Depression in patients with Huntington disease correlates with alterations of the brain stem raphe depicted by transcranial sonography

Depression in patients with Huntington disease correlates with alterations of the brain stem raphe depicted by transcranial sonography


J Psychiatry Neurosci 2011;36(3):187-94

Christos Krogias, MD; Katrin Strassburger, MD; Jens Eyding, MD; Ralf Gold, MD; Christine Norra, MD; Georg Juckel, MD; Carsten Saft, MD;* Dietmar Ninphius, MD*

Krogias, Strassburger, Eyding, Gold, Saft — Department of Neurology, St. Josef-Hospital, Ruhr University; Norra, Juckel, Ninphius — Department of Psychiatry, LWL-Universitätsklinik, Ruhr University, Bochum, Germany


Background: Transcranial sonography (TCS) has become a new diagnostic tool in the evaluation of extrapyramidal disorders. Studies of TCS report alterations of the mesencephalic raphe in patients with depression. The aim of this study was to evaluate TCS findings in patients with Huntington disease in correlation with their neurologic and psychiatric status.

Methods: We recruited patients with genetically confirmed Huntington disease. The neurological and psychiatric status of participants was assessed by independent physicians. Echogenicities were investigated according to examination protocol for extrapyramidal disorders using a Siemens Sonoline Elegra system. The sonography examiner was blinded for clinical data.

Results: We included 39 patients in our study; 21 patients (53.8%) showed symptoms of depression at the time of evaluation and, of those, 15 (71.4%) had hypoechogenic raphe structures. Thirty patients (76.9%) had a history of depressive episodes, 19 (63.3%) of them with hypoechogenic raphe structures. All 9 patients without a history of depressive episodes showed normal echogenicity of raphe structures (sensitivity 63.3%, specificity 100%). Twelve (70.6%) of the 17 patients with Huntington disease who showed psychiatric disturbances prior to the occurrence of motor symptoms exhibited pathological raphe echogenicity (sensitivity 70.6%, specificity 68.2%).

Limitations: Most of the patients were taking antichoreatic medication, which particularly influences neurologic status. Thus, a meaningful interpretation of the correlation between TCS findings and neurologic features was limited.

Conclusion: As a novel finding, a relation between mesencephalic raphe echogenicity and depressive state could be identified in patients with Huntington disease. An alteration of the serotonergic brain stem raphe might be involved in the pathogenesis of depression in these patients.

Submitted Apr. 11, 2010; Revised July 15, 2010; Accepted July 16, 2010.

Competing interests: None declared for Drs. Krogias, Strassburger, Norra and Ninphius. Dr Eyding declares having received speaker fees from Bracco. Dr. Gold declares board membership with Elan, Biogen Idec, TEVA, MerckSerono and Bayer; he has consulted for them and has received grant funding and speaker fees from them; he has a patent filed with Biogen. Dr. Juckel declares having received grants and speaker fees from Janssen-Cilag, Lilly, AstraZeneca, Pfizer, Lundbeck, BMS, Wyeth and Bayer Vital. Dr. Saft declares having received grants from TEVA, speaker fees from Temmler Pharma, travel assitance from the European Huntington’s Disease Network and compensation from NeuroSearch for the ACR-16 study and from Novartis for the AFQ-056 study.

Contributors: Drs. Krogias, Saft and Ninphius designed the study. Drs. Krogias, Strassburger, Eyding, Saft and Ninphius acquired the data, which all authors analyzed. Dr. Krogias wrote the article, and the other authors critically reviewed it. All authors approved publication of the article.

DOI: 10.1503/jpn.100067

Correspondence to: Dr. C. Krogias, Department of Neurology, Ruhr University Bochum, St. Josef-Hospital, Gudrunstr. 56, 44791 Bochum, Germany;