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Effects of EMDR psychotherapy on 99mTc-HMPAO distribution in occupation-related post-traumatic stress disorder

Pagani, Marcoa b; Högberg, Göranc; Salmaso, Dariob; Nardo, Davided; Sundin, Örjane; Jonsson, Cathrinea; Soares, Joaquimf; Åberg-Wistedt, Annag; Jacobsson, Hansa; Larsson, Stig A.a; Hällström, Torec

Nuclear Medicine Communications: October 2007 - Volume 28 - Issue 10 - p 757-765
doi: 10.1097/MNM.0b013e3282742035
Original Articles

Background Post-traumatic stress disorder (PTSD) is a derangement of mood control with involuntary, emotionally fraught recollections that may follow deep psychological trauma in susceptible individuals. This condition is treated with pharmacological and/or cognitive therapies as well as psychotherapy with eye movement desensitization and reprocessing (EMDR). However, only a very limited number of studies have been published dealing with work-related PTSD, and investigations on the effect of treatment on cerebral blood flow represent an even smaller number.

Aim To investigate the short-term outcome of occupation-related PTSD after EMDR therapy by 99mTc-HMPAO SPECT.

Method Fifteen patients, either train drivers suffering from PTSD after having been unintentionally responsible for a person-under-train accident or employees assaulted in the course of duty, were recruited for the study. 99mTc-HMPAO SPECT was performed on these patients both before and after EMDR therapy while they listened to a script portraying the traumatic event. Tracer distribution analysis was then carried out at volume of interest (VOI) level using a three-dimensional standardized brain atlas, and at voxel level by SPM. The CBF data of the 15 patients were compared before and after treatment as well as with those of a group of 27 controls who had been exposed to the same psychological traumas without developing PTSD.

Results At VOI analysis significant CBF distribution differences were found between controls and patients before and after treatment (P=0.023 and P=0.0039, respectively). Eleven of the 15 patients responded to treatment, i.e., following EMDR they no longer fulfilled the DSM-IV criteria for PTSD. When comparing only the eleven responders with the controls, the significant group difference found before EMDR (P=0.019) disappeared after treatment. Responders and non-responders showed after therapy significant regional differences in frontal, parieto-occipital and visual cortex and in hippocampus. SPM analysis showed significant uptake differences between patients and controls in the orbitofrontal cortex (Brodmann 11) and the temporal pole (Brodmann 38) both before and after treatment. A significant tracer distribution difference present before treatment in the uncus (Brodmann 36) disappeared after treatment, while a significant difference appeared in the lateral temporal lobe (Brodmann 21).

Conclusion Significant 99mTc-HMPAO uptake regional differences were found, mainly in the peri-limbic cortex, between PTSD patients and controls exposed to trauma but not developing PTSD. Tracer uptake differences between responders and patients not responding to EMDR were found after treatment suggesting a trend towards normalization of tracer distribution after successful therapy. These findings in occupational related PTSD are consistent with previously described effects of psychotherapy on anxiety disorders.

aSection of Nuclear Medicine and Department of Radiology, Karolinska University Hospital, Stockholm, Sweden

bInstitute of Cognitive Sciences and Technologies, CNR, Rome & Padua, Italy

cDepartment of Clinical Neuroscience, Huddinge

dHertie-Institute for Clinical Brain Research, Tuebingen, Germany

eSection of Psychology, Department of Social Science, Mid Sweden University, Östersund, Sweden

fStockholm Centre of Public Health and Department of Public Health Sciences

gDepartment of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden

Correspondence to Dr Marco Pagani, Institute of Cognitive Sciences and Technologies, CNR, Via S. Martino della Battaglia 44, 00185, Rome, Italy

Tel: +39 06 445 95321; fax: +39 06 445 95243;


Received 23 February 2007 Revised 24 March 2007 Accepted 8 May 2007

© 2007 Lippincott Williams & Wilkins, Inc.