Table 2:

Longitudinal MRS studies of pediatric bipolar disorder and youth at risk for bipolar disorder

StudySampleMethods (Device/FS/TR/TE/Sequence)Region-of-Interest Voxel Size and LocationFindings
Davanzo et al, 20017811 Patients with BD mania, medicated (n = 9), unmedicated (n = 2), (mean age, 11.4 yr),Signaa/1.5T/3000/30/PRESS8 mL in the anterior cingulate cortex↓ mIns/tCre was associated with acute lithium treatment (P = .047);
↓ mIns/tCre in lithium responders (P < .012);
mIns/tCre was not significantly different in lithium nonresponders (P < .655);
NAA/tCre was the metabolite least affected by lithium
Treatment with lithium for 1 week (mean lithium level = 0.64 mEq/L),
Scans obtained at baseline and day 7
DelBello et al, 20068119 Unmedicated manic or mixed patients with BD treated with olanzapine, 10–20 mg/day for 4 weeks,Signa/1.5T/2000/35/PRESS8 mL in the medial ventral prefrontal cortex,↑ tChol in medial ventral prefrontal cortex (P = .0001) associated with olanzapine treatment;
(mean age, 14.7 yr),8 mL in the left and right ventral lateral prefrontal cortices,↑ baseline tChol in the medial ventral prefrontal cortex associated with remission at 4 weeks (P = .001);
10 healthy volunteers, (mean age, 15 yr),Scans obtained at baseline, day 7, and day 28↑ NAA for 4 weeks in the medial ventral prefrontal cortex in olanzapine remitters (n = 11) vs ↓ NAA in nonremitters (n = 8) (P = .006);
↑ NAA for 4 weeks was associated with reduction in YMRS scores (r = 0.68; P = .004)
Patel et al, 20067928 Unmedicated depressed patients with BD, (mean age, 15.5 yr),Signa/1.5T/2000/35/PRESS8 mL in the medial prefrontal cortex,mIns in medial prefrontal cortex did not significantly differ among baseline, day 7, or day 42;
8 mL in the left and right lateral prefrontal cortices,↓ baseline mIns in medial prefrontal cortex in lithium remitters (n = 8) vs non-remitters (n = 20) (P = .003)
Treatment with lithium for 42 days, titrated to serum levels of 1.0–1.2 mEq/LScans obtained at baseline, day 7, and day 42
Chang et al, 20098310 Offspring of BD parents with mood symptoms but not BD, medicated (n = 3), unmedicated (n = 7), (mean age, 11.3 yr),Signa/3T/2000/35/ PRESS8 mL in the left and right dorsolateral prefrontal cortices,No significant difference in NAA in the left (P = .88) or right (P = .13) dorsolateral prefrontal cortex associated with 12 weeks of divalproex treatment;
Scans obtained at baseline and 12 weeksEffect size for decreased NAA = 0.94 for the right dorsolateral prefrontal cortex;
Exploratory analyses showed no significant differences in tChol or mIns
Treatment with divalproex for 12 weeks; mean serum VPA level = 82 μg/mL
Strawn et al, 20127625 Unmedicated manic or mixed patients with BD (mean age, 14.5),Varianb/4T/3000/23/PRESS8 mL in the anterior cingulate cortex (gray matter),↓ Glx at baseline in the left ventrolateral prefrontal cortex in treatment remitters (P = .01);
8 mL in left and right ventrolateral prefrontal cortices (white matter),In divalproex treatment remitters, change in Glu in the left ventrolateral prefrontal cortex correlated with change in YMRS score (r = 0.82; P = .03)
Treatment with divalproex for 28 days, titrated to a serum VPA level of 85–125 μg/mLScans obtained at baseline, day 7, and day 28
Chang et al, 20128226 Unmedicated depressed patients with BD,Signa/3T/2000/26/ PRESS8 mL in the anterior cingulate cortex,↓ Posttreatment mIns in the ACC in quetiapine responders (5 of 16 patients);
Treatment with either quetiapine (n = 16) or placebo (n = 10) for 8 weeks,and8 mL in the left dorsolateral prefrontal cortex,no significant change in NAA between the quetiapine and placebo groups
(mean age, 15.6 yr)Varian/4T/2000/26/PRESS8 mL in the right dorsolateral prefrontal cortex

  • Note:—TR and TE are expressed in milliseconds. FS indicates field strength; PRESS, point-resolved spectroscopic sequence; ↓, decreased; ↑, increased; tCre, total creatine; VPA, valproic acid; YMRS, Young Mania Rating Scale.

  • ↵a GE Healthcare, Milwaukee, Wisconsin.

  • ↵b Varian, Palo Alto, California.