title: Psychogenic parkinsonism: a combination of clinical, electrophysiological, and [(123)I]-FP-CIT SPECT scan explorations improves diagnostic accuracy.
abstract: 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.
authors.affiliation: Department of Neurology, Saint-Antoine Hospital, Paris, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Benaderette
authors.forename: Paolo
authors.initials: P
authors.lastname: Zanotti Fregonara
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Apartis
authors.forename: Charles
authors.initials: C
authors.lastname: Nguyen
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Trocello
authors.forename: Philippe
authors.initials: P
authors.lastname: Remy
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Devaux
authors.forename: Serge
authors.initials: S
authors.lastname: Askienazy
authors.forename: Marie
authors.initials: M
authors.lastname: Vidailhet
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D003863:Depression / Q000523:psychology*; D003937:Diagnosis, Differential; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation; D010302:Parkinson Disease, Secondary / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D011613:Psychotherapy; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon; D014326:Tropanes / Q000493:pharmacokinetics
chemical_list: D019275:Radiopharmaceuticals; D014326:Tropanes; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane