Combined use of ¹²³I-metaiodobenzylguanidine (MIBG) scintigraphy and dopamine transporter (DAT) positron emission tomography (PET) predicts prognosis in drug-induced Parkinsonism (DIP): a 2-year follow-up study.
DIP is a heterogeneous clinical syndrome; some patients develop persistent and worsening of parkinsonian symptoms after discontinuation of the offending drug, or Parkinson's disease (PD) reappears later after a full remission from DIP. However, it is difficult to predict the prognosis in patients with DIP. Herein, we evaluated whether the combined use of (18)F-N-(3-fluoropropyl)-2 beta-carbon ethoxy-3beta-(4-iodophenyl) nortropane (FP-CIT) PET and cardiac MIBG scintigraphy can be used to help distinguish the prognosis in patients with DIP. Among 20 patients enrolled, 16 showed normal DAT uptake and normal myocardial sympathetic innervation. After withdrawal of the suspected drugs, the patients experienced a clinical remission of parkinsonian motor symptoms within 3 months and did not experience any new movement symptoms after at least 2 years of follow-up. Two patients with a moderate decrease in DAT uptake and impaired sympathetic denervation showed worsening of motor manifestations 3 months after discontinuation of the drugs. Another two patients with normal DAT uptake and decreased MIBG uptake, presented full remission of motor symptoms within 2 months after discontinuation of the drugs. However, these two patients eventually developed parkinsonism within 2 years of the follow-up period. The follow-up scans revealed severe decreased DAT uptake in the putamen and similar ranges of cardiac sympathetic denervation. The results suggest that the combined use of these techniques can predict the prognosis of DIP and suggest a proper therapeutic plan for DIP.
Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 505, Banpo-dong, Seocho-gu, Seoul 137-701, Republic of Korea. neuronet@catholic.ac.kr
Joong-Seok
JS
Kim
Yoon-Sang
YS
Oh
Yeong-In
YI
Kim
Dong-Won
DW
Yang
Yong-An
YA
Chung
Ie-Ryung
IeR
You
Kwang-Soo
KS
Lee
D019797:3-Iodobenzylguanidine; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging*; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D059906:Neuroimaging / Q000379:methods; D020734:Parkinsonian Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D011877:Radionuclide Imaging / Q000379:methods
D050483:Dopamine Plasma Membrane Transport Proteins; D019797:3-Iodobenzylguanidine