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Biomedical subjects

Manfred Spitzer

Publications and source records attributed to Manfred Spitzer.

12 recordsLinked to original sources

Enantioselective quantitation of the ecstasy compound (R)- and (S)-N-ethyl-3,4-methylenedioxyamphetamine and its major metabolites in human plasma and urine.

An enantioselective HPLC method has been developed and validated for the stereospecific analysis of N-ethyl-3,4-methylenedioxyamphetamine (MDE) and its major metabolites N-ethyl-4-hydroxy-3-methoxyamphetamine (HME) and 3,4-methylenedioxyamphetamine (MDA). These compounds have been analyzed both from human plasma and urine after administration of 70 mg pure MDE-hydrochloride enantiomers to four subjects. The samples were prepared by hydrolysis of the o-glucuronate and sulfate conjugates using beta-glucuronidase/arylsulfatase and solid-phase extraction with a cation-exchange phase. A chiral stationary protein phase (chiral-CBH) was used for the stereoselective determination of MDE, HME and MDA in a single HPLC run using sodium dihydrogenphosphate, ethylendiaminetetraacetic acid disodium salt and isopropanol as the mobile phase (pH 6.44) and fluorimetric detection (lambda(ex) 286 nm, lambda(em) 322 nm). Moreover, a suitable internal standard (N-ethyl-3,4-methylenedioxybenzylamine) was synthesized and qualified for quantitation purposes. The method showed high recovery rates (>95%) and limits of quantitation for MDE and MDA of 5 ng/ml and for HME of 10 ng/ml. The RSDs for all working ranges of MDE, MDA and HME in plasma and urine, respectively, were less than 1.5%. After validation of the analytical methods in plasma and urine samples pharmacokinetic parameters were calculated. The plasma concentrations of (R)-MDE exceeded those of the S-enantiomer (ratio R:S of the area under the curve, 3.1) and the plasma half time of (R)-MDE was longer than that of (S)-MDE (7.9 vs. 4.0 h). In contrast, the stereochemical disposition of the MDE metabolites HME and MDA was reversed. Concentrations of the (S)-metabolites in plasma of volunteers were much higher than those of the (R)-enantiomers.

3,4-Methylenedioxyamphetamine↗

No hypofrontality, but absence of prefrontal lateralization comparing verbal and spatial working memory in schizophrenia.

Hypofrontality and decreased lateralization have been two major, albeit controversial, results from functional neuroimaging studies of schizophrenia. We used fMRI to study cortical activation during a verbal and spatial working memory (WM) task (2-back) in 15 inpatients acutely ill with schizophrenia and 15 matched control subjects. We hypothesized (i) hypofrontality in patients in both tasks and (ii) decreased lateralization of prefrontal activation in patients under the assumption that, in controls, left prefrontal cortex (PFC) is engaged preferentially in the verbal task (verbal domain dominance) and the right prefrontal cortex is engaged preferentially in the spatial task (spatial domain dominance). Our results showed no significant differences in frontal activation between controls and patients, i.e. no hypofrontality in patients, even at a very liberal threshold (p<0.01). This may be explained by the fact that nearly all patients studied received atypical neuroleptics. Nonetheless, we found evidence for more subtle, domain-related prefrontal dysfunction. Whereas controls showed verbal WM domain dominance in left inferior frontal cortex and spatial WM domain dominance in right prefrontal cortex, these domain dominance effects were absent in the patient group, i.e. there were no lateralization effects. Finally, only patients showed an inverse correlation between performance and right prefrontal activation in verbal WM. We conclude that the finding of hypofrontality may depend on the medication of the patients and that there is prefrontal dysfunction even in the absence of hypofrontality.

Adult↗

Emotional context modulates subsequent memory effect.

Emotions have been shown to modulate memory processes. However, the neuronal substrate underlying these modulatory effects is largely unknown. Using event-related functional magnetic resonance imaging (fMRI), we investigated whether the context of emotional encoding modulates brain activation predictive for subsequent recall of emotionally neutral material. While inferior frontal activation predicted recall in general, our data show that in a positive encoding context, recall was predicted by activation of right anterior parahippocampal and extrastriate visual brain areas, whereas in a negative encoding context, recall was predicted by activation of the amygdala. Thus, we could demonstrate that successful episodic encoding is differentially modulated by emotional context. These results contribute to the understanding of the interaction of emotion and cognition and moreover are of general relevance for studies of episodic memory.

Adult↗

Cultural objects modulate reward circuitry.

Using event-related fMRI we investigated the rewarding properties of cultural objects (cars) signaling wealth and social dominance. It has been shown recently that reward mechanisms are involved in the regulation of social relations like dominance and social rank. Based on evolutionary considerations we hypothesized that sports cars in contrast to other categories of cars, e.g. limousines and small cars, are strong social reinforcers and would modulate the dopaminergic reward circuitry. Twelve healthy male subjects were studied with fMRI while viewing photographs of different car classes followed by an attractivity rating. Behaviorally sports cars were rated significantly more attractive than limousines and small cars. Our fMRI results revealed significantly more activation in ventral striatum, orbitofrontal cortex, anterior cingulate and occipital regions for sports cars in contrast to other categories of cars. We could thus demonstrate that artificial cultural objects associated with wealth and social dominance elicit activation in reward-related brain areas.

Adult↗

Intracortical excitability is modulated by a norepinephrine-reuptake inhibitor as measured with paired-pulse transcranial magnetic stimulation.

OBJECTIVE: Paired-pulse transcranial magnetic stimulation (ppTMS) of the motor cortex can be used to measure intracortical inhibition and facilitation of evoked motor potentials dependent on different interstimulus intervals (ISI). The reuptake-inhibition of norepinephrine, known as an excitatory neuromodulator and neurotransmitter, was postulated to enhance cortical excitability through increased facilitation and reduced inhibition as measured with ppTMS. METHODS: Eight healthy subjects were examined with ppTMS at ISIs of 2, 3, 4, 5, 6, 7, 8, 10, 15 and 20 ms before and approximately 1.5 h after ingestion of 8 mg reboxetine. The group effects at the different ISIs pre/post reboxetine intake were analysed. RESULTS: Post-reboxetine ppTMS showed an enhanced intracortical facilitation effect at ISIs of 8, 10, 15 and 20 ms. A decreased inhibition was found at an ISI of 3 ms. CONCLUSIONS: Reboxetine-induced higher postsynaptic norepinephrine level enhances intracortical excitability as measured with ppTMS. This finding provides new perspectives for evaluating neurophysiological properties of antidepressive medication and for investigating the pathophysiology of depression.

Adrenergic Uptake Inhibitors↗

Human anterior cingulate cortex is activated by negative feedback: evidence from event-related potentials in a guessing task.

It has been controversially discussed whether the error-related negativity (ERN) or error negativity (N(e)), an electrophysiological index of anterior cingulate activation, reflects response conflict or response evaluation subserving error monitoring processes. We investigated event-related potentials (ERPs) in a guessing task which did not induce response conflict. Subjects had to guess which of the four aces of a French card play would be presented next and received feedback at random. We observed a negative ERP deflection in trials following negative feedback which was identified as ERN/N(e). Dipole analysis of scalp potentials indicated sources in the anterior cingulate and left inferior prefrontal cortex. The observation of the ERN/N(e) following negative feedback during guessing suggests that this ERP component mirrors response evaluation processes comparing expected and actual response outcome rather than response conflict.

Adult↗

Dissociating a common working memory network from different neural substrates of phonological and spatial stimulus processing.

Positron emission tomography was used to investigate common versus specific cortical regions for the maintenance of spatial versus phonological information in working memory (WM). Group and single-subject analyses of regional cerebral blood flow during a new 2 x 2 factorial n-back task were performed. Eight subjects had to memorize either phonological features or the location of serially presented syllables. Brain activation during phonological judgment and spatial judgment (0-back) was compared with that during two corresponding WM conditions (2-back). We observed a common network associated with the requirement of maintaining and sequencing items in WM. Seven or more subjects activated (posterior) superior frontal sulcus (pSFS, BA 6/8, global maximum) and/or adjacent gyri, posterior parietal cortex, and precuneus (BA 7). Less consistently, bilateral middle frontal gyrus (BA 9/46) was involved. Bilateral anterior (BA 39/40) and posterior (BA 7) intraparietal sulcus, as well as right pSFS, exhibited dominance for spatial WM. Although underlying stimulus processing pathways for both types of information were different, no region specific for phonological WM was found. Robust activation within the left inferior frontal gyrus (BA 44 and 45) was present, during both phonological WM and phonological judgment. We conclude that the controversial left prefrontal lateralization for verbal WM reflects more general phonological processing strategies, not necessarily required by tasks using letters. We propose a stimulus-independent role for the bilateral pSFS and its vicinity for maintenance and manipulation of different context-dependent information within working memory.

Adult↗

Spatial congruence of neuronavigated transcranial magnetic stimulation and functional neuroimaging.

OBJECTIVES: Transcranial magnetic stimulation (TMS) is progressively gaining relevance as a tool in cognitive neuroscience and clinical research. However, most studies in this field do not consider individual anatomy. Neuronavigational devices allow to guide the coil to a specific cortical area, predetermined by functional magnetic resonance imaging (fMRI). Therefore, it is crucial to know whether the area of a certain function as identified by fMRI corresponds to the area where the TMS should be placed in order to influence this function. METHODS: We investigated the spatial relation between the cortical area activated by a motor task in fMRI and the area of magnetically evoked motor potentials (MEP) in 8 subjects, using a spacing of 5x5 mm. A neuronavigational system was adapted for coil positioning and for the registration of the stimulation coordinates. RESULTS: A spatial divergence of the centers of gravity from fMRI and MEP was found with a mean distance of about 10 mm, with the MEP centers being, by a mean derivation of 7.5 mm, consistently anterior to the center of fMRI activation. However, regarding MEP areas and fMRI activities, a large overlap was found for stimulation intensities of both 110 and 120% motor threshold. CONCLUSIONS: The combination of fMRI and neuronavigated TMS is useful for non-invasive investigation of individual cortical functions predetermined by fMRI. Whereas both are spatially by and large congruent, discrepencies in the exact spatial relation between MEP and fMRI areas should be considered and further studied.

Adult↗

Add-on rTMS for treatment of depression: a pilot study using stereotaxic coil-navigation according to PET data.

OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) is regarded as a potentially new tool to treat depression. In a double-blind, randomized, sham-controlled pilot study we investigated the efficacy of neuronavigated rTMS, guided according to the prefrontal metabolic state determined by positron emission tomography (PET). METHODS: 25 patients with major depression were included. Prior to rTMS, PET scans were obtained. For the real stimulation condition, the dorsolateral prefrontal cortex (DLPFC) with lower metabolic activity compared to the contralateral hemisphere was selected, if detected by prior PET. Stimulation parameters were 15 Hz, 110% motor threshold (MT), 3000 stimuli/day, for 10 days. A neuronavigational system was used to place the magnetic coil above each individuals' selected cortical region (real condition: DLPFC, sham: midline parieto-occipital, intensity 90% of MT). RTMS was administered add-on to medication. Depression-related symptoms were rated with Beck's, Hamilton's (HAM-D), and Montgomery-Asberg's (MADRS) depression rating scales. RESULTS: Real stimulation improved depression according to HAM-D and MADRS moderately but significantly better compared to sham at the end of the stimulation sessions. In the real condition, four out of 13 patients responded with a mean improvement in HAM-D and/or MADRS of at least 50%, whereas none responded to sham. Antidepressant effects of stimulation of the relatively hypometabolic DLPFC were comparable to stimulation in absence of metabolic differences. CONCLUSIONS: A moderate improvement of depressive symptoms after rTMS was observed. Our preliminary data show that stimulation of prefrontal hypometabolism may not be advantageous to stimulation irrespective of the metabolic state.

Adult↗

Cognitive inhibition and thought disorder in schizophrenia.

In schizophrenia, inhibitory control is reported to be disturbed and has been associated with formal thought disorder (TD). The negative priming task (NP) is used as a measure for inhibition; however, controversial results are found in the literature. The aim of this study was to evaluate cognitive inhibition in schizophrenia and TD. Additionally, the influence of the course of disease and of medication were evaluated. The NP was used to compare TD patients (n = 17) with non-TD (n = 19) and healthy controls (n = 21). Results showed similar performance among TD and non-TD patients, and controls. No influence of the course of disease or medication was found. Our results are in line with recent studies, where patients, irrespective of TD, show normal performance in the NP.

Adult↗

Transcranial magnetic stimulation in the reversal of motor conversion disorder.

BACKGROUND: There is no agreement on the most effective therapy for motor conversion symptoms. Functional electric stimulation has been successfully used to reverse conversion paralysis. We tested the therapeutic potential of high-frequency repetitive transcranial magnetic stimulation (rTMS) in a 20-year-old patient suffering from a conversion paralysis of the right arm. METHOD: rTMS was applied to the contralateral motor cortex. Stimulations were performed on working days at a frequency of 15 Hz (train length 2 s; inter-train interval 4 s) yielding 4,000 pulses/day. RESULTS: Within 12 weeks, motor function, hyposensibility and muscle bulk were completely restored. CONCLUSIONS: The patient recovered completely during rTMS treatment. In addition to possible psychological effects, rTMS may have had a causal therapeutic effect by strengthening corticocortical connections and thereby priming voluntary movements. Further controlled studies are needed.

Adult↗