CLINICAL EEG and NEUROSCIENCE zyxwvuts 02004 VOL. 35 NO. 2 Quantitative Electroencephalography in Frontotemporal Dementia with Methylphenidate Response: zyx A Case Study Harold W. Goforth, Lukasz Konopka, Margaret Primeau, Amity Ruth, Kathleen O’Donnell, Roopal Patel, Teresa Poprawski, Parvez Shirazi and Murali Rao Key Words Frontotemporal Dementia LORETA Methylphenidate Quantitative EEG SPECT ABSTRACT Frontotemporal dementia is an underdiagnosed illness with predominant behavioral and executive manifestations. Historically, diagnosis has been based on a combination of clinical history, neuropsychological testing, and brain imag- ing. No effective treatment currently exists for this disorder. A case is presented using quantitative EEG with methylphenidate challenge correlated with SPECT. The patient underwent neuropsychological testing, a SPECT brain study, and a quantitative EEG, which was repeated after methylphenidate administration. SPECT was significant for hypoperfusion to the bilateralfrontotem- poral regions, with left-sided hypoperfusion greater than homologous right as demonstrated by LORETA analysis. QEEG correlated with SPECT, and demonstrated profound left greater than right bi-frontotemporal slowing, which nor- malized partially after methylphenidate administration. The patient has remained on methylphenidate as an outpatient, and has had significant behavioral improvement. Quantitative EEG may provide both diagnostic and therapeutic data with regard to frontotemporal dementia. Further studies of methylphenidate in this population are needed to confirm these data. INTRODUCTION Case Study A 72-year-old male with past medical history significant for hypertension, late onset diabetes mellitus, and an ortho- topic liver transplant presented to the neuropsychiatric clin- ic for a personality change. The patient had experienced a progressive reduction in the ability to sustain attention, marked irritability, withdrawal, apathy, speech prompt mutism, and social disinhibition, characterized by repeated instances of theft and attempting to show pornography to family acquaintances, over an 8 month period. He also began to reuse alcohol sporadically after a well document- ed period of abstinence. The subject’s neuropsychiatric his- tory was significant for the presence of alcohol abuse last occurring over 12 years prior to his presentation, and a brief period of hepatic encephalopathy, which fully resolved prior to liver transplant. There was no significant family history of dementia zyxwv or other neuropsychiatric disorder. MRI-brain scan demonstrated only mild cortical atrophy and mild periventricular ischemic changes, but the severity of the findings did not correlate with the behavioral presen- tation of the patient. On neuropsychological testing the patient demonstrated intact intellectual functioning and memory, but profoundly impaired executive function and attention. Visuospatial and constructive ability were only mildly impaired, and reflected deficits in planning and organization consistent with frontotemporal dementia. A SPECT-brain scan demonstrated a left greater than right bilateral reduction in perfusion to the frontotemporal areas, prompting a diagnosis of late onset frontotemporal dementia based on the criteria proposed by both the Lund and Manchester Groups’ as well as the Work Group on Frontotemporal Dementia and Pick’s Disease.2Quantitative electroencephalography(QEEG) acquisition correlated well with the SPECT images, and demonstrated partial resolu- tion of the deficits after treatment with methylphenidate. M ETH 0 DS The brain SPECT study was performed during an initial baseline period with the ligand injection given by a pre- established intravenous line prior to the administration of methylphenidate. A 25mCi (740-MBq) dose of technec- tium-99m-HMPAO (Amersham International) was infused Harold W. Goforth, MD, Seniof Resident, Margaret Primeau, PhD, Associate Professor of Psychdogy and Director of Nwropsychdogy, Teresa Poprawski. MD, Resident, Murali Rao, MD, Acting Chair and Assistant Professw, and Amity Ruth, PhD. are from the Department of Psychiatry and Behavioral Neuroscience, Loyola UniversityMedical Centw, Maywood, Illinois. Lukasz Konopka, zyxw AM, PhD, is Directw of Biological Psychatry Section, Hines VA Hospital, Associate Professor of Psychiatry and Pharmacdogy, Loyola University Medical Center, Maywood, Illinois. Kathleen ODonnell, PhD, Director of Neuropsychology, and P m e z Shirazi, MD. Chief of Nuclear Medicine, are from the Hines Veterans Affairs Medical Center, Hines, Illinois. Roopal Patel, MA, is from the Chicago School of Professional Psychology, Chicago, Illinois. Accepted in part for presentation at the 17th World Congress of Psychosomatic Medicine, August zyxwv 2003, Waikola, Hawaii. Address reprint requests to Lukasz Konopka, PhD, Biological Psychiatry- 116A7, Hines VA Medical Center, Hines, IL 60141, USA. Email: lukasz.konopka@med.va.gov 108 by guest on April 22, 2016 eeg.sagepub.com Downloaded from