Two-dimensional proton echo-planar spectroscopic imaging of brain metabolic changes during lactate-induced panic.

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Abstract
INDIVIDUALS with panic attacks have a specific vulnerability to precipitation of acute anxiety and/or physiological arousal by intravenous sodium lactate infusion.1 Despite extensive investigation, mechanisms underlying this lactate sensitivity remain undetermined. One theory, that patients with panic disorder could be reacting to the effects of elevated brain lactate as a possible mechanism for lactate-induced panic, was postulated on the basis of study results in monkeys that directly measured lactate rises in cisternal fluid during intravenous lactate infusion.2 To address this proposed relationship between lactate-induced panic and elevated brain lactate, a newly emerging technology, magnetic resonance spectroscopy (MRS),3 has been used to noninvasively measure brain lactate changes during lactate infusion. Magnetic resonance spectroscopy studies of rats4 and healthy human controls5 demonstrate progressive brain lactate rises in response to lactate infusion. These increases in brain lactate levels during lactate infusion occur in subjects with panic disorder and are of greater magnitude and longer duration than in control subjects.6,7