2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane and Movement-Disorders

The diagnosis of idiopathic Parkinson's disease (IPD) remains mostly clinical. Nevertheless, differentiating IPD from essential tremor or other parkinsonian syndromes solely by clinical examination can be challenging in some cases, especially in the early stage of the disease. The introduction of new isotopic functional imaging techniques, and more specifically the labelling of dopamine transporter derivatives, has improved the understanding and early detection of some diseases affecting the basal ganglia. Iodine-123-FP-CIT (DaTSCAN), a (presynaptic) dopamine transporter analogue for nuclear medicine imaging, has recently been introduced for the non-invasive differential diagnosis between IPD and essential tremor or secondary (e.g. drug-related) parkinsonian syndromes. DaTSCAN scintigraphy has also demonstrated some usefulness in the evaluation of other neurodegenerative parkinsonian syndromes such as Lewy-body dementia or multiple system atrophy. For this latter however, the DaTSCAN has to be combined with a second scintigraphy, imaging the post-synaptic dopaminergic receptors, such as the D2-ligand 123I-iodobenzamide. Combining DaTSCAN scintigraphy to a functional study of the brain cortical activity using a brain perfusion scintigraphy or to the evaluation of the cardiac adrenergic system by means of a myocardial MIBG scintigraphy (a norepinephrine storage analogue) can also be helpful to refine the diagnosis. Our experience shows that a good collaboration between the neurologist specialized in movement disorders and the nuclear medicine physician is useful, if not mandatory, to optimize the diagnostic performances of DaTSCAN scintigraphy.

Topics: Brain; Diagnosis, Differential; Essential Tremor; Humans; Movement Disorders; Parkinson Disease; Radionuclide Imaging; Tropanes

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Topics: Alzheimer Disease; Dementia; Humans; Image Processing, Computer-Assisted; Movement Disorders; Nortropanes; Observer Variation; Parkinsonian Disorders; Radiopharmaceuticals; Reproducibility of Results; Tomography, Emission-Computed, Single-Photon

Both movement (MD) and cognitive (CD) disorders can occur associated in some neurodegenerative diseases, such as Parkinson's disease (PD) and Alzheimer's disease (AD).. We further investigated the usefulness of 123I-Ioflupane SPECT and 18F-FDG PET combined use in patients with these disorders in the early stage.. We retrospectively enrolled twenty-five consecutive patients with MD and CD clinical symptoms of recent appearance. All patients had undergone neurologic examination, neuropsychological tests, and magnetic resonance imaging. 123I-Ioflupane SPECT was performed in all cases, followed by 18F-FDG PET two weeks later. In the two procedures, both qualitative (QL) and quantitative (QN) image analyses were determined.. In patients with both 123I-Ioflupane SPECT and 18F-FDG PET pathologic data, associated dopaminergic and cognitive impairments were confirmed in 56% of cases. Pathologic SPECT with normal PET in 16% of cases could diagnose MD and exclude an associated CD, despite clinical symptoms. On the contrary, normal SPECT with pathologic PET in 28% of cases could exclude basal ganglia damage while confirming CD. QN 123I-Ioflupane SPECT analysis showed better performance than QL since QN correctly characterized two cases of MD with normal QL. Moreover, correct classification of normal metabolism was made only by QN analysis of 18F-FDG PET in four cases, despite suspect areas of hypometabolism at QL.. The combined use of these imaging procedures proved a reliable diagnostic tool to accurately identify and characterize MD and CD in early stage. QN analysis was effective in supporting QL evaluation, and its routine use is suggested, especially with inconclusive QL.

Topics: Alzheimer Disease; Brain; Cognition Disorders; Fluorodeoxyglucose F18; Humans; Movement Disorders; Neurodegenerative Diseases; Nortropanes; Parkinson Disease; Positron-Emission Tomography; Radiopharmaceuticals; Retrospective Studies; Tomography, Emission-Computed, Single-Photon

The clinical diagnosis of degenerative forms of parkinsonism is imperfect, with past studies reporting a high rate of misdiagnosis by neurologists and movement disorder specialists, particularly early in the disease course. 123I-ioflupane SPECT (DaTscan) is a diagnostic neuroimaging tool used to distinguish essential tremor from tremor due to degenerative parkinsonisms. The present study expands upon prior studies of the clinical impact of DaTscan imaging in movement disorder centers by assessing quantitative estimates of diagnostic certainty, the impact on subsequent clinical decisions, and the degree to which the asymmetry in the results corresponds to laterality by clinical history and examination.. In a prospective, observational study of the impact of DaTscan imaging in a movement disorder center over the course of 18 months, 4 specialists completed a questionnaire at the time they ordered imaging and again within 1 month after imaging.. Twenty-seven patients underwent DaTscan imaging; the result was normal in 4 cases (14.8%), abnormal in 22 cases (81.4%), and equivocal in 1 case (3.7%). In all cases of a normal result, the post-scan-predicted chance of degenerative parkinsonism decreased compared to the pre-scan prediction (p < 0.05), and in all cases of abnormal scan, the post-scan chance of degenerative parkinsonism increased or remained high (p < 0.0001). Clinical impacts were observed following imaging in a total of 24 patients (88.9%), including changes in medications for 18 patients and psychological impacts for 11 patients. Asymmetric clinical symptoms were corroborated based on the expected asymmetry of dopamine uptake deficits in 57.1% of the cases, were not present in 23.8%, and were opposite of expectations in 19.0% of the scans.. DaTscan imaging results have an impact on physician's confidence in the diagnosis of parkinsonism and may also have a psychological impact on patients. DaTscan imaging may be a useful adjunct to clinical history and examination in selected patients.

Topics: Adult; Aged; Aged, 80 and over; Brain; Clinical Decision-Making; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Movement Disorders; Neuroimaging; Nortropanes; Parkinsonian Disorders; Radiopharmaceuticals; Tertiary Care Centers; Tomography, Emission-Computed, Single-Photon; Young Adult

Topics: Adult; Amphetamine-Related Disorders; Dopamine; Dopamine Plasma Membrane Transport Proteins; Facial Muscles; Humans; Male; Movement Disorders; Tomography, Emission-Computed, Single-Photon; Tropanes

Pure akinesia with gait freezing (PAGF) is a clinical syndrome characterized by freezing of gait, handwriting, and speech without abnormal eye movement or cognitive impairment. Several studies have suggested that PAGF may be a variant of progressive supranuclear palsy (PSP). However, the characteristics of striatal dopamine transporter loss in PAGF are unknown.. To investigate the subregional pattern of striatal dopamine transporter loss in patients with PAGF in comparison with patients with PSP and those with Parkinson disease (PD).. This retrospective case-control study included 15 patients with PAGF, 27 with PD, 20 with PSP, and 11 healthy controls who underwent F-18-fluorinated-N-3-fluoropropyl-2β-carboxymethoxy-3β-(4-iodophenyl)-nortropane (18F FP-CIT) positron emission tomography between September 1, 2008, and July 31, 2014. The positron emission tomographic images were analyzed with 12 striatal subregional and 1 occipital volume-of-interest templates. The specific to nonspecific binding ratio (SNBR) and intersubregional ratio (ISR) in patients with PAGF were compared with those in patients with PD and those with PSP.. Comparisons of SNBRs of striatal subregions and ISR among patients with PAGF, PD, and PSP and healthy controls.. The mean (SD) SNBRs (1.4 [0.7]) of the whole striatum in the 15 patients with PAGF (mean [SD] age, 71.4 [6.6] years; 7 men and 8 women) were similar to those in the 20 patients (mean [SD] age, 70.6 [4.5] years; 11 men and 9 women) with PSP (1.5 [0.5]) but significantly lower than those in the 27 patients (mean [SD] age, 67.7 [5.3] years; 10 men and 17 women) with PD (3.0 [1.3]). The mean (SD) SNBRs of the caudate nuclei in patients with PAGF (1.3 [0.9]) were significantly lower than those in patients with PD (3.5 [1.5]; P < .001) but slightly higher than those in patients with PSP (1.2 [0.5]). The mean [SD] anterior caudate to ventral striatum ISRs in patients with PAGF (0.5 [0.3]) were similar to those in patients with PSP (0.4 [0.2]) but not in patients with PD (1.0 [0.2]). The mean (SD) posterior to anterior putamen ISRs in patients with PAGF (0.4 [0.2]) were similar to those in patients with PD (0.5 [0.2]) and those with PSP (0.4 [0.2]).. On 18F FP-CIT positron emission tomography, patients with PAGF show a pattern of preferential dopaminergic loss similar to that seen in patients with PSP. These results suggest a similar distribution of regional neuronal loss in the substantia nigra pars compacta between PAGF and PSP. This finding may be one of the pathophysiological results suggesting that PAGF is a phenotypic variant of PSP.

Topics: Aged; Case-Control Studies; Corpus Striatum; Dopamine Plasma Membrane Transport Proteins; Female; Gait Disorders, Neurologic; Humans; Male; Middle Aged; Movement Disorders; Parkinson Disease; Pars Compacta; Positron-Emission Tomography; Supranuclear Palsy, Progressive; Syndrome; Tropanes

[(123)I]-FP-CIT is a single photon emission computed tomography (SPECT) ligand showing in vivo the loss of dopaminergic terminals in the brain and is now available in the market. Despite several systematic studies in clinically inconclusive cases, the use of such imaging in clinical routine is scarcely reported. We analyzed 516 files of subjects with movement disorders who were consecutively examined using [(123)I]-FP-CIT scan and determined whether the use of imaging was appropriate and if it improved clinical diagnosis or care of the patient. In addition, we determined if appropriate use was related to subspecialties in Neurology, e.g., movement disorders' specialists vs. general neurologists, and if appropriate use was increasing over time. Among the 516 scans, 18% were in agreement with the license, 62% were classified as appropriate and 37% were considered inappropriate. A change of management was obvious in 60% of patients, but in 92% of those with an appropriate request vs. 13% of patients with an inappropriate request. Movement disorders' specialists had more appropriate requests than other practitioners. Eventually, comparing the first 100 vs. the last 100 quantified SPECT, performed more than 2.5 years apart, we found no difference for the appropriateness of the examination. The use of [(123)I]-FP-CIT imaging in clinical routine does not fit a restrictive license. An inappropriate use is seen in nearly 40% of cases, which reduces the real cost-effectiveness of the technique suggesting a need for continuing medical education on the topic.

Topics: Adult; Aged; Aged, 80 and over; Brain; Dopamine Plasma Membrane Transport Proteins; Female; Humans; Longitudinal Studies; Male; Middle Aged; Movement Disorders; Retrospective Studies; Tomography, Emission-Computed, Single-Photon; Tropanes; Young Adult

To investigate the correlation between the striatal three-dimensional location and the Unified Parkinson's Disease Rating Scale (UPDRS) motor score in the context of idiopathic Parkinson's disease (PD) through radiolabeled N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane positron emission tomography/computed tomography (FP-CIT PET/CT).. In this cross-sectional study, we assessed the UPDRS motor score and performed FP-CIT PET/CT in patients with PD. Thirty-eight patients with idiopathic PD [average 70 years of age (range 49-86); male:female ratio 12:26] were enrolled. The correlation between FP-CIT PET/CT and the UPDRS III scores was investigated after the transformation of PET images by an alternative method using MATLAB.. Left caudate nucleus uptake negatively correlated with UPDRS items 18, 20 (face), 22 (right arm and leg), 23, 24 (right side), 26 (right side), 27, 30, and 31, while right caudate nucleus uptake positively correlated with items 18, 22 (left arm), 26, and 29. Putamen uptake correlated with items 22 and 25. Left caudate nucleus uptake positively correlated with axial and akinetic-rigidity symptoms.. FP-CIT uptake in specific basal ganglia structures strongly correlated with the UPDRS III motor score. Among these, the left caudate nucleus exhibited the strongest relationship with axial and akinetic-rigidity PD symptoms.

Topics: Aged; Aged, 80 and over; Brain; Cross-Sectional Studies; Female; Fluorodeoxyglucose F18; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Movement Disorders; Multimodal Imaging; Parkinson Disease; Positron-Emission Tomography; Retrospective Studies; Tomography, X-Ray Computed; Tropanes

Depression frequently accompanies in Parkinson's disease (PD). Previous research suggested that dopamine (DA) and serotonin systems are closely linked with depression in PD. However, comprehensive studies about the relationship between these two neurotransmitter systems are limited. Therefore, the purpose of this study is to evaluate the effect of dopaminergic destruction on the serotonin system. The interconnection between motor and depression was also examined. Two PET scans were performed in the 6-hydroxydopamine (6-OHDA) lesioned and sham operated rats: [(18) F]FP-CIT for DA transporters and [(18) F]Mefway for serotonin 1A (5-HT(1A)) receptors. Here, 6-OHDA is a neurotoxin for dopaminergic neurons. Behavioral tests were used to evaluate the severity of symptoms: rotational number for motor impairment and immobility time, acquired from the forced swim test for depression. Region-of-interests were drawn in the striatum and cerebellum for the DA system and hippocampus and cerebellum for the 5-HT system. The cerebellum was chosen as a reference region. Nondisplaceable binding potential in the striatum and hippocampus were compared between 6-OHDA and sham groups. As a result, the degree of DA depletion was negatively correlated with rotational behavior (R(2)  = 0.79, P = 0.003). In 6-OHDA lesioned rats, binding values for 5-HT(1A) receptors was 22% lower than the sham operated group. This decrement of 5-HT(1A) receptor binding was also correlated with the severity of depression (R(2)  = 0.81, P = 0.006). Taken together, this research demonstrated that the destruction of dopaminergic system causes the reduction of the serotonergic system resulting in the expression of depressive behavior. The degree of dopaminergic dysfunction was positively correlated with the impairment of the serotonin system. Severity of motor symptoms was also closely related to depressive behavior.

Topics: Animals; Brain; Depressive Disorder; Disease Models, Animal; Dopamine; Dopamine Plasma Membrane Transport Proteins; Dopaminergic Neurons; Movement Disorders; Oxidopamine; Piperazines; Positron-Emission Tomography; Pyridines; Radiopharmaceuticals; Rats, Sprague-Dawley; Receptor, Serotonin, 5-HT1A; Serotonin; Tropanes

Patients were surveyed to assess the impact of dopamine transporter imaging on diagnostic confidence, change in treatment plan, effect on medication compliance, and subjective well-being. Surveys were sent to 140 patients who completed dopamine transporter imaging an average of 18 months prior. Sixty-five surveys from patients (46%) were returned. Questions assessed patients' perceived impact of the imaging on their care. Increased diagnostic confidence following imaging was reported by 69% of patients. Changes to treatment plan from imaging were reported by 24% of patients. Overall satisfaction with the study and its impact was reported by 70% of patients. Dopamine transporter imaging increased diagnostic confidence among patients and overall patient satisfaction with the impact of imaging on clinical care was high.

Topics: Aged; Aged, 80 and over; Diagnosis, Differential; Dopamine Plasma Membrane Transport Proteins; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Movement Disorders; Nortropanes; Parkinsonian Disorders; Patient Satisfaction; Surveys and Questionnaires; Tomography, Emission-Computed, Single-Photon

To pool clinical trials of similar design to assess overall sensitivity and specificity of ioflupane I123 injection (DaTSCAN or ioflupane ((123)I)) to detect or exclude a striatal dopaminergic deficit disorder (SDDD), such as parkinsonian syndrome and dementia with Lewy bodies.. Pooled analysis of three phase 3 and one phase 4 clinical trials. These four trials were selected because they were the four studies used for the US new drug application to the Food and Drug Administration (FDA).. Multicentre, open-label, non-randomised.. Patients with either a movement disorder or dementia, and healthy volunteers.. Ioflupane ((123)I) was administered.. Images were assessed by panels of 3-5 blinded experts and/or on-site nuclear medicine physicians, classified as normal or abnormal and compared with clinical diagnosis (reference standard) to determine sensitivity and specificity.. Pooling the four studies, 928 participants were enrolled, 849 were dosed and 764 completed their study. Across all studies, when images were assessed by on-site readers, ioflupane ((123)I) diagnostic effectiveness had an overall (95% CI) sensitivity of 91.9% (88.7% to 94.5%) and specificity of 83.6% (78.7% to 87.9%). When reads were conducted blindly by a panel of independent experts, the overall sensitivity was 88.7% (86.8% to 90.4%) and specificity was 91.2% (89.0% to 93.0%).. In this pooled analysis, the visual assessment of ioflupane ((123)I) images provided high levels of sensitivity and specificity in detecting the presence/absence of an SDDD. Ioflupane ((123)I) imaging has the potential to improve diagnostic accuracy in patients with signs and symptoms of a movement disorder and/or dementia.. NCT00209456.

Topics: Adult; Aged; Aged, 80 and over; Clinical Trials, Phase III as Topic; Clinical Trials, Phase IV as Topic; Dementia; Female; Humans; Injections; Iodine Radioisotopes; Male; Middle Aged; Movement Disorders; Nortropanes; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity

¹²³I-FP-CIT (DaTSCAN) SPECT studies of the nigrostriatal pathway are a valuable tool in the diagnosis of movement disorders. However some scans are reported as equivocal with potential adverse consequences. We investigated whether the use of quantification of tracer uptake within the striatum can be used to reduce the number of equivocal reports.. BRASS software (Hermes, Sweden) was used to quantify striatal tracer uptake in DaTSCAN studies of patients referred to our institution. Scans were quantified and numerical limits were determined to distinguish between normal and abnormal scans. Scans were then re-reported both with, and without, the use of quantification. Number of equivocal reports and accuracy of reporting between the two types of reporting were compared.. Scan reporting using quantification led to a significant reduction in the number of equivocal reports with no significant change in reporting accuracy.. Automated quantification of DaTSCAN studies with BRASS and the use of numerical limits can decrease the number of equivocal reports without affecting report accuracy.

Topics: Aged; Automation; Female; Humans; Image Processing, Computer-Assisted; Male; Movement Disorders; Research Report; Sensitivity and Specificity; Software; Tomography, Emission-Computed, Single-Photon; Tropanes

Topics: Basal Ganglia Diseases; Brain; Calcinosis; Cognition Disorders; Diagnosis, Differential; Female; Humans; Middle Aged; Movement Disorders; Nortropanes; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

We recently found that patients with drug-induced parkinsonism (DIP) may have normal (group I) or abnormal (group II) putamen [(123)I]FP-CIT DAT (dopamine transporter) binding. In this study we reassessed clinical features and DAT binding in 19 of the original 32 patients (10 of group I and 9 of group II) after a 19-39-month follow-up period and tested the effects of chronic levodopa treatment in both cohorts of patients. In group I patients, [(123)I]FP-CIT SPET (single photon emission tomography) was still normal in all patients at follow-up; DAT binding and UPDRS (Unified Parkinson's Disease Rating Scale) motor score values did not differ from baseline. In group II patients, [(123)I]FP-CIT SPET was still abnormal at follow-up; putamen DAT binding was significantly reduced and UPDRS III score higher compared to baseline. Levodopa treatment improved motor symptoms in three out of ten patients of group I and in eight out of nine patients of group II. No adverse psychiatric effects were observed in any of the patients. This study shows that DAT binding imaging may help to identify subjects with DIP secondary to a loss of dopamine nerve terminals in the context of a progressive degenerative parkinsonism. Patients with DIP may benefit from levodopa therapy, particularly when dopamine nerve terminal defects are present, and this should be considered in the therapeutic management of these patients.

Topics: Aged; Aged, 80 and over; Antiparkinson Agents; Brain; Dopamine Plasma Membrane Transport Proteins; Female; Follow-Up Studies; Humans; Iodine Radioisotopes; Levodopa; Male; Middle Aged; Motor Activity; Movement Disorders; Parkinson Disease, Secondary; Severity of Illness Index; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Tropanes

Dual-head SPECT systems are used by many clinical departments for [(123)I]FP-CIT SPECT imaging, while triple-head or brain-dedicated systems with better imaging performance are more commonly used by research institutions. There are limited data comparing the capability of the two types of system to measure dopamine transporter (DAT) loss in vivo.. The aim of this study was to compare the ability of a dual-head and a brain-dedicated SPECT system to estimate the degree of DAT loss in different movement disorders with variable nigrostriatal impairment, with [(123)I]FP-CIT.. Four patients with essential tremor, 24 with Parkinson's disease (PD), six with spinocerebellar ataxia type 2 and six controls were studied with [(123)I]FP-CIT. SPECT scans were performed on a dual-head (E.CAM-Siemens) and subsequently on a brain-dedicated system (Ceraspect-DSI).. Striatal DAT outcome measures on the E.CAM and the Ceraspect were strongly correlated and the putamen-to-caudate ratios were almost identical. Although the measured values were lower by 52+/-25% in caudate and by 51+/-31% in putamen on the E.CAM (p<0.0001), the average striatal DAT decrease in each patient group compared with controls was similar for both systems. In PD patients, similar correlations (p<0.05) were found between motor UPDRS or Hoehn and Yahr stage and striatal DAT density.. Despite underestimation of striatal DAT outcome measures, the E.CAM showed similar capability as the Ceraspect in measuring the degree of nigrostriatal dopaminergic deficit and assessing the correlation between DAT outcome measures and clinical variables of PD severity and stage.

Topics: Adult; Aged; Brain; Case-Control Studies; Caudate Nucleus; Dopamine Plasma Membrane Transport Proteins; Essential Tremor; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Movement Disorders; Parkinson Disease; Putamen; Radiopharmaceuticals; Spinocerebellar Ataxias; Tomography, Emission-Computed, Single-Photon; Tropanes

The present prospective study evaluated the diagnostic value of a standardized analysis of (123)I-N-omega-(fluoropropyl)-2beta-carbomethoxy-3beta-(4-iodophenyl)tropane (FP-CIT) SPECT studies acquired on a triple-head gamma-camera for patients with clinically uncertain movement disorders having tremor as the most striking feature.. (123)I-FP-CIT studies were performed on 52 consecutive patients (27 male and 25 female; mean age, 49.2 y; range, 17-80 y) who had a clinical diagnosis of Parkinson's disease (PD) (n = 21), hypokinetic rigid syndrome (n = 19), dystonia (n = 8), or essential tremor (n = 4). In all patients, the final diagnosis was based on a thorough clinical examination, the family history, and a 2-y follow-up. Two independent technologists analyzed (123)I-FP-CIT studies using a standardized quantitative method applying both fixed regions of interest (ROIs) and manually drawn ROIs. The mean values from both methods were compared using the Student t test, and the intra- and intertechnologist variabilities were tested.. In patients with PD, all ratios were significantly lower (P < 0.001) than those in patients with other movement disorders. No significant differences were found between the other groups tested. The manual method resulted in significantly lower values than did the standardized method (P < 0.001) and, for the putamen, showed significant differences between technologists. The standardized method showed no significant differences between technologists. The intra- and intertechnologist variabilities for this method were 0.14 +/- 0.13 (confidence value, 2.4%) and 0.19 +/- 0.18 (confidence value, 3.1%), respectively, whereas the intraclass correlation coefficients were 0.99 for 1 technologist and 0.98 for the 2 independent technologists.. Our data confirm that (123)I-FP-CIT SPECT has value in the differentiation of PD from other movement disorders. Acquisition using a triple-head gamma-camera and subsequent standardized analysis using fixed ROIs result in good intra- and intertechnologist agreement and can easily be applied in clinical practice.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Female; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Movement Disorders; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Tropanes

Elderly patients with recurrent falls are frequently diagnosed with an extrapyramidal syndrome. This study aims to characterise a distinct group of patients with recurrent falls and postural instability as a hallmark of the clinical examination. The study took place in the Movement Disorders Unit, Rabin Medical Center, Petah Tiqva, Israel among 26 patients with recurrent falls who had no clinical evidence of a neurodegenerative disease. Medical records, neurological examination and brain imaging studies were assessed. Falls in these patients were sudden, unprovoked, with no vertigo or loss of consciousness. All had postural instability with minimal or no abnormality on the neurological examination. Brain imaging showed diffuse ischaemic changes in 65%. [(123)I]-FPCIT SPECT with the dopamine transporter ligand, performed in five patients, was normal in all. Recurrent falls might be caused by a neurological syndrome that primarily affects balance control. The importance of identifying this disorder is its distinction from other parkinsonian syndromes causing falls.

Topics: Accidental Falls; Aged; Aged, 80 and over; Basal Ganglia Diseases; Brain Infarction; Female; Humans; Iodine Radioisotopes; Male; Movement Disorders; Neurodegenerative Diseases; Neurologic Examination; Postural Balance; Posture; Tomography, Emission-Computed, Single-Photon; Tropanes