title: MIBG myocardial scintigraphy in pre-motor Parkinson's disease: a review.
abstract: OBJECTIVE
  Detecting very early markers of neurodegeneration that predate the diagnosis of idiopathic Parkinson's disease (PD) is a crucial research topic for the development of disease-modifying therapeutic interventions. Recently (123)I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy has become widely used for this purpose, since this test shows high sensitivity and specificity in the diagnosis of PD, based on evidence that cardiac sympathetic nerve fibers are affected early and commonly in PD. We reviewed the literature to determine the role of MIBG myocardial scintigraphy for diagnosing pre-motor PD.
  
  
  METHODS
  We performed a systematic review of the literature to identify the use of MIBG myocardial scintigraphy in relation to the constellation of pre-motor symptoms in PD.
  
  
  RESULTS
  Mild memory disorder, autonomic failure (constipation and postural hypotension), depression/anxiety, visual hallucination/psychosis (in the elderly), sleep disorder (REM sleep behavior disorder), and impaired olfaction are reported to appear as sole initial symptoms of PD. All clinical features except for impaired olfaction are accompanied by low MIBG uptake, suggestive of very early PD in situ.
  
  
  CONCLUSIONS
  Identifying persons with mild memory disorder, constipation/postural hypotension, depression/anxiety, visual hallucination/psychosis (in the elderly), and REM sleep behavior disorder associated with low MIBG uptake may provide a unique opportunity to detect very early PD in situ within a pre-clinical window. Future prospective studies to investigate further the findings of these early cases are warranted.
authors: Neurology, Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura 285-8741, Japan. Electronic address: sakakibara@sakura.med.toho-u.ac.jp.
authors: Ryuji
authors: R
authors: Sakakibara
authors: Neurology, Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura 285-8741, Japan.
authors: Fuyuki
authors: F
authors: Tateno
authors: Neurology, Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura 285-8741, Japan.
authors: Masahiko
authors: M
authors: Kishi
authors: Neurology, Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura 285-8741, Japan.
authors: Yohei
authors: Y
authors: Tsuyusaki
authors: Radiology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan.
authors: Hitoshi
authors: H
authors: Terada
authors: Radiology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan.
authors: Tsutomu
authors: T
authors: Inaoka
mesh_terms: D019797:3-Iodobenzylguanidine; D000818:Animals; D003248:Constipation / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications / Q000000981:diagnostic imaging; D008569:Memory Disorders / Q000150:complications / Q000000981:diagnostic imaging; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D010300:Parkinson Disease / Q000150:complications / Q000000981:diagnostic imaging*; D020187:REM Sleep Behavior Disorder / Q000150:complications / Q000000981:diagnostic imaging; D019275:Radiopharmaceuticals
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine
keywords: Autonomic dysfunction; Metaiodobenzylguanidine; Non-motor dysfunction; Parkinson's disease; Pre-motor dysfunction