Bartzokis G, Lu PH, Amar CP, Raven EP, Detore NR, Altshuler LL et al. Long acting injection vs oral risperidone in first-episode schizophrenia: differential impact on white matter myelination trajectory. Schizophr Res 132: 35-41

Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine at UCLA, Los Angeles, California, United States.
Schizophrenia Research (Impact Factor: 3.92). 07/2011; 132(1):35-41. DOI: 10.1016/j.schres.2011.06.029
Source: PubMed


Imaging and post-mortem studies provide converging evidence that subjects with schizophrenia (SZ) have a dysregulated trajectory of frontal lobe myelination. Prior MRI studies suggested that early in treatment of SZ, antipsychotic medications initially increase frontal lobe white matter (WM) volume, which subsequently declines prematurely in chronic stages of the disease. Insofar as the trajectory of WM decline associated with chronic disease may be due to medication non-adherence, it may be modifiable by long acting injection (LAI) formulations.
Examine the impact of antipsychotic formulation on the myelination trajectory during a randomized six-month trial of LAI risperidone (RLAI) versus oral risperidone (RisO) in first-episode SZ subjects.
Two groups of SZ subjects (RLAI, N=11; and RisO, N=13) that were matched in pre-randomization oral medication exposure and 14 healthy controls (HCs) were prospectively examined. Frontal lobe WM volume was estimated using inversion recovery (IR) MRI images. A brief neuropsychological battery that focused on reaction times was performed at the end of the study.
WM volume change scores.
WM volume remained stable in the RLAI and decreased significantly in the RisO groups resulting in a significant differential treatment effect, while the HC had a WM change intermediate and not significantly different from the two SZ groups. WM increase was associated with faster reaction times in tests involving frontal lobe function.
The results suggest that RLAI may improve the trajectory of myelination in first-episode patients and have a beneficial impact on cognitive performance. Better adherence provided by LAI may underlie the modified trajectory of myelin development. In vivo MRI biomarkers of myelination can help clarify mechanisms of action of treatment interventions.

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    • "Bartzokis et al.31) evaluated the treatment effects of RLAI on frontal lobe white matter volume in first-episode schizophrenia patients. Their randomized 6-month trial using inversion recovery magnetic resonance image image revealed that the frontal lobe white matter volume remained stable in the RLAI group whereas it significantly decreased in the oral risperidone group. "
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    • "A recent study by Bartzokis et al. [32] compared RLAI and oral risperidone treatment in subjects with first-episode schizophrenia. The study focused on changes in frontal lobe myelination and cognitive functioning. "
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