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NEUROLOGY 2004;62:1384-1390
© 2004 American Academy of Neurology

Regional metabolism in primary torsion dystonia

Effects of penetrance and genotype
M. Carbon, MD, S. Su, BSc, V. Dhawan, PhD, D. Raymond, MS, S. Bressman, MD and D. Eidelberg, MD

From the Center for Neurosciences (Drs. Carbon, Dhawan, and Eidelberg, S. Su), North Shore–Long Island Jewish Research Institute, Department of Neurology (Drs. Dhawan and Eidelberg), North Shore University Hospital and New York University School of Medicine, and Department of Neurology (Dr. Bressman, D. Raymond), Beth Israel Medical Center, New York, NY.

Address correspondence and reprint requests to Dr. D. Eidelberg, Center for Neurosciences, North Shore–Long Island Jewish Research Institute, 350 Community Dr., Manhasset, NY 11030; e-mail: david1{at}nshs.edu

Background: The authors have previously used [18F]fluorodeoxyglucose (FDG) PET to identify a reproducible pattern of regional glucose metabolism that was expressed in both manifesting and nonmanifesting carriers of the DYT1 primary dystonia mutation.

Objective: To identify specific regions that discriminated subjects according to clinical penetrance and genotype.

Methods: FDG PET was used to scan 12 nonmanifesting and 11 manifesting DYT1 gene carriers, 6 nonmanifesting DYT6 gene carriers and 7 manifesting DYT6 gene carriers, as well as 11 control subjects. The data from all five groups were analyzed with statistical parametric mapping and analysis of variance with posthoc contrasts.

Results: A dissociation of metabolic changes was found related to phenotype and genotype. Manifesting gene carriers of both genotypes exhibited bilateral hypermetabolism in the presupplementary motor area (Brodmann area [BA] 6) and parietal association cortices (BA 40/7) compared with the respective nonmanifesting counterparts. By contrast, genotype-specific increases in metabolism were found in the putamen, anterior cingulate (BA 24/32), and cerebellar hemispheres of DYT1 carriers. Genotype-specific changes in DYT6 involved hypometabolism of the putamen and hypermetabolism in the temporal cortex (BA 21).

Conclusions: Dystonia may be associated with abnormal movement preparation caused by defective sensorimotor integration. Whereas clinical manifestations are related to cortical dysfunction, metabolic abnormalities in subcortical structures may represent trait features that are specific for individual dystonia genotypes.

Received August 18, 2003. Accepted in final form December 30, 2003.




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