engleski

Changes in regional cerebral blood flow in patients with eating disorders

This study is part of a continuing effort to understand the pathophysiology of the brain in eating disorders and to correlate any abnormalities in blood flow with eating disorder psychopathology. Ten newly referred patients with a diagnosis of bulimia nervosa and four with anorexia nervosa underwent regional cerebral blood flow (rCBF) examination using single-photon computerized tomography (SPECT). Brain rCBF SPECT data from age- and sex-matched healthy volunteers were used as controls. Patients were diagnosed following DSM-IV criteria and were off psychoactive medication. SPECT scans were started 30 minutes after administration of 740 MBq of 99mTc-HMPAO in resting state, eyes closed and with low ambient noise. Tomograms were normalized to the mean brain activity and analysed visually and semi quantitatively using region-of-interest based method. Detailed neurologic and laboratory examinations, including EEG and CT, were within normal limits in all patients. Nevertheless, SPECT studies revealed that all anorexic and bulimic patients had asymmetry (hypoperfusion) of blood flow in at least one area. For all 14 patients rCBF changes were caused by decreased perfusion in the prefrontal and temporal areas which was more prominent in the left hemisphere. Regions of the brain showing hypoperfusion included the prefrontal cortex (n = 12), temporal lobe (n = 10) and in one case global hypoperfusion was observed. In five patients hypoperfusion was found exclusively in left hemisphere. Nine patients had two or more hypoperfused areas. Bulimic patients with two or more hypoperfused areas had higher EDE scale scores than those with single hypoperfused area, but the differences were not statistically significant. Compared with the normals, all patients with eating disorders were characterized by abnormal rCBF, predominantly affecting prefrontal cortex and the temporal lobes. Disturbances of these brain regions have been found in people with eating disorders, but it was not certain whether they were a cause or consequence of symptoms. Different factors might explain areas of decreased rCBF in eating disorders. It might be the consequence of neurophysiological changes following nutritional deficiencies and/or the result of some associated symptoms such as anxiety or depression. We also hypothesize that either a pathological prefrontal and temporal cortex hypoperfusion in eating disorders reflects dysfunction in neuronal activity which is responsible for the disturbances in psychological processes it mediates.

regional cerebral blood flow; eating disorder

DOI: 10.1007/s00259-013-2535-3