Differentiation of Parkinson’s disease and multiple system atrophy in early disease stages by means of I-123-MIBG–SPECT

Background: Differential diagnosis between idiopathic Parkinson’s disease (PD) and multiple system atrophy (MSA) is often difficult in early disease stages. Since MSA is misdiagnosed as PD in more than 20% of the early stages, there is need for methods refining the differentiation of the two disease...

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Bibliographic Details
Published in:Journal of the neurological sciences 2000-04, Vol.175 (1), p.3-12
Main Authors: Druschky, A, Hilz, M.J, Platsch, G, Radespiel-Tröger, M, Druschky, K, Kuwert, T, Neundörfer, B
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
Disease Progression
Female
Heart - diagnostic imaging
Heart - physiopathology
Heart Rate - physiology
Humans
I-123-MIBG–SPECT, Cardiac sympathetic denervation, Heart rate variability
Male
Medical sciences
Middle Aged
Multiple system atrophy
Multiple System Atrophy - diagnostic imaging
Multiple System Atrophy - physiopathology
Neurology
Parkinson Disease - diagnostic imaging
Parkinson Disease - physiopathology
Parkinson’s disease
Space life sciences
Sympathetic Fibers, Postganglionic - diagnostic imaging
Sympathetic Fibers, Postganglionic - physiopathology
Time Factors
Tomography, Emission-Computed, Single-Photon
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Summary:Background: Differential diagnosis between idiopathic Parkinson’s disease (PD) and multiple system atrophy (MSA) is often difficult in early disease stages. Since MSA is misdiagnosed as PD in more than 20% of the early stages, there is need for methods refining the differentiation of the two disease entities. In PD postganglionic involvement of the autonomic nervous system (ANS) predominates whereas in MSA the ANS is mainly affected in its preganglionic structures. The functional integrity of postganglionic cardiac sympathetic neurons can be investigated using I-123- metaiodobenzylguanidine–single photon emission computed tomography (MIBG–SPECT). Objectives: We investigated whether I-123-MIBG–SPECT allows to differentiate between early stages of PD and MSA in patients not yet requiring L-dopa therapy. Methods: Thirty patients (10 PD and 20 MSA patients) underwent MIBG–SPECT and evaluation of heart rate variability (HRV). Patients on any medication interfering with MIBG-accumulation were excluded from the study. Cardiac perfusion was evaluated by myocardial scintigraphy. Results: The median cardiac MIBG uptake was significantly decreased in PD as well as MSA patients compared to controls ( P
ISSN:0022-510X
1878-5883
DOI:10.1016/S0022-510X(00)00279-3