Role of dopamine transporter SPECT for the practitioner and the general neurologist.
The accurate clinical diagnosis of parkinsonism may be impeded by atypical presentations and confounding comorbidity. The presence of parkinsonism is misdiagnosed in up to a quarter of cases in general practice. Movement disorder specialists misdiagnose parkinsonian syndromes using histopathological findings as the "gold standard" in up to 10% of cases. Dopamine transporter SPECT represents a simple and fast method to confirm nigrostriatal degeneration in a given patient. This study provides several case reports to illustrate when dopamine transporter SPECT might be carried out and discusses whether dopamine transporter SPECT should be used in primary health care practice or by general neurologists in uncertain cases. Ideally, all possible cases of parkinsonism should be referred to a neurologist experienced in the field of movement disorders. If this could be achieved then the role of dopamine transporter SPECT in the general practitioner's or local neurologist's practice would be extremely limited. Future studies must clarify whether it is cost effective to generously perform dopamine transporter SPECTs to minimize the time until parkinsonism can be diagnosed.
Oertel
Wolfgang H
WH
Department of Neurology, Philipps-University Marburg, Germany. oertelw@staff.uni-marburg.de
Gerstner
Anja
A
Höffken
Helmut
H
Dodel
Richard C
RC
Eggert
Karla M
KM
Möller
Jens C
JC
D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging*; D003342:Corpus Striatum / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D050483:Dopamine Plasma Membrane Transport Proteins; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008562:Membrane Glycoproteins; D026901:Membrane Transport Proteins / Q000032:analysis*; D008875:Middle Aged; D009419:Nerve Tissue Proteins; D019636:Neurodegenerative Diseases / Q000000981:diagnostic imaging; D009462:Neurology; D020734:Parkinsonian Disorders / Q000000981:diagnostic imaging*; D010348:Patient Care Team; D012680:Sensitivity and Specificity; D013378:Substantia Nigra / Q000000981:diagnostic imaging; D014055:Tomography, Emission-Computed; D015899:Tomography, Emission-Computed, Single-Photon
D050483:Dopamine Plasma Membrane Transport Proteins; D008562:Membrane Glycoproteins; D026901:Membrane Transport Proteins; D009419:Nerve Tissue Proteins