Differentiation of PA from early PSP with different patterns of symptoms and CBF reduction.
OBJECTIVE
To clarify the features of pure akinesia (PA) and progressive supranuclear palsy (PSP) in the early stage of disease.


METHODS
We investigated 15 PA and 41 PSP patients' clinical and radiologic features including head MRI, ethyl cysteinate dimmer-single photon emission-computed tomography (ECD-SPECT) and iodine-123 meta-iodobenzyl guanidine (123I-MIBG) myocardial scintigraphy. In ECD-SPECT study, cerebral blood flow (CBF) reduction was quantitatively expressed as Z-score, and that in the frontal lobe was evaluated.


RESULTS
Many PSP patients claimed falls as the initial symptom but no PA patients did. Eye movement, as well as optokinetic nystagmus elicitation, was more frequently disturbed in PSP. Dementia, dysarthria and rigidity were also more frequent in PSP than in PA. Midbrain tegmentum atrophy in head MRI was more frequently observed in PSP. CBF in the frontal lobe, especially in the frontal eye field, was significantly lower in PSP than in PA. MIBG myocardial scintigraphy showed no difference between two groups.


CONCLUSIONS
PA and PSP show distinct symptoms from the early stage, indicating that they are distinct disorders. The occurrence of falls and eye movement disturbance, as well as CBF reduction at the frontal eye field, is very important for distinguishing these disorders.
Kurata
Tomoko
T
Department of Neurology, Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. toko11@cc.okayama-u.ac.jp
Hayashi
Takeshi
T
Murakami
Tetsuro
T
Miyazaki
Kazunori
K
Morimoto
Nobutoshi
N
Ohta
Yasuyuki
Y
Takehisa
Yasushi
Y
Nagai
Makiko
M
Kawarabayashi
Takeshi
T
Takao
Yoshiki
Y
Ohta
Taisei
T
Harigaya
Yasuo
Y
Manabe
Yasuhiro
Y
Kamiya
Tatsushi
T
Shoji
Mikio
M
Abe
Koji
K
D000368:Aged; D001284:Atrophy / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D003545:Cysteine / Q000031:analogs & derivatives; D003704:Dementia / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D003937:Diagnosis, Differential; D005133:Eye Movements / Q000502:physiology; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply / Q000000981:diagnostic imaging; D006801:Humans; D007457:Iodine Radioisotopes; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009069:Movement Disorders / Q000175:diagnosis* / Q000503:physiopathology; D009127:Muscle Rigidity; D017120:Nystagmus, Optokinetic / Q000502:physiology; D015609:Organotechnetium Compounds; D011859:Radiography; D013494:Supranuclear Palsy, Progressive / Q000175:diagnosis* / Q000503:physiopathology; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D007457:Iodine Radioisotopes; D015609:Organotechnetium Compounds; C059659:technetium Tc 99m bicisate; D003545:Cysteine