Lithium MRI scans offer personalized treatments for bipolar disorder
· News-MedicalA revolutionary scanning technique has revealed that lithium MRI is a powerful tool for studying how the drug interacts with the brain and could offer more personalized treatment for bipolar disorder.
This paves the way for the for the medical community to better understand lithium's effectiveness and agree the best prescribing advice.
- For once and twice daily dosing, blood and brain lithium levels did not differ at the standard 12 hours post-dose monitoring time point
- Brain lithium closely matched blood lithium levels across the day, and were more stable with twice daily dosing
- Brain lithium levels were higher in white matter than grey matter
Lithium is an effective long-term treatment for bipolar disorder, but prescribing practice varies and it is common for it to be given either once or twice daily. Whilst both practices are equally effective, there may be differences in side effects because once daily use results in higher night-time peaks but lower daytime levels in the blood. It has been argued that these peaks and troughs are smoothed out when lithium is absorbed by the brain, but this study shows that brain and blood levels are closely matched across the day.
This may be the oldest drug available for bipolar disorder, but our findings which provide a better understanding of how it works in practice mean it should remain at the forefront of developments." Dr. David Cousins, Director, Newcastle Magnetic Resonance Centre, Clinical Senior Lecturer at Newcastle University and Honorary Consultant Psychiatrist, CNTW NHS Foundation TrustLithium is the most effective long-term treatment for bipolar disorder, preventing episodes of illness and reducing the risk of suicide. Not everyone responds to lithium, but for those who do, it is important to individualize treatment to get the best out of this medication. This study shows that lithium MRI is a powerful tool for studying how the drug interacts with the brain and could support more personalized treatment in future.
Method
The study employed 7Li MRI, a multinuclear imaging technique developed at Newcastle University and established in centres across Europe in conjunction with CEA Neuropsin Paris as part of the Horizon 2020 R-LiNK initiative. Conducted in Dresden, 41 white European patients who were stable (euthymic) on lithium treatment (20 once-daily, 21 twice-daily) underwent three consecutive 7Li MRI scans and matched serum sampling over a 10-hour period. This is the largest 7Li MRI study to date, and the first to perform repeated measures in bipolar disorder.
Professor Peter Thelwall, Professor of Magnetic Resonance Physics and Director, Centre for In Vivo Imaging at Newcastle University said: "This new imaging technique allows us to directly visualise a drug in the brain and address important clinical questions. Our research program is also driving advances in the capability of this technique to maximise the scope of its application for patient benefit.'
The findings, from a collaboration between expert centres, represent a key output from a network of centres recently equipped with 7Li MRI.
The work received funding from the Baszucki Brain Research Foundation and the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation).
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