2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane and Parkinson-Disease--Secondary

Differentiating idiopathic Parkinson's disease from secondary parkinsonian syndromes is crucial since their management and prognosis differ considerably. Functional imaging of the dopaminergic pathway by means of [¹²³I]FP-CIT SPECT (DaTSCAN) might be useful in this regard, but its role is still controversial. The accuracy of DaTSCAN in the differential diagnosis between Parkinson's disease and vascular or drug-induced parkinsonism was therefore systematically reviewed.. MEDLINE and CENTRAL were searched for studies aiming to determine accuracy measures (sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratios) of DaTSCAN in differentiating between Parkinson's disease and vascular or drug-induced parkinsonism.. Five studies were included. Pooled accuracy measures in differentiating between Parkinson's disease and vascular or drug-induced parkinsonism were relatively high, with sensitivity and specificity values above 85% and 80%, respectively.. DaTSCAN might accurately differentiate between early Parkinson's disease and secondary parkinsonian conditions, namely vascular or drug-induced, in patients with clinically unclear parkinsonism. However, all the studies reviewed here show several methodological limits, which prevent definitive conclusions on the role of DaTSCAN being drawn in this context. Further studies are needed to confirm our results and definitely evaluate the utility of DaTSCAN in differentiating between Parkinson's disease and vascular or drug-induced parkinsonism.

Topics: Aged; Diagnosis, Differential; Humans; Middle Aged; Parkinson Disease; Parkinson Disease, Secondary; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Tropanes

Drug induced parkinsonism (DIP) is directly related to dopamine D2 receptor blockade. However, there are many references describing parkinsonian signs (PS) in naive-patients. In our previous study, we observed lower DAT binding in a group of first-episode schizophrenic patients after short-term treatment with risperidone, compared with age-matched healthy controls.. To clarify if DAT decrease could be an illness trait, excluding the effect of antipsychotics on DAT availability, and to determine whether DAT availability before treatment with antipsychotics may predict subsequent development of PS.. A new series of 20 neuroleptic-naive schizophrenic patients and 15 healthy subjects was recruited. SPECT with [(123)I] FP-CIT (DaTSCAN(R)) was performed before starting antipsychotics and after 4 weeks of treatment. PS and psychopathological status were assessed by the Simpson-Angus (SAS), CGI and PANSS scales. Quantitative analyses of SPECTs were performed using ROIs placed in the caudate, putamen and occipital cortex.. Schizophrenic patients showed lower DAT binding compared with the healthy subjects at baseline (p<0.001) and after a 4-week-treatment period (p=0.001). Six out of eight schizophrenic patients of the DIP group were symptomatic for PS at baseline, in comparison to two out of 12 in the NoDIP group. Nonetheless, no differences were observed on DAT between DIP and NoDIP, neither at baseline (p=0.360) nor at endpoint (p=0.984). Finally, no differences between baseline-endpoint DAT binding were observed, neither in the DIP group (p=0.767) nor in the NoDIP group (p=0.093).. Our new series of first-episode naive-schizophrenic patients (1) points out DAT dysfunction as an illness trait due to the significantly lower DAT binding in schizophrenic patients in comparison to healthy subjects; (2) supports the results of other authors who describe PS in never-treated patients; (3) confirms that [(123)I] FP-CIT does not allow us to predict which patients will develop parkinsonism due to the lack of differences between DIP and NoDIP patients; and (4) confirms a null effect of antipsychotics on DAT due to the lack of differences in [(123)I] FP-CIT before and after a 4-week-treatment period.

Topics: Adult; Antipsychotic Agents; Caudate Nucleus; Dopamine Plasma Membrane Transport Proteins; Down-Regulation; Female; Humans; Male; Neostriatum; Parkinson Disease, Secondary; Psychiatric Status Rating Scales; Putamen; Risperidone; Schizophrenia; Schizophrenic Psychology; Severity of Illness Index; Tomography, Emission-Computed, Single-Photon; Tropanes

Topics: Aged; Dopamine; Female; Humans; Male; Middle Aged; Parkinson Disease, Secondary; Parkinsonian Disorders; Positron-Emission Tomography; Uncertainty

To determine whether vascular parkinsonism (VaP) patients with visually normal dopamine transporter (DAT) scans have presynaptic dopaminergic depletion.. We enrolled 23 VaP patients who had parkinsonism, relevant diffuse subcortical white matter hyperintensities (WMH), and visually normal DAT scans, 23 Parkinson's disease (PD) patients, and 31 control subjects. By quantitatively analyzing. VaP patients exhibited decreased DAT availability in all striatal subregions, including posterior putamen, compared to control subjects. VaP patients and control subjects had similar patterns of anteroposterior and ventrodorsal DAT gradients in caudate and putamen level, but VaP patients exhibited significantly different patterns at putamen level, relative to PD patients. The severity of periventricular WMH was significantly correlated with all substriatal DAT availability in VaP, but not with UPDRS-III scores. The ROC analysis showed that DAT availability in caudate and posterior putamen had a fair discriminatory power when differentiating VaP patients from control subjects.. This study demonstrates that VaP patients with WMH exhibited diffusely decreased DAT availability without any specific regional gradients of DAT patterns distinct from either control subjects or PD patients.

Topics: Aged; Aged, 80 and over; Cerebrovascular Disorders; Corpus Striatum; Dopamine Plasma Membrane Transport Proteins; Female; Humans; Leukoaraiosis; Male; Parkinson Disease; Parkinson Disease, Secondary; Positron-Emission Tomography; Retrospective Studies; Tropanes

Despite its use in determining nigrostriatal degeneration, the lack of a consistent interpretation of nigrosome 1 susceptibility map-weighted imaging (SMwI) limits its generalized applicability. To implement and evaluate a diagnostic algorithm based on convolutional neural networks for interpreting nigrosome 1 SMwI for determining nigrostriatal degeneration in idiopathic Parkinson's disease (IPD).. In this retrospective study, we enrolled 267 IPD patients and 160 control subjects (125 patients with drug-induced parkinsonism and 35 healthy subjects) at our institute, and 24 IPD patients and 27 control subjects at three other institutes on approval of the local institutional review boards. Dopamine transporter imaging served as the reference standard for the presence or absence of abnormalities of nigrosome 1 on SMwI. Diagnostic performance was compared between visual assessment by an experienced neuroradiologist and the developed deep learning-based diagnostic algorithm in both internal and external datasets using a bootstrapping method with 10000 re-samples by the "pROC" package of R (version 1.16.2).. The area under the receiver operating characteristics curve (AUC) (95% confidence interval [CI]) per participant by the bootstrap method was not significantly different between visual assessment and the deep learning-based algorithm (internal validation, .9622 [0.8912-1.0000] versus 0.9534 [0.8779-0.9956], P = .1511; external validation, 0.9367 [0.8843-0.9802] versus 0.9208 [0.8634-0.9693], P = .6267), indicative of a comparable performance to visual assessment.. Our deep learning-based algorithm for assessing abnormalities of nigrosome 1 on SMwI was found to have a comparable performance to that of an experienced neuroradiologist.

Topics: Aged; Deep Learning; Dopamine Plasma Membrane Transport Proteins; Female; Humans; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Parkinson Disease; Parkinson Disease, Secondary; Positron-Emission Tomography; Reproducibility of Results; Retrospective Studies; Substantia Nigra; Tropanes

We report 2 cases of drug induced Parkinsonism followed longitudinally that remained symptomatic 22 and 27 months after stopping causative agents with normal dopamine ioflupane iodine-123 (DaT) single-photon emission computed tomography (SPECT) scans at 8 and 16 months.

Topics: Adult; Aged; Diagnostic Uses of Chemicals; Dopamine Plasma Membrane Transport Proteins; Female; Humans; Longitudinal Studies; Male; Nortropanes; Parkinson Disease, Secondary; Tomography, Emission-Computed, Single-Photon; Tranquilizing Agents

Topics: Aged; Brain Infarction; Diagnosis, Differential; Disease Progression; Female; Humans; Mesencephalon; Parkinson Disease, Secondary; Positron-Emission Tomography; Radiopharmaceuticals; Tropanes

Topics: Adult; Carbon Monoxide Poisoning; Cognitive Dysfunction; Dopamine Plasma Membrane Transport Proteins; Female; Globus Pallidus; Humans; Parkinson Disease, Secondary; Suicide, Attempted; Tomography, Emission-Computed, Single-Photon; Tropanes

Cerebral vascular lesions are integral to the diagnosis of vascular parkinsonism (VP). The VP, also referred to as lower body parkinsonism, is frequently caused by subcortical white matter lesions, but lesions at any levels of the nigro-striato-thalamo-cortical pathway can also cause VP, thus giving rise to various symptoms other than gait disturbance. Previous dopamine transporter imaging studies using SPECT showed heterogeneous patterns suggesting diverse contributing lesions to VP. Here we present 3 cases of VP demonstrated by F-FP-CIT PET/CT, visualizing vascular lesions at different levels between the midbrain and motor cortex. Distinctive clinical manifestations of them recapitulate the pathogenesis of VP.

Topics: Aged; Brain Infarction; Female; Humans; Parkinson Disease, Secondary; Positron Emission Tomography Computed Tomography; Tropanes

We report here on chronic neurological impairment in three car painters with constant occupational exposure to organic solvents. All had a clinical presentation of Parkinson's disease and, in all cases, SPECT DaTscan brain imaging, using

Topics: Basal Ganglia; Dopaminergic Neurons; Humans; Male; Masks; Middle Aged; Occupational Diseases; Occupational Exposure; Paint; Parkinson Disease, Secondary; Radiopharmaceuticals; Solvents; Tomography, Emission-Computed, Single-Photon; Tropanes; Ventilation

The study's objective was to develop diagnostic predictive models using data from two commonly used [(123)I]FP-CIT SPECT assessment methods: region-of-interest (ROI) analysis and whole-brain voxel-based analysis.. We included retrospectively 80 patients with vascular parkinsonism (VP) and 164 patients with Parkinson's disease (PD) who underwent [(123)I]FP-CIT SPECT. Nuclear-medicine specialists evaluated the scans and calculated bilateral caudate and putamen [(123)I]FP-CIT uptake and asymmetry indices using BRASS software. Statistical parametric mapping (SPM) was used to compare the radioligand uptake between the two diseases at the voxel level. Quantitative data from these two methods, together with potential confounding factors for dopamine transporter availability (sex, age, disease duration and severity), were used to build predictive models following a tenfold cross-validation scheme. The performance of logistic regression (LR), linear discriminant analysis and support vector machine (SVM) algorithms for ROI data, and their penalized versions for SPM data (penalized LR, penalized discriminant analysis and SVM), were assessed.. Significant differences were found in the ROI analysis after covariate correction between VP and PD patients in [(123)I]FP-CIT uptake in the more affected side of the putamen and the ipsilateral caudate. Age, disease duration and severity were also found to be informative in feeding the statistical model. SPM localized significant reductions in [(123)I]FP-CIT uptake in PD with respect to VP in two specular clusters comprising areas corresponding to the left and right striatum. The diagnostic predictive accuracy of the LR model using ROI data was 90.3 % and of the SVM model using SPM data was 90.4 %.. The predictive models built with ROI data and SPM data from [(123)I]FP-CIT SPECT provide great discrimination accuracy between VP and PD. External validation of these methods is necessary to confirm their applicability across centres.

Topics: Aged; Aged, 80 and over; Artificial Intelligence; Diagnosis, Differential; Female; Humans; Image Processing, Computer-Assisted; Male; Parkinson Disease; Parkinson Disease, Secondary; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Tropanes

Drug-induced parkinsonism (DIP) is the common cause of parkinsonism. It is difficult to make a differentiation between DIP and Parkinson's disease (PD) because there are no notable differences in the clinical characteristics between the two entities. In this study, we examined the relationship between the characteristics of [(18)F] fluorinated-N-3-fluoropropyl-2-β-carboxymethoxy-3-β-(4-iodophenyl)nortropane (FP-CIT) positron emission tomography (PET) images and clinical features in DIP patients. We retrospectively studied 76 patients with DIP who underwent [(18)F] FP-CIT PET. We also enrolled 16 healthy controls who underwent it. We compared the clinical characteristics between the DIP patients with normal [(18)F] FP-CIT PET scans and those with abnormal ones. Symmetric parkinsonism was more frequent in the patients with normal [(18)F] FP-CIT PET scans as compared with those with abnormal ones. Interval from drug intake to onset of parkinsonism was longer in the patients with abnormal [(18)F] FP-CIT PET scans as compared with those with normal ones. A semi-quantitative analysis showed that specific to non-specific binding ratios in the putamen was lower in the patients with abnormal [(18)F] FP-CIT PET scans as compared with those with normal ones and the age-matched control group. Our results suggest that symmetric parkinsonism was more prevalent, and the duration of drug exposure before the onset of parkinsonism was shorter in the patients with normal [(18)F] FP-CIT PET scans as compared with those with abnormal ones.

Topics: Aged; Aged, 80 and over; Brain; Brain Mapping; Female; Fluorine Radioisotopes; Humans; Male; Middle Aged; Parkinson Disease, Secondary; Positron-Emission Tomography; Radiopharmaceuticals; Retrospective Studies; Tomography, X-Ray Computed; Tropanes

We report a patient who presented with Parkinsonism after external ventricular drainage (EVD) for an intraventricular hemorrhage (IVH). We also demonstrate dopaminergic system dysfunction using (18)F-florinated-N-3-fluoropropyl-2-β-carboxymethoxy-3-β-(4-lodophenyl) nortropane ((18)F-FP-CIT) positron emission tomography (PET) scanning. A 50-year-old woman presented with manifestations of Parkinsonism, including severe rigidity and 3-Hz resting tremor, immediately after EVD for IVH. (18)F-FP-CIT PET images at 6 months after onset showed dysfunction of the bilateral caudate nuclei and putamen after EVD that seemed to have induced Parkinsonism, although no lesion was observed in those areas on either conventional computed tomography or magnetic resonance imaging. With a dose of 300/1200 mg/day carbidopa/levodopa, the rigidity of both upper and lower extremities was significantly reduced, and the tremor completely disappeared. The decreased rigidity also improved the activities of daily living performance. In summary, a patient developed Parkinsonism after EVD for IVH, and we demonstrated dopaminergic system dysfunction on (18)F-FP-CIT PET images. Clinicians should pay particular attention to the occurrence of Parkinsonism when performing procedures that can reduce intraventricular pressure.

Topics: Activities of Daily Living; Carbidopa; Caudate Nucleus; Cerebral Ventricles; Drainage; Drug Combinations; Female; Humans; Intracranial Hemorrhages; Levodopa; Magnetic Resonance Imaging; Middle Aged; Parkinson Disease, Secondary; Positron-Emission Tomography; Predictive Value of Tests; Putamen; Radiopharmaceuticals; Recovery of Function; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Tropanes; Ventriculoperitoneal Shunt

As an indicator of synchronous neural activity, resting-state functional networks are influenced by neuropathological and neurochemical changes in degenerative diseases. To further advance understanding about neurochemical and neuropathological basis for resting-state functional maps, we performed a comparative analysis of resting-state functional connectivity in patients with Parkinson's disease (PD) and drug induced parkinsonism (DIP). Resting-state neuroimaging data were analyzed with a seed-based approach to investigate striatocortical functional connectivity and cortical functional connectivity within the default mode network, executive control network, and the dorsal attention network. The striatal subregions were divided into the more or less affected sides in terms of dopamine transporter uptake. Compared with DIP, PD exhibited an increased cerebellar connectivity from the more affected side of the caudate and the less affected sides of the anterior and the posterior putamen. Additionally, PD showed increased functional connectivity in the anterior prefrontal areas from the more affected side of the anterior putamen and from the less affected side of the posterior putamen. However, PD exhibited decreased cortical functional connectivity from the posterior cingulate cortex in the left temporal area. Finally, DIP patients showed decreased cortical functional connectivity from the dorsolateral prefrontal cortex in frontal and parietal areas compared with PD patients. In summary, the present study demonstrates that PD patients exhibited a unique resting state functional connectivity that may be associated with PD-related pathological changes beyond the dopaminergic system, whereas DIP patients showed altered functional connectivity within executive control network.

Topics: Aged; Brain Mapping; Corpus Striatum; Dopamine; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nerve Net; Neural Pathways; Parkinson Disease; Parkinson Disease, Secondary; Positron-Emission Tomography; Substantia Nigra; Tropanes

Vascular parkinsonism (VP) may occur as a distinct clinicopathological entity but the comorbid presence of vascular damage in Parkinson's disease (PD) is very frequent too. This differential diagnosis has therapeutic and prognostic implications but remains challenging as the usefulness of a number of supporting tools is still controversial.. To ascertain the clinical value of cardiac (123)I-meta-iodobenzylguanidine ((123)I-MIBG) SPECT, olfactory function and (123)I-FP-CIT SPECT as supporting tools in the differential diagnosis between VP and PD.. Cross-sectional study of 15 consecutive patients with suspected VP, 15 PD patients and 9 healthy subjects. Cardiac (123)I-MIBG SPECT (heart-to-mediastinum ratio) and olfactory testing (University of Pennsylvania Smell Identification Test-UPSIT) were performed in all of them. (123)I-FP-CIT SPECT was performed in VP-suspected patients.. Heart-to-mediatinum ratio was significant lower in suspected VP (mean 1.45) and PD (mean 1.16) compared to control group (mean 1.69) (p = 0.017 and p < 0.0001). VP patients presented a higher ratio than PD patients (p = 0.001). Control group presented a significant higher UPSIT score (mean 30.71) when compared to both VP (mean 18.33) and PD (mean 15.29) (p = 0.001 for both groups). Those VP with a cardiac (123)I-MIBG non suggestive of PD were more likely to have a higher UPSIT score (p = 0.006). (123)I-FP-CIT SPECT imaging was heterogeneous (7/15 VP normal, 3/15 abnormal suggestive of PD and 5/15 abnormal but atypical for PD).. The use of cardiac (123)I-MIBG SPECT and to a lesser extent UPSIT could assist the differential diagnosis between VP and PD in subjects in which the diagnosis remains uncertain despite (123)I-FP-CIT SPECT imaging.

Topics: 3-Iodobenzylguanidine; Aged; Cross-Sectional Studies; Diagnosis, Differential; Female; Heart; Humans; Male; Parkinson Disease; Parkinson Disease, Secondary; Radiopharmaceuticals; Smell; Tomography, Emission-Computed, Single-Photon; Tropanes

In elderly patients, exposure to antipsychotic medication and subsequent withdrawal may lead to the development of persistent extrapyramidal symptoms, possibly including a syndrome suggested to be tardive parkinsonism. We describe a case in which withdrawal of antipsychotics was unexpectedly associated with progressive deterioration, rather than improvement, of extrapyramidal parkinsonian symptoms. Abnormal imaging of presynaptic dopamine transporters (DaTs) using single-photon emission computed tomography (SPECT) with ioflupane I 123 (DaTscan) substantially contributed to the differential diagnosis, suggesting it was likely that the patient had an underlying neurodegenerative disorder that preceded the onset of medicationinduced parkinsonian symptoms. Our report illustrates how novel findings from DaTscan may assist with diagnosing the cause of persistent parkinsonian symptoms after antipsychotic withdrawal and provide insight into the controversial concept of tardive parkinsonism.

Topics: Aged, 80 and over; Antipsychotic Agents; Brain; Diagnosis, Differential; Dopamine Plasma Membrane Transport Proteins; Female; Haloperidol; Humans; Iodine Radioisotopes; Lewy Body Disease; Neuroimaging; Nortropanes; Parkinson Disease, Secondary; Tomography, Emission-Computed, Single-Photon

Drug-induced parkinsonism is a major type of parkinsonism in our setting. Symptoms usually disappear after discontinuation of the drug. However, they may persist in patients with a variant known as subclinical drug-exacerbated parkinsonism; early identification of this entity has important prognostic and therapeutic implications. The most widely used complementary test in this diagnosis is single-photon emission computed tomography with ioflupane ((123)I), also known as (123)I-FP-CIT SPECT. The aim of our study is to verify its diagnostic accuracy.. We designed a prospective study of patients with drug-induced parkinsonism in which, after discontinuing the drug and undergoing a (123)I-FP-CIT SPECT scan, patients would be monitored for at least 6 months. Patients were categorised as having iatrogenic parkinsonism if symptoms disappeared, or as having subclinical drug-exacerbated parkinsonism if they persisted. Lastly, we verified concordance between the clinical diagnosis and results from the (123)I- FP-CIT SPECT scan.. The sample included 19 patients. The most commonly prescribed drug class was neuroleptic agents. For the diagnosis of both subgroups, (123)I-FP-CIT SPECT showed a sensitivity of 66.7%, specificity and positive predictive value of 100%, a negative predictive value of 86.7%, and a negative likelihood ratio of 0.33.. Although the study needs to be repeated in a larger sample of patients, (123)I-FP-CIT SPECT is useful in the diagnosis of drug-induced parkinsonism since it is a very precise tool for identifying patients with that illness.

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Female; Follow-Up Studies; Humans; Hypokinesia; Likelihood Functions; Male; Middle Aged; Parkinson Disease, Secondary; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Tropanes

To analyse the differences in the clinical features and characteristics of (123)I-labelled 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane ((123)I-FP-CIT) single photon emission CT (SPECT) imaging among patients with vascular parkinsonism (VP) and Parkinson's disease (PD).. We performed a case-control study to compare clinical features and qualitative and semi-quantitative analyses of (123)I-FP-CIT SPECT images between 106 patients with VP and 280 patients with PD. A case series study was used to search for clinical features related to SPECT or neuroimaging findings among patients with VP.. Patients with VP had a higher age at symptom onset and lower disease duration than patients with PD. The most frequent symptom at onset was gait disorder in VP and tremor in PD. Gait disorder, postural instability and falls were more frequent in VP. Rest and mixed tremor were more prevalent in PD. Of the patients who received levodopa treatment in the VP group, only about half had a good response. Qualitatively (123)I-FP-CIT SPECT images were normal in 32.5% of patients with VP and abnormal in all patients with PD. The use of different visual score patterns showed higher ability to differentiate VP from PD. Semi-quantitative analysis showed significantly higher uptake in the striatum, caudate and putamen in VP. The asymmetry index was higher in patients with PD. Among patients with VP, falls were the only clinical feature that demonstrated a correlation with the SPECT visual pattern.. Our data contribute to the confirmation that VP and PD are two different clinical entities. Neurological signs, response to treatment and qualitative and semi-quantitative (123)I-FP-CIT SPECT analyses may help to make the diagnosis.

Topics: Aged; Brain; Case-Control Studies; Cerebrovascular Disorders; Dopamine Plasma Membrane Transport Proteins; Female; Functional Neuroimaging; Humans; Iodine Radioisotopes; Male; Middle Aged; Parkinson Disease; Parkinson Disease, Secondary; Tomography, Emission-Computed, Single-Photon; Tropanes

Topics: Cerebrovascular Disorders; Dopamine Plasma Membrane Transport Proteins; Female; Functional Neuroimaging; Humans; Male; Parkinson Disease; Parkinson Disease, Secondary; Tropanes

Drug-induced parkinsonism (DIP) in patients treated with antipsychotic drugs is considered a form of post-synaptic parkinsonism, caused by D2-receptor blockade. Recent studies, however, carried out on small and heterogeneous patient samples, have shown that DIP may be associated with [(123)I]FP-CIT single photon emission computed tomography (SPECT) abnormalities, which are markers of dopamine nigrostriatal terminal defect. In the present study, outpatients fulfilling the DSM-IV criteria for schizophrenia and treated with antipsychotics for at least 6 months, were enrolled in order to estimate the prevalence of DIP and, among patients with DIP, the prevalence of [(123)I]FP-CIT SPECT abnormalities. Socio-demographic and clinical variables associated with the presence of DIP and SPECT abnormalities were also assessed. DIP was diagnosed in 149 out of 448 patients with schizophrenia (33%). Age, use of long-acting antipsychotics and a positive family history of parkinsonism were the only demographic variables significantly associated with the development of DIP. Neuroimaging abnormalities were found in 41 of 97 patients who agreed to undergo [(123)I]FP-CIT SPECT (42%). Only age differentiated this group of patients from those with normal imaging. These preliminary findings suggest that D2-receptor blockade may coexist with a dopamine nigrostriatal terminal defect, as assessed by [(123)I]FP-CIT SPECT abnormalities, in a relevant proportion of DIP patients. Longitudinal studies should be designed with the aim of improving our understanding of the mechanisms of pre-synaptic abnormalities in DIP patients and identifying specific treatment strategies.

Topics: Adult; Aged; Antipsychotic Agents; Brain; Brain Mapping; Female; Humans; Male; Middle Aged; Parkinson Disease, Secondary; Schizophrenia; Sex Factors; Statistics, Nonparametric; Tomography, Emission-Computed, Single-Photon; Tropanes

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

Topics: Aged; Antidepressive Agents, Second-Generation; Antipsychotic Agents; Cyclohexanols; Depressive Disorder, Major; Diagnosis, Differential; Dopamine Plasma Membrane Transport Proteins; Female; Haloperidol; Humans; Lewy Body Disease; Neostriatum; Parkinson Disease, Secondary; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Tropanes; Venlafaxine Hydrochloride

The objective of this study was to determine whether dopamine transporter (DAT) scintigraphy influences the management of movement disorders in clinically indeterminate cases.. Seventeen patients (ten women, seven men; age range 44-84 years) with a presumptive diagnosis of Parkinson's disease (PD) were referred for single-photon emission computed tomography (SPECT) scintigraphy using [(123)I]ioflupane between November 2002 and August 2003. The scintigraphic results, clinical diagnosis, and management intentions pre- and post-examination were recorded.. Of the 17 patients who underwent scintigraphy, two patients on neuroleptic medication exhibited features of PD; one had an abnormal scintigraphic examination that confirmed PD, the other had a negative examination, confirming drug-induced parkinsonism, and these were managed accordingly. Of the other cases, the results of 10 examinations were compatible with PD. Five were reported as being normal, the final diagnoses in this group included: cerebrovascular disease (CVD); early Alzheimer's; provisional clinical diagnosis of generalized movement disorder; and possible Wilson's disease. One patient was felt to have a parkinsonian syndrome despite the normal result (this patient had a positive apomorphine test).. This series illustrates the value of DAT scintigraphy in the management of clinically indeterminate movement disorders at a tertiary referral centre arguing for its use in the initial diagnostic process. However, it is clear that the use of DAT scintigraphy poses significant resource implications. Further evidence should clarify the exact role of DAT scintigraphy in clinically indeterminate cases.

Topics: Adult; Aged; Aged, 80 and over; Dopamine Plasma Membrane Transport Proteins; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Nortropanes; Parkinson Disease; Parkinson Disease, Secondary; Radionuclide Imaging; Retrospective Studies

There is substantial evidence to support a role for small vessel disease (SVD) as a cause for vascular parkinsonism (VP). Using [(123)I] FP-CIT SPECT (single photon emission computed tomography), we have tried to determine whether VP patients have pre-synaptic dopaminergic function similar to PD patients, and whether the severity of parkinsonian symptoms as well as the levodopa response in VP patients are correlated with pre-synaptic dopaminergic dysfunction. Thirteen patients fulfilling operational clinical criteria for VP had [(123)I] FP-CIT scans. Mean [(123)I] FP-CIT uptake in the basal ganglia was significantly lower in VP patients than in healthy controls, and the asymmetry index was not significantly different between these groups. In contrast, compared with the PD group, only the mean asymmetry index was significantly lower in VP patients. None of the parameters measured was significantly different between VP patients who had an insidious onset of parkinsonism (VPi) and those who had an acute onset (VPa). There was a significant correlation between the bilateral basal ganglia FP-CIT uptake reduction in the VP patients and UPDRS motor scores, but not with the mean % reduction in motor UPDRS after levodopa. We suggest that in the majority of VP patients, pre-synaptic dopaminergic function is reduced. The presence of a rather symmetrical FP-CIT uptake in the basal ganglia may help to distinguish VP from PD and could therefore be used as a criterion for the clinical diagnosis of VP.

Topics: Aged; Aged, 80 and over; Antiparkinson Agents; Corpus Striatum; Female; Humans; Levodopa; Male; Middle Aged; Parkinson Disease; Parkinson Disease, Secondary; Statistics, Nonparametric; Tomography, Emission-Computed, Single-Photon; Tropanes

Topics: Cerebral Infarction; Humans; Male; Middle Aged; Parkinson Disease, Secondary; Putamen; Radionuclide Imaging; Tropanes

We evaluated the concordance between independent clinical, electrophysiological, and [(123)I]-FP-CIT SPECT scan explorations as a staged procedure for an accurate diagnosis in 9 patients referred with a diagnosis of suspected psychogenic parkinsonism. Three patients were reclassified as pure psychogenic parkinsonism (PP), 6 with a form of combined psychogenic parkinsonism and Parkinson's disease (PP + PD), and none with pure Parkinson's disease (PD). Electrophysiological recordings showed the characteristics of psychogenic tremor in 5 of 7 patients with tremor. In two of these 5, PD tremor was also recorded. SPECT scan results were abnormal in five of 9 patients. In one case of clinically suspected PP + PD, SPECT scan results were normal. Long-term follow-up supported the final diagnosis of PP (initial clinical misdiagnosis). Electrophysiology contributes to the clinical diagnosis of psychogenic tremor and may help confirm associated organic PD tremor. [(123)I]-FP-CIT SPECT is a robust test to ascertain dopaminergic denervation and increase the confidence of the clinical and electrophysiological diagnosis of associated PD. A combination of clinical, electrophysiological, and [(123)I]-FP-CIT SPECT scan explorations improves diagnostic accuracy in order to distinguish PP from PP + PD.

Topics: Adult; Anxiety; Brain; Cerebrovascular Circulation; Depression; Diagnosis, Differential; Electromyography; Female; Humans; Male; Middle Aged; Muscle, Skeletal; Parkinson Disease, Secondary; Psychotherapy; Radiopharmaceuticals; Severity of Illness Index; Tomography, Emission-Computed, Single-Photon; Tropanes

Topics: Antiparkinson Agents; Brain Injuries; Female; Humans; Iodine Radioisotopes; Levodopa; Magnetic Resonance Imaging; Middle Aged; Parkinson Disease, Secondary; Substantia Nigra; Tomography, Emission-Computed, Single-Photon; Tropanes

Drug-induced parkinsonism (DIP) is one of the main causes of treatment drop-out in schizophrenic patients causing a high incidence of relapse that leads patients to a bad clinical prognosis. The dopaminergic nigrostriatal pathway is involved in the movement control, so the study of the dopamine transporter (DAT) could be of great value to determine its implication in the appearance of DIP.. The goal of the study is to determine the striatal DAT binding assessed with [(123)I] FP-CIT SPECT in first-episode neuroleptic-naive schizophrenic in-patients with DIP after short-term antipsychotic treatment.. The [(123)I] FP-CIT binding ratios of ten schizophrenic in-patients who developed DIP during the first 4-week period of risperidone treatment (6+/-2 mg/day) were compared with ten schizophrenic in-patients treated with the same doses of risperidone and who do not developed DIP and with ten age-matched healthy subjects. Quantitative analyses of SPECTs were performed using regions of interest located in caudate, putamen and occipital cortex. Parkinsonism was assessed by the Simpson-Angus Scale and the psychopathological status by the Clinical General Impression and Positive and Negative Syndrome Scales.. Whole striatal [(123)I] FP-CIT binding ratios were significantly lower in patients with and without DIP than in healthy subjects (p<0.001). This was also observed in whole putamen (p<0.001) and caudate nucleus (p<0.001). Females showed higher whole striatal [(123)I] FP-CIT binding ratios than males (p<0.05). No differences in psychopathological scales were observed between patients with and without DIP.. Our first-episode schizophrenic patients with and without DIP after short-term risperidone treatment have a decreased striatal DAT binding assessed with [(123)I] FP-CIT. This alteration could be related to the schizophrenic disease or may be secondary to the antipsychotic treatment.

Topics: Adult; Antipsychotic Agents; Binding, Competitive; Humans; Iodine Radioisotopes; Neostriatum; Parkinson Disease, Secondary; Schizophrenia; Time Factors; Tomography, Emission-Computed, Single-Photon; Tropanes