Episode 26 Imaging Post Traumatic Stress Disorder
This podcast features an interview by Bronwyn Cleary with DoctorDr Marcos Pagani
at the EANM.
Neurobiological changes in Post Traumatic Stress Disorder following treatment with Eye
Background:
Only few studies have reported functional or structural modifications in Post-traumatic Stress Disorder (PTSD) patients following pharmacological or cognitive behavioural treatment. Eye movement desensitization and reprocessing (EMDR) is a novel eclectic psychotherapy utilising, among other techniques, relaxation and safe place exercises, cognitive restructuring, future projections, and imaginal exposure of the trauma combined with sensory stimulation. The aim of the study was to analyse the differences in regional cerebral blood flow distribution and in brain volumetry before and after EMDR therapy. Subjects and 

Methods:
Fifteen subjects with chronic PTSD following occupational health hazards were treated with five sessions of EMDR. They were assessed by psychometric scales and diagnostic interviews before and directly after treatment. SPECT during administration of an individualised trauma script, was performed pre- and post-treatment using 99mTc-HMPAO. After EMDR, the subjects were subdivided into responders (R, n=10) and non-responders (NS, n=5), based on the absence or presence, respectively, of full PTSD diagnosis as assessed by DSM-IV criteria. SPECT and volumetric data (MRI, pre-treatment) analyses were carried out by Statistical Parametric Mapping (SPM2) and data were covaried by age and by time elapsed from trauma to SPECT. SPECT data were further covaried by the amount of grey matter normalised by the total intracranial volume. 

Results:
Immediate significant post-treatment changes towards normality in all scales measuring psychological status were found in responders. As compared to NR, R showed a significantly post-treatment decreased tracer uptake in parieto-occipital (Brodmann Area, BA, 37, fusiform gyrus) and in primary visual cortex (BA17) and in the hippocampus (p<0.001). The opposite comparison highlighted an increased tracer uptake in left frontal cortex (BA 44; p<0.05). Volumetric grey matter pre-treatment differences between groups were found in visual, posterior cingulate and parieto-temporal cortex (p<0.05). 

Conclusion:
The positive EMDR outcome corresponded to increased 99mTc-HMPAO uptake in the left dorsolateral frontal cortex, processing attention and self confidence and exerting an inhibitory effect on the amygdala whose firing is supposed to be responsible for PTSD. After successful treatment significant tracer uptake decreases were found in primary visual cortex, processing images of traumatic memories and flashbacks; in fusiform gyrus, processing the memories of faces, bodies and words and in the hippocampi, involved in episodic and autobiographical memories. Volumetric changes pre-treatment superimposed the neurobiological ones in all previous regions. These findings suggest that the positive clinical effect following EMDR therapy causes functional changes and that volumetric modifications pre-treatment are good predictors of psychotherapy outcome.


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