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BRIEF COMMUNICATIONS: K. Aydin, B. Tatli, M. Ozkan, K. Ciftci, Z. Unal, S. Sani, M. Ozmen, M. Caliskan, N. Aydinli, and S. Guven Quantification of neurometabolites in subacute sclerosing panencephalitis by 1H-MRS Neurology 2006; 67: 911-913 [Abstract] [Full text] [PDF]

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Quantification of neurometabolites in subacute sclerosing panencephalitis by 1H-MRS

Banu Anlar   (7 November 2006)

Reply from the Authors

Kubilay Aydin   (7 November 2006)

Quantification of neurometabolites in subacute sclerosing panencephalitis by 1H-MRS 7 November 2006
Banu Anlar, Hacettepe University Dept of Pediatric Neurology, Ankara, Turkey 06100 Send Correspondence to journal: Re: Quantification of neurometabolites in subacute sclerosing panencephalitis by 1H-MRS banlar{at}hacettepe.edu.tr Banu Anlar	The study of Aydin et al [1] adds to current data on the pathogenesis of subacute sclerosing panencephalitis (SSPE) and supports the role of neuronal loss in the progression of neurological dysfunction. The authors also observed increasing myoinositol (mI) until stage 3 of the disease, which they related to astrogliosis. However, patients progressing to stage 4 had lower concentrations of mI. Because a reduction in astrogliosis is unexpected in late stages of SSPE, I think this metabolite might have been affected by inosiplex treatment as previously reported by Kato et al. [2] All patients in the study were under inosiplex treatment, but compliance frequently diminishes when patients progress to more advanced stages of the disease despite treatment. The role of medication should be considered in interpreting MRS results. References 1.Aydin K, Tatli B, Ozkan M, et al. Quantification of neurometabolites in subacute sclerosing panencephalitis by 1H-MRS.Neurology 2006;67:911-913. 2.Kato Z, Asano T, Kondo N. Inosiplex Affects the Spectra of Proton Magnetic Resonance Spectroscopy in Subacute Sclerosing Panencephalitis. Journal of Child Neurology 2006;21:177-178. Disclosure: The author reports no conflicts of interest.
Reply from the Authors 7 November 2006
Kubilay Aydin, Istanbul University, Istanbul Medical School, Department of Neuroradiology Adnan Saygun Cad. M. Salihrustu bey sok. Ulus Konaklari, No: 8/12, Ulus, Istanbul , Turkey Send Correspondence to journal: Re: Reply from the Authors dr.aydink{at}superonline.com Kubilay Aydin	We appreciate Dr. Anlar’s comments about our recent article regarding MR spectroscopy findings in patient with subacute sclerosing panencephalitis (SSPE). We investigated the correlations between neurometabolite concentrations and duration of disease and clinical status of patients with SSPE. [1] In our study, the mean mI concentration of in the patients with stage 4 disease was lower than that of stage 3 patients. Dr. Anlar speculates that the regression of mI increase in stage 4 patient might have been caused by the effect of inosiplex. [2]. However, there was no change in the treatment protocols or in inosiplex dosage which would support such a hypothesis. Also, an increase in N-acetyl aspartate (NAA) concentration accompanying the decrease in mI concentration would be expected if the decrease in mI concentration in stage 4 patients was due to theropeutic effect of inosiplex alone. In our study, the NAA concentrations continued to decrease in stage 3 patients who progressed into stage 4. A case of SSPE in which a regression of mI increase was observed when the patient progressed into stage 4 disease has been reported. [3] There is no data to support Dr. Anlar’s speculation. We hypothesize that tissue necrosis developing in cerebral tissue of stage 4 patients may decrease mI concentration by a diluting effect. Our study was not a longitidunal study focused on investigating the effect of inosiplex on proton MR spectroscopy findings of SSPE patients. There is no current, adequate treatment for SSPE and inosiplex is one of the few drugs which has been shown to be partially effective in the treatment of SSPE. Due to ethical issues, we could not investigate potential effects of inosiplex on neurometabolite concentrations. However, the significant correlations of neurometabolite concentrations with clinical status of patients which have been observed in our study makes MR spectroscopy a potential clinical tool to follow up SSPE patients. Reference 3. Michael N, Erfurth A, Ludemann P, Schuierer G, Moller HE. Serial proton spectroscopy in a case of adult onset subacute sclerosing panencephalitis. Psychiatry Res 2005; 139: 269-273. Disclosure: The authors report no conflicts of interest.