Brain Gamma-aminobutyric Acid Research Articles

High gamma-aminobutyric acid level in cortical tubers in epileptic infants with tuberous sclerosis complex measured with the MEGA-editing J-difference method and a three-Tesla clinical MRI Instrument

The purpose of this study was to estimate the gamma-aminobutyric acid (GABA) and glutamate plus glutamine (Glx) concentrations in the cortical tubers of patients with tuberous sclerosis complex (TSC) using the MEGA-editing J-difference method and a stimulated echo-acquisition mode with a short echo time, and to determine which abnormality was more dominant between GABA and Glx in patients with TSC with epilepsy. This study included six patients with TSC (mean age, 4.3 years) and seven control subjects (mean age, 4.8 years). Measurements were obtained with a three-Tesla apparatus and postprocessing was conducted with an LCModel. The GABA level in the cortical gray matter (cgGABA) was calculated as a result of segmentation in voxels and from the literature values for gray and white matter ratios for GABA. Increased GABA and myo-inositol (mI) concentrations and a decreased N-acetyl aspartate (NAA) concentration were observed in the cortical tubers. The cgGABA level, and cgGABA/NAA and cgGABA/Glx ratios were also higher in patients with TSC than in control subjects. No significant difference was found in Glx concentration between patients with TSC and control subjects. Although the number of patients with TSC in this study was small, the increase in GABA and no significant change in Glx were consistent with previous neurochemical studies and support the hypothesis that brain GABA plays a key role in the pathophysiology of epilepsy during the process of neuronal development.

Gamma‐aminobutyric acid (GABA)‐mediated neural connections in the Drosophila antennal lobe

Inhibitory synaptic connections mediated by gamma-aminobutyric acid (GABA) play important roles in the neural computation of the brain. To obtain a detailed overview of the neural connections mediated by GABA signals, we analyzed the distribution of the cells that produce and receive GABA in the Drosophila adult brain. Relatively small numbers of the cells, which form clusters in several areas of the brain, express the GABA synthesis enzyme Gad1. On the other hand, many cells scattered across the brain express ionotropic GABA(A) receptor subunits (Lcch3 and Rdl) and metabotropic GABA(B) receptor subtypes (GABA-B-R1, -2, and -3). To analyze the expression of these genes in distinct identified cell types, we focused on the antennal lobe, where GABAergic neurons play important roles in odor coding. By combining fluorescent in situ hybridization and immunolabeling against GFP expressed with cell-type-specific GAL4 driver strains, we quantified the percentage of the cells that produce or receive GABA for each cell type. GABA was synthesized in the middle antennocerebral tract (mACT) projection neurons and two types of local neurons. Among them, mACT neurons had few presynaptic sites in the antennal lobe, making the local neurons essentially the sole provider of GABA signals there. On the other hand, not only these local neurons but also all types of projection neurons expressed both ionotropic and metabotropic GABA receptors. Thus, even though inhibitory signals are released from only a few, specific types of local neurons, the signals are read by most of the neurons in the antennal lobe neural circuitry.

Stiff person syndrome: Advances in pathogenesis and therapeutic interventions

Stiff person syndrome (SPS) varies from mild to severe, but if untreated it can be progressive and disabling. Although progress has been made in understanding and treating SPS, the disease remains underdiagnosed, delaying treatment. Antibodies against glutamic acid decarboxylase provide an excellent diagnostic marker, but their role in disease pathogenesis is uncertain. Research focused on identifying new autoantigens has provided evidence that gamma-aminobutyric acid (GABA)(A) receptor-associated protein (GABARAP), a 14-kD protein localized at the postsynaptic regions of GABAergic synapses, is an antigenic target. Circulating anti-GABARAP antibodies that inhibit GABA(A) receptor expression on GABAergic neurons have been found in up to 65% of SPS patients. The impairment of GABAergic pathways and reduction of brain GABA results in clinical manifestations of stiffness, spasms, and phobias. Increased awareness of SPS among practicing physicians is necessary to recognize the disease early and prevent permanent disability. Most patients with SPS respond to GABA-enhancing drugs, but the high doses required cause unacceptable adverse effects. The disease clearly responds to intravenous immunoglobulin, but repeated infusions are needed to maintain response. New immunomodulating agents are being explored to treat difficult cases and to induce long-lasting remissions.

An insight on the neuropharmacological activity of Telescopium telescopium– a mollusc from the Sunderban mangrove

The present study was carried out to evaluate the biological properties of the tissue extract of a marine snail Telescopium telescopium, collected from the coastal regions of West Bengal India. On extensive pharmacological screening, it was found that the biological extract of T. telescopium (TTE) produced significant central nervous system (CNS)-depressant activity as observed from the reduced spontaneous motility, potentiation of pentobarbitone induced sleeping time, hypothermia and respiratory depression with transient apnoea. The extract significantly decreased both residual curiosity and also muscle coordination. The fraction, obtained following saturation with 60-80% ammonium sulphate (80S), was also found to demonstrate predominant CNS-depressant activity. It was observed that both TTE and the 80S fraction significantly altered the brain noradrenaline and homovanillic acid levels without affecting the brain gamma amino butyric acid (GABA) concentration. Based on the present observations, it can be suggested that the CNS-depressant effects produced by TTE and 80S could be attributable to modified catecholamine metabolism in the brain.

The evaluation of effect of alpha-lipoic acid and vitamin E on the lipid peroxidation, gamma-amino butyric acid and serotonin level in the brain of mice ( Mus musculus) acutely intoxicated with lindane

The objective of the present study was to evaluate the neurotoxic effects of lindane, in mice and the protective potential of two antioxidants alpha-lipoic acid (ALA) and vitamin E, against the observed lindane induced toxicity. 7–8 weeks old healthy Swiss mice were administered acute doses of lindane (40 mg/kg b.w.) or antioxidants or both subcutaneously and analyzed 18 h later. ALA and vitamin E were used in the combination for neuroprotection in the concentration of 20 mg/kg b.w. and 50 mg/kg b.w. respectively. Lipid peroxidation, gamma-amino butyric acid (GABA) and serotonin level were used as biochemical test of toxic action for lindane induced acute toxicity. Protective effects of ALA and vitamin E were also evaluated on the same parameters. Reduced glutathione (GSH) and thiobarbituric acid reactive substances (TBARS) level served as an index for determining the extent of lipid peroxidation. Treatment of lindane to normal control animals resulted in a significant decrease and increase in GSH ( P < 0.01) and TBARS level ( P < 0.01) respectively in crude homogenate of whole brain. Antioxidants treatment significantly altered the level of GSH ( P < 0.01) and TBARS ( P < 0.01). GABA and serotonin level in whole brain as well as in different regions of brain were measured. Main brain regions under the investigation were olfactory lobe, cerebrum, hippocampus–hypothalamus, cerebellum and pons-medulla. Critical difference (CD) of GABA level in various groups was found significant at 1% in cerebrum and hippocampus–hypothalamus, at 5% in whole brain, cerebellum and pons-medulla (i.e. P < 0.01 and P < 0.05 respectively). Change in serotonin level in whole brain as well as in all studied brain regions of various groups was found significant at 1% CD (i.e. P < 0.01).

The Effects of Electroconvulsive Therapy on GABAergic Function in Major Depressive Patients

It has been proposed that major depression is associated with a dysfunction of the gamma-aminobutyric acid (GABA) system. This study was planned to investigate whether there are any alterations in GABAergic activities in major depressive patients and, if there are, whether electroconvulsive therapy (ECT) has any effect on these changes. Twenty-five depressed inpatients who responded to a course of ECT and 23 healthy subjects were included in the study. Serum GABA levels were measured 2 days before and 10 minutes after the first ECT and 3 days after the last ECT, and a baclofen challenge test was performed 2 days before the first ECT and 3 days after the last ECT in the patients. The same tests were carried out only once in the control group. Depressive patients had lower serum GABA levels compared with healthy individuals, and ECT caused a significant increase in these levels. The acute effect of the one-ECT procedure was a huge increase in the baseline GABA levels. Although there was no difference in the maximum alteration in growth hormone with baclofen between the patients and controls before the therapeutic ECT course, it became significantly higher in the depressive patients than in the controls after the treatment. The findings of this study support the GABA deficit hypothesis of major depression because major depressive patients have lower levels of serum GABA that are increased by a completed ECT course. ECT seems to increase brain GABA levels as well as GABAB activity, and these effects may contribute to its mechanism of therapeutic effect.

Simultaneous observation of glutamate, γ‐aminobutyric acid, and glutamine in human brain at 4.7 T using localized two‐dimensional constant‐time correlation spectroscopy

Localized two-dimensional constant-time correlation spectroscopy (CT-COSY) was used to resolve glutamate (Glu), gamma-aminobutyric acid (GABA), and glutamine (Gln) in the human brain at 4.7 T. In this method, three-dimensional localization was achieved using three radio frequency pulses of the CT-COSY module for slice selection. As this sequence could decouple JHH along the F1 direction, peak resolution of metabolites was improved even on a magnitude-mode display. In experiments on a phantom containing N-acetylaspartate, creatine, Glu, Gln, and GABA with a constant time delay (Tct) of 110 ms, cross peaks of Glu, Gln, and GABA were obtained on a spectrum processed with standard sine-bell windows, which emphasize sine-dependent signals along the t2 direction. In contrast, diagonal peaks of Glu C4H at 2.35 ppm, GABA C2H at 2.28 ppm, and Gln C4H at 2.44 ppm were resolved on a spectrum processed with Gaussian windows, which emphasize cosine-dependent signals along t2. Human brain spectra were obtained from a 27 mL voxel within the parieto-occipital region using a volume transverse electromagnetic (TEM) coil for both transmission and reception. Tct was 110 ms; the total scan time was 30 min. Diagonal peaks of Glu C4H, GABA C2H, and Gln C4H were also resolved on the spectrum processed with Gaussian windows. These results show that the localized two-dimensional CT-COSY method featuring 1H decoupling along the F1 direction could resolve Glu, GABA, and Gln signals in the human brain.

High-field MRS study of GABA, glutamate and glutamine in social anxiety disorder: Response to treatment with levetiracetam

Objective Abnormalities in brain gamma-aminobutyric acid (GABA) and glutamate may be relevant to the underlying pathophysiology of anxiety disorders including social anxiety disorder (SAD). Methods We used proton magnetic resonance spectroscopy (pMRS) to examine whole brain and regional GABA, glutamate and glutamine in patients ( N = 10) with SAD at baseline compared to a matched group of healthy controls (HC), and changes following 8 weeks of pharmacotherapy with levetiracetam. Results For SAD subjects, there were significantly higher whole brain levels of glutamate and glutamine, though no significant differences in GABA. In the thalamus, glutamine was higher and GABA lower for SAD subjects. There was a significant reduction in thalamic glutamine with levetiracetam treatment. Conclusion Our findings provide preliminary support for impaired GABAergic and overactive glutamatergic function in social anxiety disorder and the potential relevance of changes in these systems for the anxiolytic response to levetiracetam.

Elimination of spatial interference in PRESS‐localized editing spectroscopy

Unambiguous detection of gamma-amino butyric acid (GABA) in the human brain is hindered by low concentration and spectral overlap with other metabolites. The popular MEGA-PRESS (PRESS: point-resolved spectroscopic sequence) method allows spectral separation of GABA from other metabolites, but suffers from a significant signal-to-noise ratio (SNR) reduction due to the 4-compartment artifact. An alternative PRESS localization technique (PRESS+4) was investigated and compared to MEGA-PRESS using numerical simulations, phantom, and in vivo experiments. It was shown that while the MEGA-PRESS method suffers significant signal loss ( approximately equal 20% for the difference spectrum), GABA signal intensity in PRESS+4 is reduced by only 2% compared to the nonlocalized condition at 4T. The improved method retains important features of the popular MEGA-PRESS such as additional water suppression and macromolecular elimination as demonstrated in human brain experiments. This method is not limited to GABA J-difference editing, but can be applied in any PRESS-based experiments. It should prove particularly useful at higher field, where the 4-compartment artifact is especially detrimental.

A practical guide to robust detection of GABA in human brain by J-difference spectroscopy at 3 T using a standard volume coil

gamma-Aminobutyric acid (GABA) is the major inhibitory neurotransmitter in human brain and has been implicated in several neuropsychiatric disorders. In vivo human brain GABA concentrations are near the detection limit for magnetic resonance spectroscopy ( approximately 1 mM), and because of overlap with more abundant compounds, spectral editing is generally necessary to detect GABA. In previous reports, GABA spectra edited by J-difference spectroscopy vary considerably in appearance. We have evaluated the factors that affect GABA spectra and the conditions necessary for robust acquisition of J-difference spectra from arbitrary brain regions. In particular, we demonstrate that variations in spectral quality can be explained in part by the incoherent addition of transients that results from shot to shot frequency and phase variations. An automated time-domain spectral alignment strategy that enables reproducible acquisition of high-quality GABA spectra at 3 T with a standard 30-cm T/R volume coil is presented. Representative GABA spectra from human frontal lobe, an area where susceptibility-induced frequency and phase variations are especially troublesome, that demonstrate the robustness of the acquisition and data handling strategy used in this study are presented.

Oral L‐glutamine increases GABA levels in striatal tissue and extracellular fluid

We explored the possibility that circulating glutamine affects gamma-aminobutyric acid (GABA) levels in rat striatal tissue and GABA concentrations in striatal extracellular fluid (ECF). Striatal microdialysates, each collected over a 20 min interval, were obtained after no treatment, oral L-glutamine (0.5 g/kg), or glutamine followed by NMDA (administered via the microdialysis probe). GABA concentrations were measured by HPLC using a stable OPA/sulfite precolumn derivatization and an electrochemical detection method. L-Glutamine administration significantly increased ECF GABA concentrations by 30%, and enhanced the response evoked by NMDA alone (70%) to 120% over baseline (all P<0.05). Striatal GABA levels increased significantly 2.5 h after oral L-glutamine (e.g., from 1.76 +/- 0.04 micromol/g in vehicle-treated rats to 2.00 +/- 0.15 micromol/g in those receiving 2.0 g/kg of glutamine). Striatal glutamine levels also increased significantly, but not those of glutamate. These data suggest that GABA synthesis in, and release from, rat striatum may be regulated in part by circulating glutamine. Hence, glutamine administration may provide a useful adjunct for treating disorders (e.g., anxiety, seizures) when enhanced GABAergic transmission is desired. Moreover, the elevation in plasma and brain glutamine associated with hepatic failure may, by increasing brain GABA release, produce some of the manifestations of hepatic encephalopathy.

Decreased GABA levels in anterior cingulate and basal ganglia in medicated subjects with panic disorder: A proton magnetic resonance spectroscopy ( 1H-MRS) study

The purpose of this study was to investigate the brain gamma-aminobutyric acid (GABA) concentration and its relationship with clinical variables in patients with panic disorder (PD). Single voxel proton magnetic resonance spectroscopy ( 1H-MRS) scan was performed on 22 medicated subjects with PD and 25 age and sex-matched healthy comparison subjects. GABA and other metabolite levels were measured in the anterior cingulate cortex (ACC) and basal ganglia. GABA levels were significantly lower in the ACC and basal ganglia of PD patients relative to comparison subjects. Lactate and choline concentrations in the ACC in PD patients were also higher than in the comparison subjects. Our data suggested in part that alterations of the GABA function and the energy metabolism in ACC and basal ganglia may play an important role in the pathophysiology of panic disorder.

The Neurobiology of Cognition in Schizophrenia

Cognitive dysfunction in schizophrenia differs from cognitive dysfunction in neurodegenerative illnesses because it is associated with neuronal dysfunction and not neurodegeneration. Pharmacologically, potential targets for developing treatments may differ from cognition in dementing disorders. Several putative molecular targets for treating cognition in schizophrenia show promise, such as treatments that act on the D(1) receptor of the dopamine system; the 5HT(1A), 5HT(2A), and 5HT(6), receptors of the serotonin system; and ampakines, Glycine/D-cycloserine, D-serine, and mGluR 2/3 agonists of the glutamatergic system. Other receptors associated with improvement in cognition include nicotinic and muscarinic receptors, and the alphalpha2 subunit receptor of the brain GABA system. Domain treatment of schizophrenia is a new method of treating schizophrenia that involves treating a single domain of dysfunction at a time.

γ-Aminobutyric Acid Type A Receptors and Alcoholism

Alcohol facilitates gamma-aminobutyric acid (GABA) function, and GABA type A (GABA(A)) receptor-facilitating agents suppress alcohol withdrawal symptoms. Advances in molecular neuroscience, genetics, and neuroimaging provide new insights into the role of brain GABA systems in short- and long-term alcohol effects. To review the role of brain GABA systems in alcohol response, alcohol dependence, alcoholism vulnerability, and alcoholism pharmacotherapy. Literature review. Alcohol increases GABA release, raises neurosteroid levels, and may potently enhance the function of a GABA(A) receptor subclass that shows high affinity for GABA and neurosteroids, relative insensitivity to benzodiazepines, low chloride conductance, and an extrasynaptic location. Variation in GABA(A) receptor subunit genes may contribute to the vulnerability to alcoholism, particularly in the context of environmental risk factors. Alcohol dependence is associated with time-dependent changes in brain GABA(A) receptor density and subunit gene expression levels that contribute to a withdrawal-related deficit in GABA(A) receptor function. However, cortical GABA levels are not reduced during acute withdrawal. Benzodiazepine-assisted detoxification enhances a phasic component of GABA function. However, novel treatments target the tonic component of GABA neurotransmission mediated by benzodiazepine-insensitive GABA(A) receptors. Smoking attenuates withdrawal-related disturbances in brain GABA function, perhaps contributing to comorbid nicotine and alcohol dependence. The GABA systems show recovery with long-term sobriety. Recent research deepens our understanding of the role of GABA systems in alcohol action, alcohol dependence, and the vulnerability to alcoholism. Also, GABA(A) receptor subtype-selective treatments merit exploration for reducing withdrawal symptoms and drinking in alcohol-dependent individuals.

(659): Pregabalin reduces primary and secondary hyperalgesia in a rat model of chronic muscle inflammation

Pregabalin, (S-(+)-Isobutylgaba, (S)-3-(aminomethyl)-5-methylhexanoic acid) is a structural analogue of gamma-aminobutyric acid (GABA) approved by FDA for partial epilepsy and neuropathic pain from post-herpetic neuralgia and diabetic peripheral neuropathy. It is not active at GABA receptors and does not alter brain GABA concentrations, but is a selective high-affinity ligand at the calcium channel alpha-2-delta protein. Effectiveness of pregabalin in musculoskeletal pain has not, as yet, been tested. Intramuscular injection of carrageenan is a model of inflammation characterized by bilateral long-lasting hyperalgesia of the paw. In the present study, we evaluated the effect of pregabalin in a rat model of chronic muscle inflammation, measuring both primary hyperalgesia of the muscle (withdrawal threshold to compression of the muscle) and secondary hyperalgesia of the paw (withdrawal threshold to von Frey filaments). After baseline measurements, 3% carrageenan was injected in the gastrocnemius muscle of male Sprague-Dawley rats. Two weeks after injection, there was a significant decrease in the withdrawal threshold to mechanical stimulation of the paw bilaterally, and a decrease in withdrawal threshold to compression of the muscle ipsilaterally. Pregabalin was then administered systemically in separate groups of animals as follows: 0 (saline), 10, 30, 60, and 100 mg/kg. The decreased withdrawal threshold to mechanical stimulation of the paw was reversed 1h and 2h after administration of the 100 mg/kg dose of pregabalin (contralateral: p=0.02, p=0.002, ipsilateral: p=0.02, p=0.001). The decreased withdrawal threshold to compression of the muscle was reversed ipsilaterally with 30, 60, and 100 mg/kg of pregabalin 1h and 2h after administration (30mg/kg: p=0.01, 60mg/kg: p=0.01, 100mg/kg: p=0.03). These data show that carrageenan injection in the gastrocnemius muscle causes bilateral cutaneous hyperalgesia, but ipsilateral muscle hyperalgesia. Pregabalin reduces both secondary and primary hyperaglesia induced by chronic muscle inflammation. Supported by Pfizer, Inc. and K02 AR02201.

Two‐dimensional, J‐resolved spectroscopic imaging of GABA at 4 Tesla in the human brain

A method for measuring brain gamma-amino butyric acid (GABA) levels is presented that combines 2D J-resolved magnetic resonance spectroscopy (J-MRS) techniques with chemical-shift imaging (2D-JMRSI) at 4 Tesla (T). The results of phantom and in vivo experiments agree well in demonstrating that the (2)CH(2) GABA resonance situated at 2.97 ppm can be resolved from the neighboring creatine (Cr) resonance at 3.03 ppm and quantified. Single-voxel, J-resolved standard and metabolite-nulled in vivo experiments on six healthy subjects reveal a broad component from the underlying macromolecules (MM) that resonates at and around 3.00 ppm, which is estimated to contribute approximately 15% to the J-resolved GABA resonance in this large voxel at a repetition time (TR) of 4.5 s. With our 2D-JMSRI at 1.25 s TR, the macromolecule resonance contribution to our GABA measurements is approximated to be 12%. Six healthy human subjects underwent scanning at 4T with this sequence, yielding a global brain GABA concentration of 0.76 +/- 0.20 mM after correction for 12% macromolecule contribution.

Normal Prefrontal Gamma-Aminobutyric Acid Levels in Remitted Depressed Subjects Determined by Proton Magnetic Resonance Spectroscopy

There is growing evidence that the brain gamma-aminobutyric acid (GABA) system is involved in depression. Lowered plasma GABA levels were identified as a traitlike abnormality found in patients with remitted unipolar depression and in healthy first-degree relatives of patients with unipolar depression. Major depressive disorder has been associated with neuroimaging and neuropathological abnormalities in the prefrontal cortex by various types of evidence. As a result, the current study investigates whether GABA levels in the prefrontal cortex differ between unmedicated subjects with remitted major depressive disorder (rMDD) and healthy control subjects. Sixteen rMDD subjects and 15 healthy control subjects underwent magnetic resonance spectroscopy. We used a 3 Tesla GE whole body scanner with a homogeneous resonator coil providing a homogenous radiofrequency field and capability of obtaining measurement from the prefrontal cortex. Gamma-aminobutyric acid levels were measured in the ventromedial prefrontal cortex and dorsolateral/anterior medial prefrontal cortex. There was no difference in GABA concentrations between rMDD subjects and healthy control subjects in the ventromedial prefrontal cortex and dorsolateral/anterior medial prefrontal cortex. Secondary analyses provided preliminary evidence for a negative relationship between the glutamate/glutamine (Glx)/GABA ratio and age of onset of major depression in the ventromedial prefrontal cortex. This result suggests that GABA levels in the prefrontal cortex, if found to be reduced in symptomatic depression, do not represent a persistent characteristic of major depression. Further research is needed to determine brain GABA levels in different brain regions, in different stages of depressive illness, and in different depressive subtypes.

Effects of tiagabine in combination with intravenous nicotine in overnight abstinent smokers

Preclinical studies suggest that medications enhancing the brain gamma amino butyric acid (GABA) system attenuate the rewarding effects of stimulants including nicotine. These preclinical studies have not been followed up in systematic human studies. This study was conducted to examine the effects of a GABAergic medication, tiagabine, on acute physiological and subjective effects of intravenous (i.v.) nicotine and on tobacco withdrawal symptoms in overnight abstinent smokers. The proposed mechanism of action for tiagabine is selective inhibition of GABA transporter type I, which leads to increases in synaptic GABA levels. Eight male and four female smokers participated in a double-blind, placebo-controlled, crossover study. In each of three experimental sessions, participants were treated orally with a single 4- or 8-mg dose of tiagabine or placebo. Two hours following the medication treatment, participants received i.v. saline, followed 30 min later by 1.5 mg/70 kg i.v. nicotine. Tiagabine treatment did not affect the heart rate or blood pressure changes induced by nicotine. There was a significant treatment effect for the subjective responses to nicotine, such that tiagabine, compared to placebo, attenuated the ratings of "good effects" and "drug liking." Tiagabine treatment at 8 mg attenuated the craving for cigarettes and enhanced the cognitive performance in the Classical Stoop Tests, compared to placebo or 4 mg tiagabine condition. These results suggest that GABA enhancing medication tiagabine may reduce the rewarding effects of nicotine and improve cognitive performance in abstinent smokers. The utility of GABA medications for smoking cessation needs to be examined further in controlled clinical trials.

Brain γ-Aminobutyric Acid Changes in Stiff-Person Syndrome

Patients with stiff-person syndrome (SPS) have circulating antibodies against glutamic acid decarboxylase, the rate-limiting enzyme responsible for the synthesis of gamma-aminobutyric acid (GABA). Although the patients' symptoms of stiffness and unexpected spasms can be explained on the basis of reduced or impaired inhibitory neurotransmitters, such as GABA, it is unclear whether the level of GABA in the brains of these patients is reduced and, if so, whether the reduction is due to anti-glutamic acid decarboxylase antibodies. To measure GABA levels in the brains of patients with SPS. Prospective case-control study. National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md. Eight patients with SPS with high titers of circulating anti-glutamic acid decarboxylase antibodies and typical clinical symptoms of SPS and 16 control subjects. Results of brain magnetic resonance imaging and magnetic resonance spectroscopy, which measures GABA levels in specific brain regions. No abnormalities were noted on brain magnetic resonance images. A prominent and significant decrease in GABA level was, however, observed in the sensorimotor cortex and a smaller decrease in the posterior occipital cortex but not in the cingulate cortex or pons. The reduction of brain GABA in patients with SPS supports the clinical symptoms and indicates that the inhibitory GABAergic pathways are involved in the disease. Regardless of the responsible autoantigens, in SPS autoantibodies block the function of GABAergic neurons and interfere with the synthesis of GABA but do not cause structural changes in the brain.

Brain Gamma-Aminobutyric Acid Levels Are Decreased in Patients With Phantageusia and Phantosmia Demonstrated by Magnetic Resonance Spectroscopy

Olfactory and gustatory hallucinations (phantosmias and phantageusias, respectively) are sensory distortions that commonly follow losses of olfactory and gustatory acuity (hyposmia and hypogeusia, respectively). The biochemical basis of these hallucinations is unclear. Functional magnetic resonance imaging has been used previously to demonstrate widespread and robust central nervous system (CNS) activation to memories of these sensory distortions in patients with these symptoms. In this study, possible CNS mechanisms responsible for these distortions were evaluated using magnetic resonance spectroscopy, because this technique has been used to measure various CNS metabolites in patients with neurologic disorders. Forty-seven subjects were studied: 28 normal volunteers (13 men and 15 women) and 19 patients (8 men and 11 women) with persistent oral global phantageusia and/or birhinal phantosmia studied before any treatment. Four patients (1 man and 3 women) were studied before and after pharmacologic treatment that reduced the severity of their sensory distortions. All subjects were studied in a Signa 1.5-T magnetic resonance scanner with a quadrature head coil using a modified standard 2-dimensional J-point resolved excitation in the steady state (PRESS) sequence by which gamma-aminobutyric acid (GABA), glutamic acid, choline, N-acetylaspartate, and creatine (Cre) were measured in various CNS regions. Results were expressed using Cre as a denominator to determine ratios for each measurement. Differences were defined between normal subjects and patients before treatment and in patients before and after successful pharmacologic treatment. Before treatment, GABA levels in several CNS regions were lower in patients than in normal volunteers and were the only biochemical changes found; significantly lowered GABA levels were found in the cingulate, right and left insula, and left amygdala. No differences between patients and normal volunteers were found in any of the metabolites in the posterior occipital region. After treatment that inhibited sensory distortions, CNS GABA levels increased in the cingulate, insula, and amygdala but significantly only in the left insula and in the right and left amygdala. After this successful treatment, no change in any biochemical parameter was found in the posterior occipital region. These results indicate that decreased brain GABA levels can serve as biochemical markers of phantageusia and/or phantosmia in patients with these distortions and are the first biochemical changes in the CNS that reflect these sensory changes. After successful treatment of these distortions, CNS GABA levels increased to levels at or near normal, consistent with functional remission of these symptoms. These results substantiate a role for CNS GABA in the generation and inhibition of these sensory hallucinations. Although the underlying biochemical mechanism(s) for the generation of these decreased GABA levels are complex, because similar types of sensory hallucinations occur as auras or prodromata of epileptic seizure and migraine activity, these results suggest that there may be common biochemical changes among these disorders.