior putamen (to 18% of the control mean, p<0.00001), anterior putamen (28%, p<0.00001), and caudate nucleus (51%, p<0.00001) in the total population of patients with Parkinsons disease. The reduction in [18F]β-CFT uptake was more pronounced with more severe disability of the patients, the correlations between the total motor score of the unified Parkinsons disease rating scale (UPDRS) and [18F]β-CFT uptake being significant in the posterior putamen (r=−0.62 p=0.0005), anterior putamen (r=-0.64, p=0.0003), and the caudate nucleus (r=−0.62, p=0.0006). There was a significant negative correlation with putaminal [18F]β-CFT uptake and the hypokinesia and rigidity scores, but not with the tremor score of the UPDRS motor part. In nine patients with early disease and without any antiparkinsonian medication the reduction in the [18F]β-CFT uptake (average of ipsilateral and contralateral side) was reduced in the total putamen to 34% of the mean control value (p<0.00001). The corresponding figures in the other brain areas were: posterior putamen 21% (p<0.00001), anterior putamen 43% (p<0.00001), and caudate nucleus 76% (p<0.01). The reductions in [18F]β-CFT uptake were more severe in the contralateral than in the ipsilateral side. Individually, [18F]β-CFT uptake in the putamen in all patients was below 3 SD from the control mean. CONCLUSIONS [18F]β-CFT is a sensitive marker of nigrostriatal dopaminergic dysfunction in Parkinsons disease and can be used in the diagnosis, assessment of disease severity, and follow up of patients.