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PET measures of benzodiazepine receptors in progressive supranuclear palsy

From the Departments of Neurology (Drs. Foster and Gilman and M. Heumann), Internal Medicine (Nuclear Medicine) (Drs. Minoshima and Kuhl), and Biostatistics (Ms. Johanns and Dr. Little), University of Michigan at Ann Arbor.

Address correspondence and reprint requests to Dr. Norman L. Foster, Department of Neurology, University of Michigan, 1920 Taubman Center, Box 0316, Ann Arbor, MI 48109-0316; e-mail: nlfoster{at}umich.edu

OBJECTIVE: To evaluate the integrity of neurons containing benzodiazepine receptors in metabolically affected regions of the brain in patients with clinically diagnosed progressive supranuclear palsy (PSP).

METHODS: The cerebral distribution of [¹¹C]flumazenil (FMZ), a ligand that binds to the gamma-aminobutyric acid A (GABA_A) receptor, and [¹⁸F]fluorodeoxyglucose (FDG), a measure of local cerebral glucose metabolism, was determined with PET in 12 patients with PSP and 10 normal control subjects. Tracer kinetic analysis was applied to quantify data and analysis was performed using three-dimensional stereotactic surface projections and stereotactically determined volumes of interest.

RESULTS: There was a global reduction in FMZ binding of 13%, with a reduction in the anterior cingulate gyrus of 20% (p = 0.004), where glucose metabolic rates also showed the greatest reduction.

CONCLUSIONS: PSP causes loss of benzodiazepine receptors in the cerebral cortex. Consistent with postmortem studies, the authors did not find significant changes in FMZ binding in subcortical nuclei that exhibit the most pathologic change. This study suggests that both loss of intrinsic neurons containing benzodiazepine receptors and deafferentation of the cerebral cortex from distant brain regions contribute to cerebral cortical hypometabolism in PSP.

Key words: Progressive supranuclear palsy—PET—Benzodiazepine receptors—Flumazenil—GABA—Glucose metabolism

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