Two-year follow-up in 150 consecutive cases with normal dopamine transporter imaging.
OBJECTIVE
Functional pre-synaptic dopamine brain imaging is generally abnormal when parkinsonism is degenerative (such as in idiopathic Parkinson's disease) and normal in patients with non-degenerative movement disorder (such as essential tremor). However, some patients diagnosed as early Parkinson's disease have normal presynaptic dopamine imaging. Follow-up of patients with normal imaging should help determine whether such patients truly have degenerative parkinsonism (and therefore represent false negative imaging results), or emerge as cases of non-degenerative parkinsonism (and therefore represent initial clinical over-diagnosis of Parkinson's disease).


RESULTS
One hundred and fifty cases with normal I-FP-CIT SPECT undertaken during routine care over a 3-year period were reviewed 2.4 years (interquartile range, 2.2-3.1 years) after SPECT. Diagnosis after follow-up was non-degenerative parkinsonism or tremor in 146 (97%), who did not progress clinically, and degenerative parkinsonism in four (3%), in whom clinical progression was noted. Anti-Parkinson therapy was used in 36, and withdrawn in 27 with no deterioration in 25. Patients strictly fulfilling Brain Bank criteria (part 1) were more likely to undergo a trial of anti-Parkinson therapy (P < 0.05) but were no more likely to maintain or respond to anti-Parkinson therapy than those not fulfilling criteria.


CONCLUSIONS
The clinical profile and therapy response during follow-up of patients with normal presynaptic dopamine imaging supports the diagnosis of a non-degenerative movement disorder in nearly all cases.
Marshall
Vicky L
VL
Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK. v.marshall@clinmed.gla.ac.uk
Patterson
Jim
J
Hadley
Donald M
DM
Grosset
Katherine A
KA
Grosset
Donald G
DG
D000978:Antiparkinson Agents / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D010300:Parkinson Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014326:Tropanes / Q000493:pharmacokinetics; D006113:United Kingdom / Q000453:epidemiology
D000978:Antiparkinson Agents; D050483:Dopamine Plasma Membrane Transport Proteins; D019275:Radiopharmaceuticals; D014326:Tropanes; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane