Prospective study of presynaptic dopaminergic imaging in patients with mild parkinsonism and tremor disorders: Part 1. Baseline and 3-month observations

• Published in: Movement disorders 2003-09, Vol.18 (9), p.977-984
• Main Authors: Benamer, Hani T.S., Oertel, Wolfgang H., Patterson, Jim, Hadley, Donald M., Pogarell, Oliver, Höffken, H., Gerstner, A., Grosset, Donald G.
• Format: Article
• Language: English
• Subjects: [123I]-FP-CIT SPECT; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Corpus Striatum - diagnostic imaging; Corpus Striatum - metabolism; Dopamine - deficiency; Dopamine Plasma Membrane Transport Proteins; Essential Tremor - diagnostic imaging; Essential Tremor - metabolism; Female; Humans; Iodine Isotopes; Male; Medical sciences; Membrane Glycoproteins; Membrane Transport Proteins; Middle Aged; Nerve Tissue Proteins; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Nortropanes; Parkinson Disease - diagnostic imaging; Parkinson Disease - metabolism; parkinsonism; Radiography; Severity of Illness Index; Time Factors; Tomography, Emission-Computed, Single-Photon; tremor; Tropanes
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.10482

To record prospectively, from early presentation, the clinical features of parkinsonism and tremor disorders, in relation to evidence of dopaminergic deficit shown with [123I]‐FP‐CIT (DaTSCAN, Amersham Health) single photon emission computerised tomography (SPECT). Clinical signs were recorded in 62 patients, of whom 24 failed standard Parkinson's disease (PD) and essential tremor criteria, and 38 fulfilled UK Brain Bank step 1 PD criteria. Striatal radioligand uptake was graded visually as normal or abnormal, and specific:nonspecific ratios were calculated. Bradykinesia and rigidity showed significant overall association with abnormal scans (P ≤ 0.003), but rest tremor did not (P = NS). In the 24 patients not fulfilling specific criteria (mean age 63 [SD 9] years, disease duration 3 [SD 4] years), 10 (42%) had abnormal visual SPECT assessment and 14 (58%) had normal scans. Of 38 patients with early PD by clinical criteria (mean age 60 [SD 9] years, disease duration 3 [SD 1.7] years), 33 (87%) were visually abnormal. Baseline clinical diagnosis corresponded with SPECT imaging results in 51 of 62 cases (82%), which increased to 56 of 62 cases (90%) with amendment of seven clinical diagnoses at 3 months (blind to SPECT results). Akinetic–rigid cardinal diagnostic features of parkinsonism associate well with dopaminergic deficit in patients with early and mild clinical features. When these clinical features are uncertain, or the patient fails clinical diagnostic criteria, testing for dopaminergic deficit with [123I]‐FP‐CIT SPECT may assist the diagnostic process. © 2003 Movement Disorder Society