Possible impact of dopamine SPECT on decision-making for drug treatment in Parkinsonian syndrome.
Single-photon emission computed tomography (SPECT) markers allow measuring the integrity of the brain dopaminergic system in vivo. We used dopamine transporter (DAT) SPECT with [(123)I]FP-CIT and dopamine D(2)/D(3) receptor SPECT with [(123)I]IBZM to evaluate whether there is a reduction of DAT and/or D(2)/D(3) receptor SPECT in treated and untreated patients with Parkinsonian syndrome (PS). We found that almost a quarter of our patients treated with anti-Parkinsonian medication prior to SPECT imaging did not show evidence of a presynaptic dopaminergic deficit while 37% of untreated patients were diagnosed as having Parkinson's disease. 17% of treated patients had additional loss of D(2)/D(3) receptor binding capacity in concordance with the clinical follow-up diagnoses of multiple system atrophy, progressive nuclear palsy, and vascular Parkinsonism. Apart from 38% clinically uncertain cases, SPECT was in concordance with 75% of initial clinical diagnoses. 25% were reclassified as indicated by SPECT findings and confirmed by a 1.5-year clinical follow-up. We conclude that dopamine SPECT may support establishing or refuting the clinical diagnosis and, therefore, help to make the decision for or against dopaminomimetic treatment in cases with PS.
Hesse
S
S
Clinic for Nuclear Medicine, University Hospital, Leipzig, Germany. hessw@medizin.uni-leipzig.de
Oehlwein
C
C
Barthel
H
H
Schwarz
J
J
Polster
D
D
Wagner
A
A
Sabri
O
O
D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D001549:Benzamides; D003937:Diagnosis, Differential; D004298:Dopamine / Q000378:metabolism / Q000502:physiology*; D015259:Dopamine Agents / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000627:therapeutic use; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000378:metabolism; D011759:Pyrrolidines; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D014326:Tropanes
D000978:Antiparkinson Agents; D001549:Benzamides; D015259:Dopamine Agents; D018491:Dopamine Agonists; D050483:Dopamine Plasma Membrane Transport Proteins; D011759:Pyrrolidines; D019275:Radiopharmaceuticals; D014326:Tropanes; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane; D007980:Levodopa; C055743:3-iodo-2-hydroxy-6-methoxy-N-((1-ethyl-2-pyrrolidinyl)methyl)benzamide; D004298:Dopamine