Cardiac sympathetic denervation in bradykinesia-dominant Parkinson's disease

Abstract

Cardiac iodine-123-labeled-metaiodobenzylguanidine uptake is reduced in early-stage Parkinson's disease, suggesting sympathetic nerve degeneration. The scintigraphic findings in patients with Parkinson's disease with different clinical features have, however, not been established. Iodine-123-labeled-metaiodobenzylguanidine myocardial scintigraphy was performed in 143 patients with Parkinson's disease. The early and delayed heart to mediastinum ratios were analyzed according to the dominant motor deficit (tremor, bradykinesia, rigidity, and postural instability), age, sex, age at onset, disease duration, and Hoehn and Yahr stage. Both ratios correlated with bradykinesia, age at disease onset, and disease duration; but not with sex, Hoehn and Yahr stage, tremor, rigidity, and postural instability. Our results suggest a close link between myocardial sympathetic degeneration and bradykinesia, age at onset and disease duration.

Different patterns of cardiac sympathetic denervation in tremor-type compared to akinetic-rigid-type Parkinson’s disease: Molecular imaging with 123I-MIBG

“…This finding was more marked for the delayed compared to the early images ( Figs. 1 and 2), in agreement with several previous studies (4,7,8,(16)(17)(18)(19)(20). The use of 123 I-MIBG has been suggested as a useful marker in the diagnosis of PD (19) and as a sensitive tool in the early detection of silent autonomic dysfunction (18).…”

“…By contrast, Suzuki et al did not find such a correlation in their population where 123 I-MIBG myocardial uptake was correlated only with the severity of bradykinesia but not with tremor or rigidity (7). In our study, 123 I-MIBG myocardial uptake was significantly lower in TDT patients when compared to ART patients (P=0.0167), findings that are in contrast with those of other studies (7,8,20). These discrepancies may be due to the different disease duration in these two subgroups.…”

“…To the best of our knowledge, only a few studies have evaluated the 123 I-MIBG myocardial uptake in different Parkinson's phenotypes (7,8,20). In their study, Spiegel et al found that myocardial 123 I-MIBG uptake was significantly less impaired in TDT patients than in ART patients at the same stage of the disease (8).…”

“…The lack of a clear relationship of 123 I-MIBG myocardial uptake with disease severity detectable by means of UPDRS and H&Y stage has been previously described (8,19). In their study performed on a pool of 143 patients, Suzuki et al hypothesized that 61.3% of the variation in the observed early H/M ratio and 68.2% of that in the delayed H/M ratio could be explained by their linear relationship with disease duration, gender, H&Y stages and the clinical features of their population (7). Nevertheless, their data indicated no such correlation with clinical disease severity of PD (H&Y stage) and 123 I-MIBG myocardial uptake (7).…”

MIBG Myocardial Scintigraphy can Predict the Occurrence of Wearing-off Phenomenon in Early-stage Parkinson’s Disease

“…Moreover, the accumulated evidence has indicated that the heart-tomediastinum (H/M) ratio correlates with the disease severity of hypokinesia/bradykinesia and rigidity [2,3,4] To the best of our knowledge, there have been few studies about prognosis predictions, except for one paper about the effects of subthalamic stimulation [5]. The present report describes the wearing-off predictions obtained from MIBG scintigraphy in patients with early-stage PD.…”