AYTÜL KARABEKİROĞLU, Koray KARABEKİROĞLU, Gül bahar CÖMERT, VOLKAN TOPÇUOĞLU

Panik bozukluğunda beyin görüntüleme çalışmaları

Amaç ve Yöntem: Panik bozukluğu (PB) yineleyici, beklenmedik panik ataklarına ek olarak başka ataklar olacağına ilişkin sürekli kaygı duyma ve ataklarla ilişkili belirgin davranış değişiklikleri gösterme ile belirlenen bir anksiyete bozukluğudur. PB ile ilgili beyin bölgeleri henüz net olarak ortaya konmamıştır. PB’nda panik ataklarının beyin sapı kaynaklı olduğu, beklenti anksiyetesinin limbik yapılarla ilişkili olduğu ve agorafobinin ise frontal korteksle ilişkili olduğu belirtilmiş olsa da, bu kadar kesin ayrımlar yapmanın olası olmadığını ortaya koyan araştırmalar da vardır. Bu yazıda, PB hastalarında yapılmış yapısal ve işlevsel beyin görüntüleme çalışmaları gözden geçirilecek ve panik bozukluğu ile ilişkili olduğu düşünülen başlıca nöroanatomik bölgeler tartışılacaktır. Bulgular: Yapısal ve işlevsel beyin görüntüleme çalışmalarında, PB hastalarının kontrol olgularına göre belirli farklılıklar gösterdiği bildirilmektedir. Bu farklılıklar özellikle parahipokampal alanlarda ve frontal kortekste olduğu dikkati çekmektedir. PB olgularında sağ parahipokampal bölgede sola göre kanlanma artışı olduğu ve frontal bölge aktivitesinde azalma olduğu saptanmıştır. Tartışma: Prefrontal korteksteki etkinlik düşüklüğü, amigdalada görülen etkinlik artışı ile birliktelik göstermektedir. Prefrontal korteksin bir parçasını oluşturan ön singulat korteksin duyusal girdinin emosyonel içeriğine daha duyarlı olduğu bildirilmektedir. Singulat korteks korku ile ilişkili otomatik reaksiyonun oluşmasını engellemek amacı ile amigdala üzerinde baskılayıcı bir etkide bulunur. PB’nda prefrontal kortekste görülen etkinlik azalması, amigdalanın anksiyetenin oluşumuna yol açan beyin yapılarını uygunsuz olarak uyarmasına yol açabilmektedir. Sağ hemisferin otonomik işlev değişikliklerini ve içsel algıları kontrol ettiği gösterilmiştir. Sağ parahipokampal alanda sola göre daha çok etkinlik artışı olması, PB hastalarının içsel uyaranlara olan duyarlılık artışına işaret etmektedir.

Anahtar Kelimeler:

Manyetik rezonans görüntüleme, Beyin görüntüleme, Pozitron-emisyon tomografisi, Tomografi, x-ışınlı bilgisayarlı, Tomografi, emisyon bilgisayarlı, tek foton, Panik bozukluğu

Neuroimaging studies in panic disorder

Objectives and Methods: Panic disorder (PD) is an anxiety disorder that is characterized by repetetive, unpredicted panic attacks in addition to anticipatory anxiety and significant behavioral disturbences related to panic attacks. Brain regions which are related to PD are not adequately idendified. Despite panic attacks are assumed to be related to brainstem, anticipatory anxiety to limbic structures and agoraphobia to frontal cortex, these differentiations are not validated. This article reviews the structural and functional brain imaging studies in PD and discusses the relations between certain neuroanatomic structures and PD. Results: In terms of structural and functional neuroimaging findings, specific consistent differences are reported between PD patients and control subjects. The differences are especially found in parahippocampal areas and frontal cortex. Patients with PD have increased perfusion in right parahippocampal area in respect to left and decreased activity in frontal lobes. Discussion: Decreased activity in prefrontal area is related to increased activity seen in amygdala. Anterior cingulate cortex which is a part of prefrontal cortex is reported to be sensitive to emotional content of sensory input more. Cingulate cortex has an inhibitory effect on amygdala in order to inhibit spontaneous response related to fear and anxiety. The decreased activity in prefrontal cortex that is reported in patients with PD may predispose amygdala for inconvenient activation of structures that are responsible for anxiety symptoms. Right hemisphere is shown to regulate autonomic functions and internal inputs. Increased perfusion in right parahippocampal area in respect to left may be related to the increased sensitivity to internal inputs seen in patients with PD.

Keywords:

Magnetic Resonance Imaging, Neuroimaging, Positron-Emission Tomography, Tomography, X-Ray Computed, Tomography, Emission-Computed, Single-Photon, Panic Disorder,

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