DEFECTIVE BRAIN ENERGY-METABOLISM SHOWN BY INVIVO P-31 MR SPECTROSCOPY IN 28 PATIENTS WITH MITOCHONDRIAL CYTOPATHIES

We studied brain energy metabolism by phosphorus magnetic resonance spectroscopy (P-31 MRS) in 28 patients with mitochondrial cytopathies, and 20 normal control subjects. Fourteen patients had myopathy alone, six had only mild brain symptoms, and eight showed different degrees of brain involvement. Brain P-31 MRS showed a low phosphocreatine content in all patients, accompanied by a high inorganic phosphate in 14 of 28 patients. The average value of the P(i) concentration in the patient group was significantly (p = 0.009) different from the control group. The cytosolic pH was normal. From these data were derived a high concentration of ADP (calculated from the creatine kinase equilibrium), a high percent value of V/V(max) for ATP biosynthesis, and a low phosphorylation potential, all features showing a derangement of brain energy metabolism, in all patients with mitochondrial cytopathies. P-31 MRS proved to be sensitive enough to disclose a deficit of mitochondrial functionality not only in the affected patients, but also in those without clinically evident brain symptoms.