31P NMR examination of a case of progressive external ophthalmoplegia with focal cytochrome c oxidase deficiency

A 30-year-old man of histochemically confirmed focal cytochrome c oxidase deficiency (FCCOD) with chronic progressive external ophthalmoplegia and mild weakness of upper extremities was examined by 31P NMR spectroscopy using whole body MR. The activities of enzymes of respiratory chain ; complex I-III, complex II-III and complex IV, in mitochondrial fraction of biopsied muscle were all normal. At rest, the ratio of phosphocreatine (PCr) to inorganic phosphate (Pi) was normal value of 7.0. After the exercise of 90 watt for 3 minutes using ergometer, PCr/Pi ratio dropped to 2.6 and the recovery of the ratio prolonged for 8 minutes. We could not decide cytoplasmic pH because the peak of Pi at rest was relatively obscure. These results confirmed the existance of impairment of ATP production in our case, though the decreased activities of enzymes could not be shown by the biochemical analysis. We would like to stress the diagnostic importance of 31P NMR spectroscopy in mitochondrial cytopathy whose chemical abnormalities are not always easy to find out. (author)