Cardiac 123I-MIBG scintigraphy in patients with drug induced parkinsonism

Lee, Phil Hyu; Kim, Joong‐Seok; Shin, Dong Hoon; Yoon, Seok-Nam; Huh, Kyu Ha

doi:10.1136/jnnp.2005.073999

Cited by 44 publications

(32 citation statements)

References 20 publications

(20 reference statements)

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“…In this study DIP patients underwent cardiac MIBG scintigraphy, which, like [ 123 I] FP-CIT SPECT, was used to ''unmask'' PD among DIP patients [29]. Although the authors found that global smell function in DIP patients was slightly, but not significantly, different from that of control subjects, worthy of note is the fact that, in the only DIP patient with decreased smell function, cardiac MIBG uptake was significantly decreased, and a positive response to levodopa was also present.…”

Section: Discussionmentioning

confidence: 99%

The status of olfactory function and the striatal dopaminergic system in drug-induced parkinsonism

et al. 2010

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Olfactory impairment has been reported in drug-induced parkinsonism (DIP), but the relationship between dopaminergic dysfunction and smell deficits in DIP patients has not been characterized. To this end, we studied 16 DIP patients and 13 patients affected by Parkinson's disease (PD) using the "Sniffin' Sticks" test and [(123)I] FP-CIT SPECT (single-photon emission computed tomography). DIP patients were divided based on normal (n = 9) and abnormal (n = 7) putamen dopamine transporter binding. Nineteen healthy age- and sex-matched subjects served as controls of smell function. Patients with DIP and pathological putamen uptake had abnormal olfactory function. In this group of patients, olfactory TDI scores (odor threshold, discrimination and identification) correlated significantly with putamen uptake values, as observed in PD patients. By contrast, DIP patients with normal putamen uptake showed odor functions-with the exception of the threshold subtest-similar to control subjects. In this group of patients, no significant correlation was observed between olfactory TDI scores and putamen uptake values. The results of our study suggest that the presence of smell deficits in DIP patients might be more associated with dopaminergic loss rather than with a drug-mediated dopamine receptor blockade. These preliminary results might have prognostic and therapeutic implications, as abnormalities in these individuals may be suggestive of an underlying PD-like neurodegenerative process.

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Section: Discussionmentioning

confidence: 99%

The status of olfactory function and the striatal dopaminergic system in drug-induced parkinsonism

et al. 2010

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“…DIP was defined by the following criteria: the presence of at least two of four cardinal signs (tremor, rigidity, bradykinesia, and impaired postural reflexes), the absence of a personal history of extrapyramidal disorders before treatment with the offending drug, and the onset of symptoms in the course of treatment with the offending drug [12]. If parkinsonism was aggravated by a dopamine-blocking drug in a patient who had already been diagnosed as PD, we classified the patient as DIP with PD.…”

Section: Methodsmentioning

confidence: 99%

Movement disorders at a university hospital emergency room

et al. 2008

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We prospectively evaluated the clinical features and etiologies of all common categories of movement disorder seen in the emergency room (ER) of an urban university hospital over a period of 12 months. We divided movement disorders according to the presenting phenomenology likely to dominate the clinical presentation, that is, gait disorder, tremor, dystonia, myoclonus, and acute akinetic crisis and classified a specific etiology in the individual phenomenology. In one year, there were 60,002 ER visits; of these, 58 (0.09 %) were diagnosed as a primary movement disorder. The most common clinical presentation was gait disorder (n = 21, 36.2 %), followed by myoclonus (n = 16, 27.6 %), dystonia (n = 10, 17.2 %), tremor (n = 8, 13.8 %), and acute akinetic crisis (n = 3, 5.2 %). Comparing the movement disorders, the mean age of the patients with dystonia was significantly lower than that of patients with other movement disorders (P < 0.001). Of the patients, 37 (63.8 %) had drug-related movement disorders. The contribution of drugs was significantly higher in patients with dystonia compared with the other movement disorders (P < 0.01). Our study showed that a large proportion of the movement disorders seen in the ER are drug-related. Careful selection of drugs while prescribing would decrease movement disorder-related visits to the ER.

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“…Patients were treated with donepezil, starting at 5 mg daily for 4 wk, which was increased to 10 mg daily. Of 12 patients initially diagnosed with PDD, 2 were excluded in this analysis; one could not tolerate donepezil; and was treated with galantamine, and the other had the delayed heart-to-mediastinum ratio that did not lie more than 2 SDs below the normal mean of our hospital (18). The mean delayed cardiac 123 I-MIBG uptake in patients with PDD included in this study was 1.23.…”

Section: Subjectsmentioning

confidence: 98%

Changes in Cerebral Glucose Metabolism in Patients with Parkinson Disease with Dementia After Cholinesterase Inhibitor Therapy

Lee¹,

Yong²,

An³

2008

J Nucl Med

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We investigated changes in cerebral glucose metabolism after cholinesterase inhibitor (ChEI) therapy in patients with Parkinson disease dementia (PDD) to determine whether cognitive improvements would be reflected in changes of cerebral metabolic patterns, thus offering insight into the neural substrate of cognitive dysfunction in patients with PDD. Methods: We performed a serial PET study before (baseline) and after ChEI therapy on 10 patients with PDD, using statistical parametric mapping. Additionally, covariance analysis was performed to extract regions in which increased change in regional cerebral metabolism correlated significantly with increased Mini-Mental State Examination scores. Results: The statistical parametric mapping analysis indicated that significantly increased cerebral metabolism after ChEI therapy, compared with at baseline, was most evident in the left angular gyrus extending to the supramarginal area and left superior and middle frontal gyri. Additionally, cerebral metabolism was significantly increased in the right superior frontal and left middle orbitofrontal gyri. In contrast, the right fusiform gyrus showed significantly decreased metabolism after ChEI, compared with at baseline. In the correlation analysis, improvements in Mini-Mental State Examination scores after ChEI treatment were significantly associated with increased cerebral metabolism in the left supramarginal, orbitofrontal, and cingulate areas. Conclusion: Our data suggest that prefrontal and parietal association areas may be relevant structures for the pharmacologic response to ChEI in patients with PDD. Cogni tive dysfunction occurs in 25%230% of patients with Parkinson disease (PD); this prevalence is 6 times greater than that among the population in general (1-3). The key feature of dementia in PD is executive dysfunction; thus, patients with PD dementia (PDD) have difficulty in tasks that require generation of mental sets, planning, and cognitive sequencing. Additionally, patients with PDD often exhibited worse performance in visuospatial tasks and memory impairment in free recalls, which improved significantly with external cues, suggesting that these patients still had the ability to store new information (3,4).Although the exact pathophysiologic substrate in PDD is still controversial, progressive involvement of subcortical and cortical structures, by Lewy-type pathology or Alzheimer disease-like histologic changes, has been suggested (5,6). Regarding neurochemical substrates in PDD, recent pathologic and functional studies have suggested that cholinergic deficits were significantly correlated with cognitive dysfunction in patients with PD (7-9). Various kinds of cholinesterase inhibitors (ChEIs), including rivastigmine (10), donepezil (11), and galantamine (12), have proven to be effective in improving cognitive function in patients with PDD, supporting this theory.Only 1 study, which used SPECT, reported that ChEIs significantly increased cerebral perfusion in frontal and cingulate areas (13). However, images ob...

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Cardiac 123I-MIBG scintigraphy in patients with drug induced parkinsonism

Cited by 44 publications

References 20 publications

The status of olfactory function and the striatal dopaminergic system in drug-induced parkinsonism

The status of olfactory function and the striatal dopaminergic system in drug-induced parkinsonism

Movement disorders at a university hospital emergency room

Changes in Cerebral Glucose Metabolism in Patients with Parkinson Disease with Dementia After Cholinesterase Inhibitor Therapy

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