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August 30, 2016; 87 (9) ArticleOpen Access

GABA deficiency in NF1

A multimodal [11C]-flumazenil and spectroscopy study

Inês R. Violante, Miguel Patricio, Inês Bernardino, José Rebola, Antero J. Abrunhosa, Nuno Ferreira, Miguel Castelo-Branco
First published July 29, 2016, DOI: https://doi.org/10.1212/WNL.0000000000003044
Inês R. Violante
From the Institute for Biomedical Imaging and Life Sciences, Faculty of Medicine (I.R.V., M.P., I.B., J.R., M.C.-B.), Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine (M.P., M.C.-B.), and Institute of Nuclear Sciences Applied to Health (A.J.A., N.F., M.C.-B.), University of Coimbra, Portugal; and Division of Brain Sciences (I.R.V.), Department of Medicine, Hammersmith Hospital Campus, Imperial College London, UK.
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Miguel Patricio
From the Institute for Biomedical Imaging and Life Sciences, Faculty of Medicine (I.R.V., M.P., I.B., J.R., M.C.-B.), Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine (M.P., M.C.-B.), and Institute of Nuclear Sciences Applied to Health (A.J.A., N.F., M.C.-B.), University of Coimbra, Portugal; and Division of Brain Sciences (I.R.V.), Department of Medicine, Hammersmith Hospital Campus, Imperial College London, UK.
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Inês Bernardino
From the Institute for Biomedical Imaging and Life Sciences, Faculty of Medicine (I.R.V., M.P., I.B., J.R., M.C.-B.), Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine (M.P., M.C.-B.), and Institute of Nuclear Sciences Applied to Health (A.J.A., N.F., M.C.-B.), University of Coimbra, Portugal; and Division of Brain Sciences (I.R.V.), Department of Medicine, Hammersmith Hospital Campus, Imperial College London, UK.
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José Rebola
From the Institute for Biomedical Imaging and Life Sciences, Faculty of Medicine (I.R.V., M.P., I.B., J.R., M.C.-B.), Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine (M.P., M.C.-B.), and Institute of Nuclear Sciences Applied to Health (A.J.A., N.F., M.C.-B.), University of Coimbra, Portugal; and Division of Brain Sciences (I.R.V.), Department of Medicine, Hammersmith Hospital Campus, Imperial College London, UK.
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Antero J. Abrunhosa
From the Institute for Biomedical Imaging and Life Sciences, Faculty of Medicine (I.R.V., M.P., I.B., J.R., M.C.-B.), Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine (M.P., M.C.-B.), and Institute of Nuclear Sciences Applied to Health (A.J.A., N.F., M.C.-B.), University of Coimbra, Portugal; and Division of Brain Sciences (I.R.V.), Department of Medicine, Hammersmith Hospital Campus, Imperial College London, UK.
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Nuno Ferreira
From the Institute for Biomedical Imaging and Life Sciences, Faculty of Medicine (I.R.V., M.P., I.B., J.R., M.C.-B.), Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine (M.P., M.C.-B.), and Institute of Nuclear Sciences Applied to Health (A.J.A., N.F., M.C.-B.), University of Coimbra, Portugal; and Division of Brain Sciences (I.R.V.), Department of Medicine, Hammersmith Hospital Campus, Imperial College London, UK.
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Miguel Castelo-Branco
From the Institute for Biomedical Imaging and Life Sciences, Faculty of Medicine (I.R.V., M.P., I.B., J.R., M.C.-B.), Laboratory of Biostatistics and Medical Informatics, Faculty of Medicine (M.P., M.C.-B.), and Institute of Nuclear Sciences Applied to Health (A.J.A., N.F., M.C.-B.), University of Coimbra, Portugal; and Division of Brain Sciences (I.R.V.), Department of Medicine, Hammersmith Hospital Campus, Imperial College London, UK.
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Citation
GABA deficiency in NF1
A multimodal [11C]-flumazenil and spectroscopy study
Inês R. Violante, Miguel Patricio, Inês Bernardino, José Rebola, Antero J. Abrunhosa, Nuno Ferreira, Miguel Castelo-Branco
Neurology Aug 2016, 87 (9) 897-904; DOI: 10.1212/WNL.0000000000003044

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    Figure 1 Magnetic resonance spectroscopy measurements

    Localization of the magnetic resonance spectroscopy voxel (yellow square) in the visual cortex (A) and FEF as localized with a functional localizer (B). (C) Edited magnetic resonance spectroscopy spectrum from a representative participant showing clearly resolved peaks for GABA+ and glutamine + glutamate (Glx). The inset on the right shows the fit output for the GABA+ signal. MEGA-PRESS spectra were processed using the Gannet 2.0 toolkit, the green line shows the raw GABA data, the blue line the postphase and frequency aligned GABA data, and the black line is the residual difference between the experimental data and the curve fit. (D) Single-voxel–localized PRESS spectrum (blue line) from a representative participant with spectral fits (red line) and the residual difference between the experimental data and the curve fit (black line) determined using LCModel. Cr = creatine; FEF = frontal eye field; GABA = γ-aminobutyric acid; Gln = glutamine; Glu = glutamate; GPC = glycerophosphocholine; mI = myo-inositol; PCr = phosphocreatine; tNAA = total N-acetylaspartate (NAA [N-acetylaspartate] + NAAG [N-acetylaspartylglutamine]).

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    Figure 2 Magnetic resonance spectroscopy alterations in patients with NF1

    Metabolites showing differences between patients with NF1 (green) and controls (gray) in the occipital cortex and the FEF. The triangle shape indicates a patient with NF1 in whom GABA+ was measured in the left hemisphere and the white-filled circle represents a patient in whom the FEF location was determined using anatomical landmarks. Graphs depict individual values, mean, and SD. FEF = frontal eye field; GABA = γ-aminobutyric acid; Glu = glutamate; NAA = N-acetylaspartate; NF1 = neurofibromatosis type 1.

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    Figure 3 [11C]-Flumazenil PET binding differences between patients with NF1 and controls

    Areas showing decreased [11C]-flumazenil binding in patients (contrast control > NF1, p < 0.05 corrected). NF1 = neurofibromatosis type 1.

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    Figure 4 Cross-modality correlations between magnetic resonance spectroscopy and PET

    (A) Results for the occipital voxel and (B) for the FEF voxel, for patients with NF1 (green) and controls (gray). The triangle shape indicates a patient with NF1 in whom measurements were performed in the left hemisphere and the white-filled circle represents a patient in whom the FEF location was determined using anatomical landmarks. In patients with NF1, the concentration of GABA+ was negatively correlated with the density of GABA type A receptors in the FEF (r = −0.842, p = 0.004, n = 9, 95% confidence interval = −1.000 to −0.368 calculated from 10,000 bootstrap samples). BP = binding potential; FEF = frontal eye field; GABA = γ-aminobutyric acid; NF1 = neurofibromatosis type 1.

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