High-energy phosphate metabolism in the frontal lobes of patients with panic disorder detected by phase-encoded 31P-MRS

Using phosphorus-31 magnetic resonance spectroscopy (31P-MRS), we analyzed the brain phosphorous metabolism in 18 patients with panic disorder (PD) and in 18 sex-, age-, and handedness-matched normal controls (NC). All patients were receiving ongoing drug treatments for PD. The evaluation of phosphorous metabolism in the whole frontal lobes revealed no significant differences between the patients and controls in 31P metabolite levels, although the PD patients showed slightly decreased inorganic phosphate (Pi) concentration of the frontal lobes. Moreover, we found a significant asymmetry (left > right) of phosphocreatine (PCr) concentration in the frontal lobes in the patients with PD, suggesting that abnormalities of phosphorous metabolism are present in the frontal lobes of PD patients. Two patients in whom a limited panic episode occurred during measurements showed frontal lobe intracellular pH higher than that in the other patients and that in the NC, suggesting respiratory gaseous alkalosis due to hyperventilation in the anxiety state. 31P-MRS has potential for application in the assessment of brain abnormalities and anxiety state, such as that accompanied by hyperventilation, in PD patients.