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Eur J Nucl Med Mol Imaging. 2019 May 31. doi: 10.1007/s00259-019-04360-1. [Epub ahead of print]

Increase of precuneus metabolism correlates with reduction of PTSD symptoms after EMDR therapy in military veterans: an 18F-FDG PET study during virtual reality exposure to war.

Author information

1
Laboratoire de Neurosciences Sensorielles et Cognitives, Aix-Marseille Université CNRS, Marseille, France.
2
Department of Psychiatry, La Conception University Hospital, Marseille, France.
3
Department of Nuclear Medicine & Nancyclotep Imaging Platform, CHRU Nancy, Lorraine University, Nancy, France.
4
IADI, INSERM, UMR 1254, Lorraine University, Nancy, France.
5
Service de Psychiatrie, Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France.
6
CNRS, Ecole Centrale de Marseille, UMR 7249, Institut Fresnel, Aix-Marseille Université, Marseille, France. eric.guedj@ap-hm.fr.
7
Department of Nuclear Medicine, Assistance Publique Hôpitaux de Marseille, Timone University Hospital, Marseille, France. eric.guedj@ap-hm.fr.
8
CERIMED, Aix-Marseille University, Marseille, France. eric.guedj@ap-hm.fr.

Abstract

PURPOSE:

The prevalence of posttraumatic stress disorder (PTSD) is higher among veterans, and can lead to disastrous consequences such as suicide. Eye movement desensitization and reprocessing (EMDR) is recommended in first-line psychotherapies for PTSD. Virtual reality exposure (VRE) coupled with 18F-FDG PET imaging can highlight the activated brain regions during stress exposure. The objective of this study is to identify, after EMDR therapy, the regions of brain metabolism that evolve during the stress exposure of a war scene with symptomatic remission in a group of military veterans suffering from PTSD, and to secondarily search for predictive metabolic features.

METHODS:

We recruited 15 military veterans suffering from PTSD who performed an 18F-FDG PET sensitized by the exposure to a virtual war scene, before (T0) and after (T1) EMDR therapy. Statistical parametric mapping was used to compare brain metabolism before and after treatment and to study correlations between metabolism and evolution scores on PTSD clinical scales (PTSD Checklist Scale, PCLS; Clinician-Administered PTSD Scale, CAPS).

RESULTS:

The metabolic activity of the precuneus was increased after EMDR therapy (p < 0.005 uncorrected, k > 180) and correlated with clinical improvement with the CAPS scale (r = -0.73 and p < 0.001). Moreover, the precuneus metabolic value before therapy predicted the clinical improvement on the PCLS scale (T1-T0) after EMDR (r = -0.667 and p < 0.006).

CONCLUSION:

The clinical improvement in military patients with PTSD after EMDR is related to increased precuneus metabolism upon VR stress exposure.

KEYWORDS:

Brain metabolism; Eye movement desensitization and reprocessing; PET; Posttraumatic stress disorder; Veterans; Virtual reality exposure; War

PMID:
31152209
DOI:
10.1007/s00259-019-04360-1

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