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Brain metabolite changes on proton magnetic resonance spectroscopy in children with poorly controlled type 1 diabetes mellitus

  • Paediatric Neuroradiology
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Abstract

The metabolite changes in the brains of children with poorly controlled type 1 diabetes mellitus (DM) were investigated by proton magnetic resonance spectroscopy (MRS). A total of 30 subjects and 14 age-matched healthy volunteers underwent single-voxel MRS (TE: 136). The duration of disease, medication, presence of hypoglycaemia episodes and the level of haemoglobin A1C (HbA1C) in the patients were noted. Voxels were placed in the pons, left basal ganglion (LBG) and left posterior parietal white matter (PPWM). N-acetylaspartate (NAA)/creatinine (Cr) and choline (Cho)/Cr ratios were calculated. The average HbA1c level was 11.9±3.4 (8.2–19.4). The average number of keto-acidosis episodes was 1.9±2.2 (0–9) and the average number of daily insulin injections was 2.8±0.97 (2–4). MRS revealed lower NAA/Cr and Cho/Cr ratios in the pons and lower NAA/Cr ratio in the PPWM of patients with DM than in control subjects. No significant correlation was observed between the number of hypoglycaemia episodes and metabolite ratios. Metabolic abnormalities have been observed by MRS in the brain of poorly controlled type 1 DM children. These metabolic changes, in particular in the pons region, include a decrease in NAA, indicating neuronal loss or functional impairment, and likely explanations for a decrease in Cho may be dynamic changes in membrane lipids and/or decreased membrane turnover.

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References

  1. Harati Y (1996) Diabetes and nervous system. Endocrinol Metab Clin North Am 25:325–359

    CAS  PubMed  Google Scholar 

  2. Gispen WH, Biessels GJ (2000) Cognition and synaptic plasticity in diabetes mellitus. Trends Neurosci 23:542–549

    Article  CAS  PubMed  Google Scholar 

  3. Franceschi M, Cecchetto R, Minicucci F, Smizne S, Baio G, Canal N (1984) Cognitive processes in insulin-dependent diabetes. Diabetes Care 7:228–231

    CAS  PubMed  Google Scholar 

  4. McCarthy AM, Lindgren S, Mengeling MA, Tsalikian E, Engvall JC (2002) Effects of diabetes on learning in children. Pediatrics 109:E9

    Article  PubMed  Google Scholar 

  5. Widom B, Simonson DC (1990) Glycemic control and neuropsychologic function during hypoglycemia in patients with insulin-dependent diabetes mellitus. Ann Intern Med 112:904–912

    CAS  PubMed  Google Scholar 

  6. Brands AM, Kessels RP, de Haan EH, Kappelle LJ, Biessels GJ (2004) Cerebral dysfunction in type 1 diabetes: effects of insulin, vascular risk factors and blood-glucose levels. Eur J Pharmacol 490:159–168

    Article  CAS  PubMed  Google Scholar 

  7. Biessels GJ, Cristino NA, Rutten GJ, Hamers FP, Erkelens DW, Gispen WH (1999) Neurophysiological changes in the central and peripheral nervous system of streptozotocin-diabetic rats. Course of development and effects of insulin treatment. Brain 122:757–768

    Article  PubMed  Google Scholar 

  8. Biessels GJ, van der Heide LP, Kamal A, Bleys RL, Gispen WH (2002) Ageing and diabetes: implications for brain function. Eur J Pharmacol 441:1–14

    Article  CAS  PubMed  Google Scholar 

  9. Biessels GJ, Braun KP, de Graaf RA, van Eijsden P, Gispen WH, Nicolay K (2001) Cerebral metabolism in streptozotocin-diabetic rats: an in vivo magnetic resonance spectroscopy study. Diabetologia 44:346–353

    Article  CAS  PubMed  Google Scholar 

  10. Kreis R, Ross BD (1992) Cerebral metabolic disturbances in patients with subacute and chronic diabetes mellitus: detection with proton MR spectroscopy. Radiology 184:123–130

    Google Scholar 

  11. Perros P, Deary IJ, Sellar RJ, Best JJ, Frier BM (1997) Brain abnormalities demonstrated by magnetic resonance imaging in adult IDDM patients with and without a history of recurrent severe hypoglycemia. Diabetes Care 20:1013–1018

    CAS  PubMed  Google Scholar 

  12. Biessels GJ, Kappelle AC, Bravenboer B, Erkelens DW, Gispen WH (1994) Cerebral function in diabetes mellitus. Diabetologia 37:643–650

    Article  CAS  PubMed  Google Scholar 

  13. Tallroth G, Ryding E, Agardh CD (1993) The influence of hypoglycaemia on regional cerebral blood volume in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 36:530–535

    CAS  PubMed  Google Scholar 

  14. Vincent AM, Brownlee M, Russell JW (2002) Oxidative stress and programmed cell death in diabetic neuropathy. Ann N Y Acad Sci 959:368–383

    CAS  PubMed  Google Scholar 

  15. Kumar JS, Menon VP (1993) Effect of diabetes on levels of lipid peroxides and glycolipids in rat brain. Metabolism 42:1435–1439

    Article  CAS  PubMed  Google Scholar 

  16. Miller BL (1991) A review of chemical issues in 1H NMR spectroscopy: N-acetyl-L-aspartate, creatine and choline. NMR Biomed 4:47–52

    CAS  Google Scholar 

  17. Demougeot C, Garnier P, Mossiat C, Bertrand N, Giroud M, Beley A, Marie C (2001) N-acetylaspartate, a marker of both cellular dysfunction and neuronal loss: its relevance to studies of acute brain injury. J Neurochem 77:408–415

    Article  CAS  PubMed  Google Scholar 

  18. Lai PH, Chen PC, Chang MH, Pan HB, Yang CF, Wu MT, Li JY, Chen C, Liang HL, Chen WL (2001) In vivo proton MR spectroscopy of chorea-ballismus in diabetes mellitus. Neuroradiology 43:525–531

    Article  CAS  PubMed  Google Scholar 

  19. Cox IJ (1996) Development and applications of in vivo clinical magnetic resonance spectroscopy. Prog Biophys Mol Biol 65:45–81

    Article  CAS  PubMed  Google Scholar 

  20. Ross B, Michaelis T (1994) Clinical applications of magnetic resonance spectroscopy. Magn Reson Q 10:191–247

    CAS  PubMed  Google Scholar 

  21. Jagannathan NR, Tandon N, Raghunathan P, Kochupillai N (1998) Reversal of abnormalities of myelination by thyroxine therapy in congenital hypothyroidism: localized in vivo proton magnetic resonance spectroscopy (MRS) study. Brain Res Dev Brain Res 109:179–186

    Article  CAS  PubMed  Google Scholar 

  22. Bhatara VS, Tripathi RP, Sankar R, Gupta A, Khushu S (1998) Frontal lobe proton magnetic-resonance spectroscopy in Graves’ disease: a pilot study. Psychoneuroendocrinology 23:605–612

    Article  CAS  PubMed  Google Scholar 

  23. Thomke F, Urban PP, Marx JJ, Mika-Gruttner A, Hopf HC (2002) Seventh nerve palsies may be the only clinical sign of small pontine infarctions in diabetic and hypertensive patients. J Neurol 249:1556–1562

    Article  PubMed  Google Scholar 

  24. Khardori R, Soler NG, Good DC, DevlescHoward AB, Broughton D, Walbert J (1986) Brainstem auditory and visual evoked potentials in type 1 (insulin-dependent) diabetic patients. Diabetologia 29:362–365

    Article  CAS  PubMed  Google Scholar 

  25. Toth F, Varkonyi TT, Rovo L, Lengyel C, Legrady P, Jori J, Czigner J, Kiss JG (2003) Investigation of auditory brainstem function in diabetic patients. Int Tinnitus J 9:84–86

    PubMed  Google Scholar 

  26. Ferguson SC, Blane A, Perros P, McCrimmon RJ, Best JJ, Wardlaw J, Deary IJ, Frier BM (2003) Cognitive ability and brain structure in type 1 diabetes: relation to microangiopathy and preceding severe hypoglycemia. Diabetes 52:149–156

    CAS  PubMed  Google Scholar 

  27. The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of the long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 329:977–986

    Google Scholar 

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Sarac, K., Akinci, A., Alkan, A. et al. Brain metabolite changes on proton magnetic resonance spectroscopy in children with poorly controlled type 1 diabetes mellitus. Neuroradiology 47, 562–565 (2005). https://doi.org/10.1007/s00234-005-1387-3

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  • DOI: https://doi.org/10.1007/s00234-005-1387-3

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