Glutamatergic dysregulation in pediatric psychiatric disorders: a systematic review of the magnetic resonance spectroscopy literature.
Level 4 - case-series / case-control
Systematic review of observational neuroimaging case-control and cross-sectional studies.
PubMed 25271988 · doi:10.4088/JCP.13r08767
What was done
Authors conducted a systematic review of English-language peer-reviewed articles indexed in PubMed through August 14, 2013, examining magnetic resonance spectroscopy (MRS) measurements of glutamatergic metabolites in pediatric psychiatric populations. From 50 included studies, data were extracted regarding participant demographics, clinical characteristics, treatment status, scanner magnetic field strength, brain regions of interest, and findings on glutamatergic metabolites.
What was found
The abstract reports qualitative directional patterns without numerical effect sizes, sample counts, or statistical values. The most consistent finding across studies was an elevation of glutamatergic metabolites in the anterior cingulate cortex and other brain regions in youth with attention-deficit/hyperactivity disorder (ADHD). Limited evidence indicated elevated glutamatergic metabolites in autism spectrum disorders, emotional dysregulation, and clinical high risk for schizophrenia, alongside reduced levels in pediatric major depressive disorder, bipolar disorder, and obsessive-compulsive disorder. Limited evidence also suggested normalization of glutamate levels following treatment in ADHD and bipolar disorder.
Why it matters
This review synthesizes pediatric MRS literature across major psychiatric conditions, showing that while glutamatergic alterations are widespread, evidence is most consistent for anterior cingulate cortex elevations in ADHD.
Limits
The abstract provides no pooled quantitative estimates or total participant counts across the 50 included studies. Findings are constrained by substantial methodological variation, including differences in scanner field strengths, acquisition parameters, subject age, symptom severity, medication exposure, and small study numbers for non-ADHD disorders.
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