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Brain hypermetabolism in amyotrophic lateral sclerosis: a FDG PET study in ALS of spinal and bulbar onset

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

An Erratum to this article was published on 16 December 2011

Abstract

Purpose

To identify the neurobiological traits of amyotrophic lateral sclerosis (ALS) and to elucidate functional differences between ALS of spinal and bulbar onset. We hypothesized that glucose metabolism distribution might vary between groups.

Methods

The study groups comprised 32 patients with ALS of either bulbar (n = 13) or spinal (n = 19) onset and 22 subjects as controls. They were investigated by [18F]fluorodeoxyglucose (FDG) positron emission tomography (FDG PET), comparing the patient groups with each other and with the controls by statistical parametric mapping.

Results

Highly significant relative increases in glucose metabolism distribution were found in the group comprising all 32 ALS patients as compared with the controls in the bilateral amygdalae, midbrain, pons and cerebellum. Relative hypermetabolism was also found in patients with spinal onset as compared with the controls in the right midbrain. In patients with bulbar onset compared with the controls and with patients with spinal onset, large relatively hypometabolic areas were found in the bilateral frontal cortex, right insula, anterior cingulate, precuneus and inferior parietal lobe. Patients with spinal onset had significantly higher scores in a neuropsychological test assessing verbal fluency compared with patients with bulbar onset.

Conclusion

This large FDG PET investigation provided unprecedented evidence of relatively increased metabolism in the amygdalae, midbrain and pons in ALS patients as compared with control subjects, possibly due to local activation of astrocytes and microglia. Highly significant relative decreases in metabolism were found in large frontal and parietal regions in the bulbar onset patients as compared with the spinal onset patients and the controls, suggesting a differential metabolic and neuropsychological state between the two conditions.

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Acknowledgments

The authors wish to thank the patients who kindly agreed to participate in this study, Ms Deborah Bertoluzzo and the personnel of IRMET for their valuable help in patient management, and Mrs Emanuela Enrico for English editing. This work was in part supported by Compagnia di San Paolo, Programma Neuroscienze 2008–2009 (to Consuelo Valentini e Andrea Calvo), and by the European Community’s Health Seventh Framework Programme (FP7/2007-2013) to Adriano Chiò (grant 259867).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Positron Emission Tomography Center IRMET S.p.A, Turin, Italy

    Angelina Cistaro & Piercarlo Fania

  2. Department of Neuroradiology, CTO Hospital, Turin, Italy

    Maria Consuelo Valentini & Giovanna Carrara

  3. Department of Neuroscience, ALS Center, University of Turin, Turin, Italy

    Adriano Chiò, Andrea Calvo, Cristina Moglia & Anna Montuschi

  4. Department of Neurosciences, Clinical Neurophysiology Unit, Ophthalmology and Genetics, University of Genoa, Genoa, Italy

    Flavio Nobili

  5. Department of Internal Medicine, Nuclear Medicine Unit, University of Genoa, Genoa, Italy

    Silvia Morbelli

  6. Institute of Cognitive Sciences and Technologies, CNR, Rome & Padua, Italy

    Dario Salmaso & Marco Pagani

  7. Department of Nuclear Medicine, Karolinska Hospital, Stockholm, Sweden

    Marco Pagani

  8. Institute of Cognitive Sciences and Technologies, CNR, Via Palestro 32, 00185, Rome, Italy

    Marco Pagani

Authors
  1. Angelina Cistaro
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  2. Maria Consuelo Valentini
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Corresponding author

Correspondence to Marco Pagani.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00259-011-2029-0.

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Cistaro, A., Valentini, M.C., Chiò, A. et al. Brain hypermetabolism in amyotrophic lateral sclerosis: a FDG PET study in ALS of spinal and bulbar onset. Eur J Nucl Med Mol Imaging 39, 251–259 (2012). https://doi.org/10.1007/s00259-011-1979-6

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  • DOI: https://doi.org/10.1007/s00259-011-1979-6

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