A Brain Imaging-Based Diagnostic Biomarker for Periodic Catatonia: Preliminary Evidence Using a Bayesian Approach

Neuropsychobiology. 2020;79(4-5):352-365. doi: 10.1159/000501830. Epub 2019 Sep 10.

Abstract

Periodic catatonia (PC) is a psychomotor phenotype with a progressive-remitting course. While it can fit any disorder diagnosis of the schizoaffective spectrum, its core features consist of a mix of hypo- and hyperkinesias resulting in distortions of expressive movements such as grimacing and parakinesias. The replication of cerebral blood flow (CBF) increases in the left supplementary motor area (L-SMA) and lateral premotor cortex (L-LPM) in acute and remitting PC patients indicates that these increases could be used as diagnostic biomarkers. In this proof-of-concept study, 2 different MRI sequences were repeated on 3 separate days to get reliable measurement values of CBF in 9 PC and 26 non-PC patients during different cognitive tasks. Each patient was compared to 37 controls. In L-SMA [-9; +10; +60] and L-LPM [-46; -12; +43], a test was positive if the t value was >2.02 (α < 0.05; two tailed). The measurements had good analytical performance. Regarding the tests, their sensitivities and specificities were significantly different from the chance level on both measures, except for L-SMA sensitivities. When combining all the tests, among regions and methods, sensitivity was 98% (95% credible interval [CI] 76-100%) and specificity 88% (72-97%). Bayesian inferences of its negative predictive values for PC were >95% regardless of the context, while its positive predictive values reached 94% but only when used in combination with clinical criteria. The case-by-case analysis suggests that non-PC patients with neurological motor deficits are at risk to be false positive.

Keywords: Biomarkers; Endogenous psychoses; Functional brain imaging; Periodic catatonia; Regional cerebral blood flow; Schizophrenia.

MeSH terms

  • Adult
  • Bayes Theorem
  • Biomarkers
  • Catatonia / diagnostic imaging*
  • Catatonia / physiopathology*
  • Cerebrovascular Circulation* / physiology
  • Female
  • Functional Neuroimaging / standards*
  • Humans
  • Magnetic Resonance Imaging / standards*
  • Male
  • Middle Aged
  • Proof of Concept Study
  • Sensitivity and Specificity
  • Young Adult

Substances

  • Biomarkers