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Georgiopoulos C, Davidsson A, Engström M, Larsson EM, Zachrisson H, Dizdar N. The diagnostic value of dopamine transporter imaging and olfactory testing in patients with parkinsonian syndromes. J Neurol 2015; 262:2154-63. [PMID: 26122543 DOI: 10.1007/s00415-015-7830-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/10/2015] [Accepted: 06/17/2015] [Indexed: 11/27/2022]
Abstract
The aim of the study was to compare the efficacy of olfactory testing and presynaptic dopamine imaging in diagnosing Parkinson's disease (PD) and atypical parkinsonian syndromes (APS); to evaluate if the combination of these two diagnostic tools can improve their diagnostic value. A prospective investigation of 24 PD patients, 16 APS patients and 15 patients with non-parkinsonian syndromes was performed during an 18-month period. Single photon emission computed tomography with the presynaptic radioligand (123)I-FP-CIT (DaTSCAN(®)) and olfactory testing with the Brief 12-item Smell Identification Test (B-SIT) were performed in all patients. DaTSCAN was analysed semi-quantitatively, by calculating two different striatal uptake ratios, and visually according to a predefined ranking scale. B-SIT score was significantly lower for PD patients, but not significantly different between APS and non-parkinsonism. The visual assessment of DaTSCAN had higher sensitivity, specificity and diagnostic accuracy compared to olfactory testing. Most PD patients (75%) had visually predominant dopamine depletion in putamen, while most APS patients (56%) had visually severe dopamine depletion both in putamen and in caudate nucleus. The combination of DaTSCAN and B-SIT led to a higher rate of correctly classified patients. Olfactory testing can distinguish PD from non-parkinsonism, but not PD from APS or APS from non-parkinsonism. DaTSCAN is more efficient than olfactory testing and can be valuable in differentiating PD from APS. However, combining olfactory testing and DaTSCAN imaging has a higher predictive value than these two methods separately.
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Affiliation(s)
- Charalampos Georgiopoulos
- Department of Radiology, Linköping University, 581 85, Linköping, Sweden. .,Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden. .,Center for Medical Image Science and Visualization (CMIV), Linköping University, 581 85, Linköping, Sweden.
| | - Anette Davidsson
- Department of Clinical Physiology, Linköping University, 581 85, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden
| | - Maria Engström
- Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, 581 85, Linköping, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences/Radiology, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden
| | - Helene Zachrisson
- Department of Clinical Physiology, Linköping University, 581 85, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden
| | - Nil Dizdar
- Department of Neurology, Linköping University, 581 85, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, 581 85, Linköping, Sweden
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Abstract
Interferon has been used to treat chronic viral hepatitis and several malignancies. However, it may cause various neuropsychiatric adverse effects including parkinsonism. We report a rare case of interferon alpha-2a therapy-related parkinsonism in a 67-year-old man with metastatic papillary renal cell carcinoma and our experience of using Tc-99m-TRODAT-1 single photon emission computed tomography (SPECT) as a tool for evaluation of parkinsonism. Physicians should be alert to the possibility of interferon alpha-2a-related parkinsonism.
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Suwijn SR, van Boheemen CJM, de Haan RJ, Tissingh G, Booij J, de Bie RMA. The diagnostic accuracy of dopamine transporter SPECT imaging to detect nigrostriatal cell loss in patients with Parkinson's disease or clinically uncertain parkinsonism: a systematic review. EJNMMI Res 2015; 5:12. [PMID: 25853018 PMCID: PMC4385258 DOI: 10.1186/s13550-015-0087-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/19/2015] [Indexed: 02/08/2023] Open
Abstract
In specialized movement disorder centers, Parkinson's disease (PD) is wrongly diagnosed in 6 to 25% of cases. To improve the accuracy of the clinical diagnosis, it is necessary to have a reliable and practical reference standard. Dopamine transporter single-photon emission computed tomography (DAT SPECT) imaging might have the potential (high diagnostic accuracy and practical to use) to act as reference standard in detecting nigrostriatal cell loss in patients with (early stage) parkinsonism. We performed a systematic review to evaluate if DAT SPECT imaging can be used as such. Relevant studies were searched in the MEDLINE and EMBASE databases. Studies were selected when they met the following criteria: (1) all patients were adults with a clinical diagnosis of PD or clinically uncertain parkinsonism and (2) the study reported original data. In addition, studies needed to fulfill one of the two following criteria: (1) patients underwent at least one DAT SPECT and had a neuropathological confirmed diagnosis and (2) patients underwent at least two DAT SPECT scans, performed at least 2 years apart. The search identified 1,649 articles. Eight studies fulfilled our selection criteria and were included in this review. There was only one study including patients with diagnostic uncertainty. Sensitivity and specificity of DAT SPECT imaging to detect nigrostriatal cell loss were 98%. The other studies included patients with a diagnosis of PD in whom there was no uncertainty. In these studies, sensitivity was 100%. Our systematic review indicates that DAT SPECT imaging seems to be accurate to detect nigrostriatal cell loss in patients with parkinsonism.
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Affiliation(s)
- Sven R Suwijn
- />Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Caroline JM van Boheemen
- />Department of Neurology, Medical Center Haaglanden, Lijnbaan 32, PO Box 432, 2501 CK The Hague, The Netherlands
| | - Rob J de Haan
- />Department of Clinical Research Unit, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Gerrit Tissingh
- />Department of Neurology, Atrium Medical Center Parkstad, Henri Dunantstraat 5, PO Box 4446, 6401 CX Heerlen, The Netherlands
| | - Jan Booij
- />Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Rob MA de Bie
- />Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands
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Robust, fully automatic delineation of the head contour by stereotactical normalization for attenuation correction according to Chang in dopamine transporter scintigraphy. Eur Radiol 2015; 25:2709-17. [PMID: 25716941 DOI: 10.1007/s00330-015-3667-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 01/27/2015] [Accepted: 02/12/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Chang's method, the most widely used attenuation correction (AC) in brain single-photon emission computed tomography (SPECT), requires delineation of the outer contour of the head. Manual and automatic threshold-based methods are prone to errors due to variability of tracer uptake in the scalp. The present study proposes a new method for fully automated delineation of the head based on stereotactical normalization. The method was validated for SPECT with I-123-ioflupane. METHODS The new method was compared to threshold-based delineation in 62 unselected patients who had received I-123-ioflupane SPECT at one of 3 centres. The impact on diagnostic power was tested for semi-quantitative analysis and visual reading of the SPECT images (six independent readers). RESULTS The two delineation methods produced highly consistent semi-quantitative results. This was confirmed by receiver operating characteristic analyses in which the putamen specific-to-background ratio achieved highest area under the curve with negligible effect of the delineation method: 0.935 versus 0.938 for stereotactical normalization and threshold-based delineation, respectively. Visual interpretation of DVR images was also not affected by the delineation method. CONCLUSIONS Delineation of the head contour by stereotactical normalization appears useful for Chang AC in I-123-ioflupane SPECT. It is robust and does not require user interaction. KEY POINTS •Chang attenuation correction in brain SPECT requires delineation of the head contour. •Manual and threshold-based methods are prone to errors. •The study proposes a fully-automated method for delineation based on stereotactical normalization. •The method is shown to work reliably in I-123-ioflupane SPECT. •It might improve the workflow of I-123-ioflupane SPECT in everyday patient care.
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Moccia M, Pappatà S, Erro R, Picillo M, Vitale C, Amboni M, Longo K, Palladino R, Barone P, Pellecchia MT. Uric acid relates to dopamine transporter availability in Parkinson's disease. Acta Neurol Scand 2015; 131:127-31. [PMID: 25288358 DOI: 10.1111/ane.12295] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Diagnosing Parkinson's disease (PD) and tracking its progression may require the combination of reliable biomarkers. Among them, both serum uric acid (UA) and dopamine transporter (DaT) binding deserve more investigations. AIMS OF THE STUDY We aimed to investigate the relationship between serum UA levels and DaT availability in newly diagnosed, drug-naïve PD patients, by means of semiquantitative [(123) I]FP-CIT-SPECT. METHODS We recruited 52 newly diagnosed, drug-naïve PD patients, and performed serum UA dosage and [(123) I]FP-CIT-SPECT. RESULTS Pearson's correlation analysis showed that UA levels were significantly higher in patients with higher averaged, ipsilateral and contralateral DaT binding in caudate, putamen, and striatum. CONCLUSIONS We showed, for the first time, by regional semiquantitative analysis of DaT binding in PD patients that UA levels significantly correlates with the severity of dopaminergic impairment in caudate, putamen, and striatum. This study broadens our knowledge on the importance of UA as a biomarker of PD.
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Affiliation(s)
- M. Moccia
- Department of Neuroscience, Reproductive Science and Odontostomatology; Federico II University; Naples Italy
| | - S. Pappatà
- Institute of Biostructure and Bioimaging; CNR; Naples Italy
| | - R. Erro
- Sobell Department of Motor Neuroscience and Movement Disorders; University College London (UCL), Institute of Neurology; London UK
- Dipartimento di Scienze Neurologiche e del Movimento; Università di Verona, Policlinico Borgo Roma; Verona Italy
| | - M. Picillo
- Department of Neuroscience, Reproductive Science and Odontostomatology; Federico II University; Naples Italy
| | - C. Vitale
- University of Naples Parthenope; Naples Italy
- IDC Hermitage-Capodimonte; Naples Italy
| | - M. Amboni
- IDC Hermitage-Capodimonte; Naples Italy
| | - K. Longo
- IDC Hermitage-Capodimonte; Naples Italy
| | - R. Palladino
- Department of Primary Care and Public Health; Imperial College; London UK
- Department of Public Health; Federico II University; Naples Italy
| | - P. Barone
- Center for Neurodegenerative Diseases (CEMAND); Neuroscience Section; Department of Medicine; University of Salerno; Salerno Italy
| | - Maria Teresa Pellecchia
- Center for Neurodegenerative Diseases (CEMAND); Neuroscience Section; Department of Medicine; University of Salerno; Salerno Italy
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Sadasivan S, Friedman JH. Experience with DaTscan at a tertiary referral center. Parkinsonism Relat Disord 2015; 21:42-5. [DOI: 10.1016/j.parkreldis.2014.10.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/19/2014] [Accepted: 10/21/2014] [Indexed: 11/28/2022]
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Bor-Seng-Shu E, Felicio AC, Braga-Neto P, Batista IR, Paiva WS, de Andrade DC, Teixeira MJ, de Andrade LAF, Barsottini OGP, Shih MC, Bressan RA, Ferraz HB. Dopamine transporter imaging using 99mTc-TRODAT-1 SPECT in Parkinson's disease. Med Sci Monit 2014; 20:1413-8. [PMID: 25109468 PMCID: PMC4138066 DOI: 10.12659/msm.890522] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Although the decrease in striatal dopamine transporter (DAT) density has been described in North American, European, and Asian Parkinson’s disease (PD) patients, studies on this issue are required in the rest of the world. This study examined the diagnostic utility of DAT imaging in Brazilian PD patients. Material/Methods Twenty PD patients (13 males, 7 females, median age: 62 years, median age at disease onset: 56 years, median disease duration: 5 years, and median UPDRS-III score: 29) and 9 age- and sex-matched healthy subjects underwent single-photon emission computerized tomography (SPECT) using 99mTc-TRODAT-1. Results PD patients showed a significant decrease in the striatum, caudate nucleus, and putamen DAT densities compared with data from healthy subjects. Striatal 99mTc-TRODAT-1 bindings had the highest diagnostic accuracy compared to those estimates from caudate nucleus and putamen. For the diagnosis of PD, a striatal 99mTc-TRODAT-1 binding cut-off value of 0.90 was associated with a sensitivity of 100% and a specificity of 89%. There was no significant difference between striatal 99mTc-TRODAT-1 binding values provided by different readers, contrary to 99mTc-TRODAT-1 binding estimates in the caudate nucleus. Conclusions Striatal DAT imaging using 99mTc-TRODAT-1 can be considered a marker for differentiating PD patients from healthy individuals, with a good interobserver reproducibility.
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Affiliation(s)
- Edson Bor-Seng-Shu
- Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Andre C Felicio
- Departments of Neurology and Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Pedro Braga-Neto
- Department of Neurology and Neurosurgery, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Ilza Rosa Batista
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Wellingson Silva Paiva
- Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Daniel Ciampi de Andrade
- Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | | | | | - Ming Chi Shih
- Department of Neurology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Rodrigo A Bressan
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
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iPLA2β knockout mouse, a genetic model for progressive human motor disorders, develops age-related neuropathology. Neurochem Res 2014; 39:1522-32. [PMID: 24919816 DOI: 10.1007/s11064-014-1342-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 04/23/2014] [Accepted: 05/22/2014] [Indexed: 12/21/2022]
Abstract
Calcium-independent phospholipase A2 group VIa (iPLA2β) preferentially releases docosahexaenoic acid (DHA) from the sn-2 position of phospholipids. Mutations of its gene, PLA2G6, are found in patients with several progressive motor disorders, including Parkinson disease. At 4 months, PLA2G6 knockout mice (iPLA2β(-/-)) show minimal neuropathology but altered brain DHA metabolism. By 1 year, they develop motor disturbances, cerebellar neuronal loss, and striatal α-synuclein accumulation. We hypothesized that older iPLA2β(-/-) mice also would exhibit inflammatory and other neuropathological changes. Real-time polymerase chain reaction and Western blotting were performed on whole brain homogenate from 15 to 20-month old male iPLA2β(-/-) or wild-type (WT) mice. These older iPLA2β(-/-) mice compared with WT showed molecular evidence of microglial (CD-11b, iNOS) and astrocytic (glial fibrillary acidic protein) activation, disturbed expression of enzymes involved in arachidonic acid metabolism, loss of neuroprotective brain derived neurotrophic factor, and accumulation of cytokine TNF-α messenger ribonucleic acid, consistent with neuroinflammatory pathology. There was no evidence of synaptic loss, of reduced expression of dopamine active reuptake transporter, or of accumulation of the Parkinson disease markers Parkin or Pink1. iPLA2γ expression was unchanged. iPLA2β deficient mice show evidence of neuroinflammation and associated neuropathology with motor dysfunction in later life. These pathological biomarkers could be used to assess efficacy of dietary intervention, antioxidants or other therapies on disease progression in this mouse model of progressive human motor diseases associated with a PLA2G6 mutation.
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Booth TC, Nathan M, Waldman AD, Quigley AM, Schapira AH, Buscombe J. The role of functional dopamine-transporter SPECT imaging in parkinsonian syndromes, part 2. AJNR Am J Neuroradiol 2014; 36:236-44. [PMID: 24924549 DOI: 10.3174/ajnr.a3971] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY The functional imaging technique most widely used in European clinics to differentiate a true parkinsonian syndrome from vascular parkinsonism, drug-induced changes, or essential tremor is dopamine-transporter SPECT. This technique commonly reports dopamine-transporter function, with decreasing striatal uptake demonstrating increasingly severe disease. The strength of dopamine-transporter SPECT is that nigrostriatal degeneration is observed in both clinically inconclusive parkinsonism and early, even premotor, disease. In this clinical review (Part 2), we present the dopamine-transporter SPECT findings in a variety of neurodegenerative diseases, including multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, and dementia with Lewy bodies. The findings in vascular parkinsonism, drug-induced parkinsonism, and essential tremor are also described. It is hoped that this technique will be the forerunner of a range of routinely used, process-specific ligands that can identify early degenerative disease and subsequently guide disease-modifying interventions.
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Affiliation(s)
- T C Booth
- From the Department of Neuroradiology (T.C.B.), National Hospital for Neurology and Neurosurgery, London, UK
| | - M Nathan
- Department of Nuclear Medicine (M.N., A.-M.Q.), Royal Free Hospital NHS Trust, London, UK
| | - A D Waldman
- Department of Imaging (A.D.W.), Imperial College Healthcare NHS Trust, London, UK
| | - A-M Quigley
- Department of Nuclear Medicine (M.N., A.-M.Q.), Royal Free Hospital NHS Trust, London, UK
| | - A H Schapira
- Department of Clinical Neurosciences (A.H.S.), Institute of Neurology, University College London, London, UK
| | - J Buscombe
- Department of Nuclear Medicine (J.B.), Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Booth TC, Nathan M, Waldman AD, Quigley AM, Schapira AH, Buscombe J. The role of functional dopamine-transporter SPECT imaging in parkinsonian syndromes, part 1. AJNR Am J Neuroradiol 2014; 36:229-35. [PMID: 24904053 DOI: 10.3174/ajnr.a3970] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
SUMMARY As we defeat infectious diseases and cancer, one of the greatest medical challenges facing us in the mid-21st century will be the increasing prevalence of degenerative disease. Those diseases, which affect movement and cognition, can be the most debilitating. Dysfunction of the extrapyramidal system results in increasing motor disability often manifest as tremor, bradykinesia, and rigidity. The common pathologic pathway of these diseases, collectively described as parkinsonian syndromes, such as Parkinson disease, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, and dementia with Lewy bodies, is degeneration of the presynaptic dopaminergic pathways in the basal ganglia. Conventional MR imaging is insensitive, especially in early disease, so functional imaging has become the primary method used to differentiate a true parkinsonian syndrome from vascular parkinsonism, drug-induced changes, or essential tremor. Unusually for a modern functional imaging technique, the method most widely used in European clinics depends on SPECT and not PET. This SPECT technique (described in the first of 2 parts) commonly reports dopamine-transporter function, with decreasing striatal uptake demonstrating increasingly severe disease.
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Affiliation(s)
- T C Booth
- From the Department of Neuroradiology (T.C.B.), National Hospital for Neurology and Neurosurgery, London, UK
| | - M Nathan
- Department of Nuclear Medicine (M.N., A.-M.Q.), Royal Free Hospital National Health Service Trust, London, UK
| | - A D Waldman
- Department of Imaging (A.D.W.), Imperial College Healthcare National Health Service Trust, London, UK
| | - A-M Quigley
- Department of Nuclear Medicine (M.N., A.-M.Q.), Royal Free Hospital National Health Service Trust, London, UK
| | - A H Schapira
- Department of Clinical Neurosciences (A.H.S.), Institute of Neurology, University College London, London, UK
| | - J Buscombe
- Department of Nuclear Medicine (J.B.), Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Vriend C, Nordbeck AH, Booij J, van der Werf YD, Pattij T, Voorn P, Raijmakers P, Foncke EM, van de Giessen E, Berendse HW, van den Heuvel OA. Reduced dopamine transporter binding predates impulse control disorders in Parkinson's disease. Mov Disord 2014; 29:904-11. [DOI: 10.1002/mds.25886] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/17/2014] [Accepted: 03/17/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chris Vriend
- Department of Psychiatry; VU University Medical Center; Amsterdam The Netherlands
- Department of Anatomy & Neurosciences; VU University Medical Center; Amsterdam The Netherlands
- Neuroscience Campus Amsterdam; VU/VUmc; Amsterdam The Netherlands
| | - Anna H. Nordbeck
- Department of Anatomy & Neurosciences; VU University Medical Center; Amsterdam The Netherlands
| | - Jan Booij
- Department of Nuclear Medicine; Academic Medical Center; Amsterdam The Netherlands
| | - Ysbrand D. van der Werf
- Department of Anatomy & Neurosciences; VU University Medical Center; Amsterdam The Netherlands
- Neuroscience Campus Amsterdam; VU/VUmc; Amsterdam The Netherlands
- Netherlands Institute for Neuroscience; Royal Netherlands Academy of Arts and Sciences; Amsterdam The Netherlands
| | - Tommy Pattij
- Department of Anatomy & Neurosciences; VU University Medical Center; Amsterdam The Netherlands
| | - Pieter Voorn
- Department of Anatomy & Neurosciences; VU University Medical Center; Amsterdam The Netherlands
| | - Pieter Raijmakers
- Department of Radiology & Nuclear Medicine; VU University Medical Center (VUmc); Amsterdam The Netherlands
| | | | | | - Henk W. Berendse
- Department of Neurology; VU University Medical Center; Amsterdam The Netherlands
| | - Odile A. van den Heuvel
- Department of Psychiatry; VU University Medical Center; Amsterdam The Netherlands
- Department of Anatomy & Neurosciences; VU University Medical Center; Amsterdam The Netherlands
- Neuroscience Campus Amsterdam; VU/VUmc; Amsterdam The Netherlands
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Marek K, Seibyl J, Eberly S, Oakes D, Shoulson I, Lang AE, Hyson C, Jennings D. Longitudinal follow-up of SWEDD subjects in the PRECEPT Study. Neurology 2014; 82:1791-7. [PMID: 24759846 DOI: 10.1212/wnl.0000000000000424] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the clinical and imaging characteristics of those PRECEPT (Parkinson Research Examination of CEP-1347 Trial) subjects with a scan without evidence of dopaminergic deficit (SWEDD) to those with dopamine transporter (DAT) deficit scans at study baseline and during a 22-month follow-up. METHODS Baseline (n = 799) and 22-month follow-up (n = 701) [(123)I] β-CIT SPECT scans were acquired. The percent change in [(123)I] β-CIT striatal binding ratio, the percentage of subjects requiring dopaminergic therapy, the change in Unified Parkinson's Disease Rating Scale (UPDRS) score, and the PRECEPT Study investigators' diagnosis at study termination were compared between SWEDD and DAT deficit subjects. RESULTS SWEDD subjects (n = 91) compared with DAT deficit subjects (n = 708) showed reduced UPDRS score at baseline (18.7 [SD 8.5] vs 25.5 [SD 10.5], p < 0.05) and minimal change in both [(123)I] β-CIT striatal binding ratio (-0.2% [SD 12.2] vs -8.5% [SD 11.9], p < 0.0001) and UPDRS score (0.5 [SD 6.9] vs 10.5 [SD 8.9], p < 0.0001) at follow-up assessments. At PRECEPT termination, the diagnosis by study investigators was changed from Parkinson disease (PD) to other disorders not associated with DAT deficit in 44% (95% confidence interval 34.2, 54.7) of SWEDD subjects compared with 3.6% (95% confidence interval 2.3, 5.1) of DAT deficit subjects. CONCLUSION These results indicate that subjects identified as having a SWEDD, with DAT imaging within the normal range, have minimal evidence of clinical or imaging PD progression. These data strongly suggest that SWEDD subjects are unlikely to have idiopathic PD.
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Affiliation(s)
- Kenneth Marek
- From the Institute for Neurodegenerative Disorders (K.M., J.S., D.J.), University of Rochester (S.E., D.O.), Rochester, NY; Georgetown University (I.S.), Washington, DC; University of Toronto (A.E.L.); and Western University (C.H.), London, Ontario, Canada.
| | - John Seibyl
- From the Institute for Neurodegenerative Disorders (K.M., J.S., D.J.), University of Rochester (S.E., D.O.), Rochester, NY; Georgetown University (I.S.), Washington, DC; University of Toronto (A.E.L.); and Western University (C.H.), London, Ontario, Canada
| | - Shirley Eberly
- From the Institute for Neurodegenerative Disorders (K.M., J.S., D.J.), University of Rochester (S.E., D.O.), Rochester, NY; Georgetown University (I.S.), Washington, DC; University of Toronto (A.E.L.); and Western University (C.H.), London, Ontario, Canada
| | - David Oakes
- From the Institute for Neurodegenerative Disorders (K.M., J.S., D.J.), University of Rochester (S.E., D.O.), Rochester, NY; Georgetown University (I.S.), Washington, DC; University of Toronto (A.E.L.); and Western University (C.H.), London, Ontario, Canada
| | - Ira Shoulson
- From the Institute for Neurodegenerative Disorders (K.M., J.S., D.J.), University of Rochester (S.E., D.O.), Rochester, NY; Georgetown University (I.S.), Washington, DC; University of Toronto (A.E.L.); and Western University (C.H.), London, Ontario, Canada
| | - Anthony E Lang
- From the Institute for Neurodegenerative Disorders (K.M., J.S., D.J.), University of Rochester (S.E., D.O.), Rochester, NY; Georgetown University (I.S.), Washington, DC; University of Toronto (A.E.L.); and Western University (C.H.), London, Ontario, Canada
| | - Chris Hyson
- From the Institute for Neurodegenerative Disorders (K.M., J.S., D.J.), University of Rochester (S.E., D.O.), Rochester, NY; Georgetown University (I.S.), Washington, DC; University of Toronto (A.E.L.); and Western University (C.H.), London, Ontario, Canada
| | - Danna Jennings
- From the Institute for Neurodegenerative Disorders (K.M., J.S., D.J.), University of Rochester (S.E., D.O.), Rochester, NY; Georgetown University (I.S.), Washington, DC; University of Toronto (A.E.L.); and Western University (C.H.), London, Ontario, Canada
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Song IU, Chung YA, Oh JK, Chung SW. An FP-CIT PET comparison of the difference in dopaminergic neuronal loss in subtypes of early Parkinson's disease. Acta Radiol 2014; 55:366-71. [PMID: 23943629 DOI: 10.1177/0284185113498075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with tremor-dominant Parkinson's disease (PD) have slower disease progression, show less cognitive decline, and have more favorable outcomes than patients with non-tremor PD. However, the pathophysiology of PD tremor remains unclear. Whether there are differences in nigrostriatal dopaminergic dysfunction between the two PD subtypes is unknown. PURPOSE To evaluate the differences in regional dopamine transporter (DAT) density in the brain between different subtypes of early PD using FP-CIT PET/CT. MATERIAL AND METHODS We recruited 43 patients with PD (21 tremor-dominant PD [TP] and 22 non-tremor-dominant PD [NTP]) and 18 age-matched healthy controls. All patients with PD underwent FP-CIT PET/CT imaging and evaluated Parkinsonian motor severity by using the Hoehn and Yahr stage and Part III of the Unified Parkinson's Disease Rating Scale (UPDRS). We also compared tremor and non-tremor symptoms with motor phenotype scores between two subtypes of PD. RESULTS All patients with PD demonstrated a significantly decreased FP-CIT uptake in the putamen compared to healthy controls. Differences in putamen FP-CIT uptake versus caudate nucleus FP-CIT uptake in PD showed putamen uptake was significantly more impaired than that in the caudate nucleus. However, there was no significant difference in FP-CIT uptake in the striatum between both PD groups at the same early stage of disease. CONCLUSION We suggest that differential of DAT uptake in the striatum did not allow for a reliable separation of subtypes into tremor-dominant and non-tremor-dominant, especially in the early stages of PD. Therefore, we assumed that many systems besides the nigrostriatal dopaminergic system are involved in the generation of tremors in PD.
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Affiliation(s)
- In-Uk Song
- Department of Neurology, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Yong-An Chung
- Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Jin-Kyoung Oh
- Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Sung-Woo Chung
- Department of Neurology, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
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Nissen T, Malek N, Grosset KA, Newman EJ, Patterson J, Hadley D, Grosset DG. Baseline [(123) I]FP-CIT SPECT (DaTSCAN) severity correlates with medication use at 3 years in Parkinson's disease. Acta Neurol Scand 2014; 129:204-8. [PMID: 23962145 DOI: 10.1111/ane.12178] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Presynaptic dopaminergic deficiency on dopamine transporter imaging supports a clinical diagnosis of Parkinson's disease and correlates with the severity of rigidity and bradykinesia. Baseline dopaminergic deficiency predicts clinical severity, but the relationship with subsequent medication use has not been reported. METHODS A randomly selected cross section of 83 Parkinson's disease (PD) patients who had [(123) I] FP-CIT SPECT at the time of clinical diagnosis was identified. Dopaminergic deficiency was graded 1, 2 or 3 with increasing severity using visual assessment and by semiquantitative analysis of putamen and caudate uptake. Antiparkinson medication usage and clinical severity by Hoehn and Yahr were noted annually to 3 years. RESULTS In 83 patients (66% male, median age 65.0 years, IQ 55.4-71.8), [(123) I]FP-CIT SPECT was grade 1 in 20 (24%), grade 2 in 53 (64%) and grade 3 in 10 patients (12%). Dopamine transporter uptake ratios were inversely associated with antiparkinson medication usage (r = -0.26, P = 0.0201) and Hoehn Yahr stage (r = -0.32, P = 0.0029) at 3 years from baseline, but there was considerable variation in drug usage in individual patients. At 3 years, patients with grade 1 scans at baseline received a median dose of 325 levodopa equivalent units (LEU) (interquartile range 175-433); grade 2 scan patients 400 LEU (interquartile range 300-635); and grade 3 scan patients 460 LEU (interquartile range 252-658). CONCLUSION The degree of reduction in presynaptic dopaminergic uptake at baseline is associated with higher antiparkinson drug dosage at follow-up, but the wide variation means that the baseline FP-CIT SPECT does not reliably predict drug use in individual cases.
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Affiliation(s)
- T. Nissen
- Department of Neurology; Klinikum Bremerhaven; Bremerhaven Germany
| | - N. Malek
- Department of Neurology; Institute of Neurological Sciences; Southern General Hospital; Glasgow UK
| | - K. A. Grosset
- Department of Neurology; Institute of Neurological Sciences; Southern General Hospital; Glasgow UK
| | - E. J. Newman
- Department of Neurology; Institute of Neurological Sciences; Southern General Hospital; Glasgow UK
| | - J. Patterson
- Department of Nuclear Medicine Physics; Institute of Neurological Sciences; Southern General Hospital; Glasgow UK
| | - D. Hadley
- Department of Neuroradiology; Institute of Neurological Sciences; Southern General Hospital; Glasgow UK
| | - D. G. Grosset
- Department of Neurology; Institute of Neurological Sciences; Southern General Hospital; Glasgow UK
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Imaging of the dopamine transporter predicts pattern of disease progression and response to levodopa in patients with schizophrenia and parkinsonism: a 2-year follow-up multicenter study. Schizophr Res 2014; 152:344-9. [PMID: 24369987 DOI: 10.1016/j.schres.2013.11.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 11/17/2013] [Accepted: 11/18/2013] [Indexed: 12/21/2022]
Abstract
Similarly to subjects with degenerative parkinsonism, (123)I-FP-CIT SPECT has been reported either normal or abnormal in patients with drug-induced parkinsonism (DIP), challenging the notion that parkinsonism might be entirely due to post-synaptic D2-receptors blockade by antipsychotic drugs. In a previous multicenter cross-sectional study conducted on a large sample of patients with schizophrenia, we identified 97 patients who developed parkinsonism with a similar bi-modal distribution of DAT-SPECT. In this longitudinal study, we reported clinical and imaging features associated with progression of motor disability over 2-year follow-up in 60 out of those 97 patients with schizophrenia and parkinsonism who underwent (123)I-FP-CIT SPECT at baseline evaluation (normal SPECT=33; abnormal SPECT=27). As second end-point, chronic response to levodopa over a 3-month period was tested in a subgroup of subjects. Motor Unified Parkinson's Disease Rating Scale (UPDRS) at follow-up significantly increased in patients with abnormal SPECT. Specifically, a 6-point worsening was demonstrated in 18.5% of the subjects with abnormal SPECT and in none of the subjects with normal SPECT. Levodopa treatment improved motor UPDRS only in the group with abnormal SPECT. After adjustment for possible confounders, linear regression analysis demonstrated that abnormal SPECT findings at baseline were the only predictor of motor disability progression and of better outcome of levodopa treatment. Our results support the notion that a degenerative disease might underlie parkinsonism in a minority of schizophrenic patients chronically exposed to antipsychotics. Functional imaging of the dopamine transporter can be helpful to select this patient sub-group that might benefit from levodopa therapy.
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Antonini A, Isaias IU. Single photon-emission computed tomography imaging in early Parkinson’s disease. Expert Rev Neurother 2014; 8:1853-64. [DOI: 10.1586/14737175.8.12.1853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bozzali M, Serra L. Biomarkers for Alzheimer’s Disease and Frontotemporal Lobar Degeneration: Imaging. NEURODEGENER DIS 2014. [DOI: 10.1007/978-1-4471-6380-0_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kim JM, Kim JS, Kim KW, Lee SB, Park JH, Lee JJ, Kim YK, Kim SE, Jeon BS. Study of the prevalence of Parkinson's disease using dopamine transporter imaging. Neurol Res 2013; 32:845-51. [DOI: 10.1179/016164109x12581096796396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Vriend C, Pattij T, van der Werf YD, Voorn P, Booij J, Rutten S, Berendse HW, van den Heuvel OA. Depression and impulse control disorders in Parkinson's disease: two sides of the same coin? Neurosci Biobehav Rev 2013; 38:60-71. [PMID: 24239733 DOI: 10.1016/j.neubiorev.2013.11.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/11/2013] [Accepted: 11/03/2013] [Indexed: 02/01/2023]
Abstract
Depression and impulse control disorders (ICD) are two common neuropsychiatric features in Parkinson's disease (PD). Studies have revealed that both phenomena are associated with aberrations in ventral striatal dopamine signaling and concomitant dysfunction of the reward-related (limbic) cortico-striatal-thalamocortical (CSTC) circuit. Depression in PD seems associated with decreased activity in the limbic CSTC circuit, whereas ICD seem associated with increased limbic CSTC circuit activity, usually after commencing dopamine replacement therapy (DRT). Not all DRT using PD patients, however, develop symptoms of ICD, suggesting an additional underlying neurobiological susceptibility. Furthermore, the symptoms of depression and ICD frequently coincide even though they are related to seemingly contrasting limbic CSTC circuit activation states. The aim of this review is to provide an overview of the currently available literature on the neurobiology of PD-related depression and ICD and discusses possible susceptibility factors. Finally, we propose a neurobiological model that identifies ventral striatal dopaminergic denervation as a common underlying neurobiological substrate of depression and ICD and subsequent dysfunction of reward and motivation-related brain areas.
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Affiliation(s)
- Chris Vriend
- Department of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands; Department of Anatomy & Neurosciences, VUmc, Amsterdam, The Netherlands; Neuroscience Campus Amsterdam, VU/VUmc, Amsterdam, The Netherlands.
| | - Tommy Pattij
- Department of Anatomy & Neurosciences, VUmc, Amsterdam, The Netherlands; Neuroscience Campus Amsterdam, VU/VUmc, Amsterdam, The Netherlands
| | - Ysbrand D van der Werf
- Department of Anatomy & Neurosciences, VUmc, Amsterdam, The Netherlands; Neuroscience Campus Amsterdam, VU/VUmc, Amsterdam, The Netherlands; Department of Emotion & Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Pieter Voorn
- Department of Anatomy & Neurosciences, VUmc, Amsterdam, The Netherlands
| | - Jan Booij
- Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Sonja Rutten
- Department of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands; Department of Anatomy & Neurosciences, VUmc, Amsterdam, The Netherlands
| | - Henk W Berendse
- Neuroscience Campus Amsterdam, VU/VUmc, Amsterdam, The Netherlands; Department of Neurology, VUmc, Amsterdam, The Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands; Department of Anatomy & Neurosciences, VUmc, Amsterdam, The Netherlands; Neuroscience Campus Amsterdam, VU/VUmc, Amsterdam, The Netherlands
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Ciarmiello A, Giovacchini G, Guidotti C, Meniconi M, Lazzeri P, Carabelli E, Mansi L, Mariani G, Volterrani D, Del Sette M. Weighted registration of123I-FP-CIT SPECT images improves accuracy of binding potential estimates in pathologically low striatal uptake. J Cell Physiol 2013; 228:2086-94. [DOI: 10.1002/jcp.24378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 03/25/2013] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Claudio Guidotti
- Nuclear Medicine Department; Hospital S. Andrea; La Spezia; Italy
| | - Martina Meniconi
- Nuclear Medicine Department; Hospital S. Andrea; La Spezia; Italy
| | - Patrizia Lazzeri
- Nuclear Medicine Department; Hospital S. Andrea; La Spezia; Italy
| | | | - Luigi Mansi
- Nuclear Medicine; Second University of Naples; Napoli; Italy
| | - Giuliano Mariani
- Regional Center of Nuclear Medicine; University of Pisa Medical School; Pisa; Italy
| | - Duccio Volterrani
- Regional Center of Nuclear Medicine; University of Pisa Medical School; Pisa; Italy
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Berardelli A, Wenning GK, Antonini A, Berg D, Bloem BR, Bonifati V, Brooks D, Burn DJ, Colosimo C, Fanciulli A, Ferreira J, Gasser T, Grandas F, Kanovsky P, Kostic V, Kulisevsky J, Oertel W, Poewe W, Reese JP, Relja M, Ruzicka E, Schrag A, Seppi K, Taba P, Vidailhet M. EFNS/MDS-ES/ENS [corrected] recommendations for the diagnosis of Parkinson's disease. Eur J Neurol 2013; 20:16-34. [PMID: 23279440 DOI: 10.1111/ene.12022] [Citation(s) in RCA: 335] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/18/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND A Task Force was convened by the EFNS/MDS-ES Scientist Panel on Parkinson's disease (PD) and other movement disorders to systemically review relevant publications on the diagnosis of PD. METHODS Following the EFNS instruction for the preparation of neurological diagnostic guidelines, recommendation levels have been generated for diagnostic criteria and investigations. RESULTS For the clinical diagnosis, we recommend the use of the Queen Square Brain Bank criteria (Level B). Genetic testing for specific mutations is recommended on an individual basis (Level B), taking into account specific features (i.e. family history and age of onset). We recommend olfactory testing to differentiate PD from other parkinsonian disorders including recessive forms (Level A). Screening for pre-motor PD with olfactory testing requires additional tests due to limited specificity. Drug challenge tests are not recommended for the diagnosis in de novo parkinsonian patients. There is an insufficient evidence to support their role in the differential diagnosis between PD and other parkinsonian syndromes. We recommend an assessment of cognition and a screening for REM sleep behaviour disorder, psychotic manifestations and severe depression in the initial evaluation of suspected PD cases (Level A). Transcranial sonography is recommended for the differentiation of PD from atypical and secondary parkinsonian disorders (Level A), for the early diagnosis of PD and in the detection of subjects at risk for PD (Level A), although the technique is so far not universally used and requires some expertise. Because specificity of TCS for the development of PD is limited, TCS should be used in conjunction with other screening tests. Conventional magnetic resonance imaging and diffusion-weighted imaging at 1.5 T are recommended as neuroimaging tools that can support a diagnosis of multiple system atrophy (MSA) or progressive supranuclear palsy versus PD on the basis of regional atrophy and signal change as well as diffusivity patterns (Level A). DaTscan SPECT is registered in Europe and the United States for the differential diagnosis between degenerative parkinsonisms and essential tremor (Level A). More specifically, DaTscan is indicated in the presence of significant diagnostic uncertainty such as parkinsonism associated with neuroleptic exposure and atypical tremor manifestations such as isolated unilateral postural tremor. Studies of [(123) I]MIBG/SPECT cardiac uptake may be used to identify patients with PD versus controls and MSA patients (Level A). All other SPECT imaging studies do not fulfil registration standards and cannot be recommended for routine clinical use. At the moment, no conclusion can be drawn as to diagnostic efficacy of autonomic function tests, neurophysiological tests and positron emission tomography imaging in PD. CONCLUSIONS The diagnosis of PD is still largely based on the correct identification of its clinical features. Selected investigations (genetic, olfactory, and neuroimaging studies) have an ancillary role in confirming the diagnosis, and some of them could be possibly used in the near future to identify subjects in a pre-symptomatic phase of the disease.
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Affiliation(s)
- A Berardelli
- Dipartimento di Neurologia e Psichiatria and IRCCS NEUROMED Institute, Sapienza, Università di Roma, Rome, Italy.
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Poewe W, Seppi K. Diagnosis of drug-induced parkinsonism: can transcranial sonography make the difference? Eur J Neurol 2013; 20:1429-30. [PMID: 23678988 DOI: 10.1111/ene.12189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- W Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
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Chang FCF, Josephs KA. Levodopa Responsiveness in Adult-onset Lower Limb Dystonia is Associated with the Development of Parkinson's Disease. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2013; 3. [PMID: 23610745 PMCID: PMC3629864 DOI: 10.7916/d8vd6x5m] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 02/26/2013] [Indexed: 12/01/2022]
Abstract
Background Adult-onset primary lower limb dystonia (AOPLLD) has been reported as an early sign of Parkinson’s disease (PD) or Parkinson-plus syndrome in case series. No prior systematic analysis has assessed clinical clues predicting later development of PD or Parkinson-plus syndrome. Methods We identified patients with AOPLLD from medical records. We excluded patients who had not been diagnosed by a neurologist, and who had a pre-existing diagnosis of PD, psychogenic, or secondary dystonia. Records were subdivided into those who later developed PD or Parkinson-plus disorders and those who did not. The following clinical characteristics were compared between the two groups: dystonia onset age, type of dystonia, levodopa response, anticholinergic response, and family history of Parkinsonism or tremor. Results Twenty-two AOPLLD patients were identified: 77% female; the median dystonia onset age was 53 years. Eight (37%) developed Parkinson’s disease; 2 (9%) developed corticobasal syndrome. Twelve patients (54%) did not develop Parkinsonism after a median follow-up period of 1.5 years. There was a significant difference in leg dystonia levodopa response between the two groups (p = 0.02). Conclusion In patients with AOPLLD, leg dystonia with levodopa response is associated with the future development of PD.
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Buttarelli FR, Fanciulli A, Pellicano C, Pontieri FE. The dopaminergic system in peripheral blood lymphocytes: from physiology to pharmacology and potential applications to neuropsychiatric disorders. Curr Neuropharmacol 2012; 9:278-88. [PMID: 22131937 PMCID: PMC3131719 DOI: 10.2174/157015911795596612] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 09/17/2010] [Accepted: 09/24/2010] [Indexed: 12/12/2022] Open
Abstract
Besides its action on the nervous system, dopamine (DA) plays a role on neural-immune interactions. Here we review the current evidence on the dopaminergic system in human peripheral blood lymphocytes (PBL). PBL synthesize DA through the tyrosine-hydroxylase/DOPA-decarboxylase pathway, and express DA receptors and DA transporter (DAT) on their plasma membrane. Stimulation of DA receptors on PBL membrane contributes to modulate the development and initiation of immune responses under physiological conditions and in immune system pathologies such as autoimmunity or immunodeficiency. The characterization of DA system in PBL gave rise to a further line of research investigating the feasibility of PBL as a cellular model for studying DA derangement in neuropsychiatric disorders. Several reports showed changes of the expression of DAT and/or DA receptors in PBL from patients suffering from several neuropsychiatric disorders, in particular parkinsonian syndromes, schizophrenia and drug- or alcohol-abuse. Despite some methodological and theoretical limitations, these findings suggest that PBL may prove a cellular tool with which to identify the derangement of DA transmission in neuropsychiatric diseases, as well as to monitor the effects of pharmacological treatments.
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Les mouvements anormaux psychogènes. Rev Neurol (Paris) 2012; 168:662-7. [DOI: 10.1016/j.neurol.2012.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 06/04/2012] [Accepted: 06/04/2012] [Indexed: 11/20/2022]
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The relationship between cerebral vascular disease and parkinsonism: The VADO study. Parkinsonism Relat Disord 2012; 18:775-80. [PMID: 22531611 DOI: 10.1016/j.parkreldis.2012.03.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 03/04/2012] [Accepted: 03/19/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND The observation of gait abnormalities, parkinsonism and vascular lesions in elderly patients is often reported as vascular parkinsonism (VP). However the status of striatal dopamine transporter (DAT) and the effects of brain vascular lesions on motor features and levodopa responsiveness are poorly defined. METHODS We recorded clinical features, chronic response to levodopa and vascular risk factors in a cross-sectional cohort of consecutive elderly patients with possible Parkinson's disease (PD) or VP recruited in 20 centers in Italy. RESULTS We included a total of 158 patients. Onset of motor symptoms was asymmetric in 93 (59%) and symmetric in 65 patients (41%). Symmetric motor onset was associated with greater disease severity. Chronic levodopa response was positive in 75 (47.8%) and negative in 82 patients (52.2%). A negative response to levodopa was associated with greater frequency of symmetric onset of motor symptoms, worst disease severity, absence of dyskinesia and greater number of vascular risk factors. Frontal lobe showed largest vascular load. Striatal DAT was normal in 48 (30.4%) and abnormal in 110 (69.6%) patients. Patients with normal DAT binding showed higher vascular load at MRI. Significant predictive factors of worst disease severity and negative response to levodopa were hypertension, vascular lesions in basal ganglia/periventricular regions, and normal DAT uptake. CONCLUSIONS Multiple cerebral vascular lesions modify clinical presentation and severity in patients with parkinsonism and this is underlined by specific risk factors primarily hypertension. Striatal DAT assessment is helpful in identifying patients where therapy benefit is less likely.
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Shin HW, Chung SJ. Drug-induced parkinsonism. J Clin Neurol 2012; 8:15-21. [PMID: 22523509 PMCID: PMC3325428 DOI: 10.3988/jcn.2012.8.1.15] [Citation(s) in RCA: 194] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 11/17/2022] Open
Abstract
Drug-induced parkinsonism (DIP) is the second-most-common etiology of parkinsonism in the elderly after Parkinson's disease (PD). Many patients with DIP may be misdiagnosed with PD because the clinical features of these two conditions are indistinguishable. Moreover, neurological deficits in patients with DIP may be severe enough to affect daily activities and may persist for long periods of time after the cessation of drug taking. In addition to typical antipsychotics, DIP may be caused by gastrointestinal prokinetics, calcium channel blockers, atypical antipsychotics, and antiepileptic drugs. The clinical manifestations of DIP are classically described as bilateral and symmetric parkinsonism without tremor at rest. However, about half of DIP patients show asymmetrical parkinsonism and tremor at rest, making it difficult to differentiate DIP from PD. The pathophysiology of DIP is related to drug-induced changes in the basal ganglia motor circuit secondary to dopaminergic receptor blockade. Since these effects are limited to postsynaptic dopaminergic receptors, it is expected that presynaptic dopaminergic neurons in the striatum will be intact. Dopamine transporter (DAT) imaging is useful for diagnosing presynaptic parkinsonism. DAT uptake in the striatum is significantly decreased even in the early stage of PD, and this characteristic may help in differentiating PD from DIP. DIP may have a significant and longstanding effect on patients' daily lives, and so physicians should be cautious when prescribing dopaminergic receptor blockers and should monitor patients' neurological signs, especially for parkinsonism and other movement disorders.
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Affiliation(s)
- Hae-Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
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Xia Y, Jiang C, Cao Z, Shi K, Wang Y. Co-transplantation of macaque autologous Schwann cells and human embryonic nerve stem cells in treatment of macaque Parkinson's disease. ASIAN PAC J TROP MED 2012; 5:7-14. [PMID: 22182636 DOI: 10.1016/s1995-7645(11)60237-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 11/15/2011] [Accepted: 12/15/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the therapeutic effects of co-transplantation with Schwann cells (SCs) and human embryonic nerve stem cells (NSCs) on macaque Parkinson's disease (PD). METHODS Macaque autologous SCs and human embryonic NSCs were adopted for the treatment of macaque PD. RESULTS Six months after transplantation, positron emission computerized tomography showed that (18)F-FP-β-CIT was significantly concentrated in the injured striatum in the co-transplanted group. Immunohistochemical staining of transplanted area tissue showed migration of tyroxine hydroxylase positive cells from the transplant area to the surrounding area was significantly increased in the co-transplanted group. CONCLUSIONS Co-transplantation of SCs and NSCs could effectively cure PD in macaques. SCs harvested from the autologous peripheral nerves can avoid rejection and the ethics problems, so it is expected to be applied clinically.
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Affiliation(s)
- Ying Xia
- Department of Neurosurgery, Haikou Hospital, Xiangya Medical School, Central South University, Haikou, China.
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Interobserver variability, and visual and quantitative parameters of 123I-FP-CIT SPECT (DaTSCAN) studies. Ann Nucl Med 2012; 26:234-40. [DOI: 10.1007/s12149-011-0564-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 12/04/2011] [Indexed: 11/25/2022]
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Melamed E, Poewe W. Taking sides: Is handedness involved in motor asymmetry of Parkinson's disease? Mov Disord 2012; 27:171-3. [DOI: 10.1002/mds.24048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 10/25/2011] [Accepted: 10/31/2011] [Indexed: 11/06/2022] Open
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Kefalopoulou Z, Aviles-Olmos I, Foltynie T. Critical aspects of clinical trial design for novel cell and gene therapies. PARKINSON'S DISEASE 2011; 2011:804041. [PMID: 22254150 PMCID: PMC3255302 DOI: 10.4061/2011/804041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 10/13/2011] [Indexed: 11/23/2022]
Abstract
Neural cell transplantation and gene therapy have attracted considerable interest as promising therapeutic alternatives for patients with Parkinson's disease (PD). Preclinical and open-label studies have suggested that grafted fetal neural tissue or viral vector gene transfer can achieve considerable biochemical and clinical improvements, whereas subsequent double-blind, placebo-controlled protocols have produced rather more modest and variable results. Detailed evaluation of these discordant findings has highlighted several crucial issues such as patient selection criteria, details surrounding transplantation or gene therapy methodologies, as well as the study designs themselves that ought to be carefully considered in the planning phases of future clinical trials. Beyond the provision of symptomatic efficacy and safety data, it also remains to be identified whether the possibilities offered by stem cell and gene therapy technological advances might translate to meaningful neuroprotection and/or disease-modifying effects or alleviate the nonmotor aspects of PD and thus offer additional benefits beyond those achieved through conventional pharmacotherapy or deep brain stimulation (DBS).
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Affiliation(s)
- Zinovia Kefalopoulou
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Iciar Aviles-Olmos
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Djang DSW, Janssen MJR, Bohnen N, Booij J, Henderson TA, Herholz K, Minoshima S, Rowe CC, Sabri O, Seibyl J, Van Berckel BNM, Wanner M. SNM practice guideline for dopamine transporter imaging with 123I-ioflupane SPECT 1.0. J Nucl Med 2011; 53:154-63. [PMID: 22159160 DOI: 10.2967/jnumed.111.100784] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- David S W Djang
- Seattle Nuclear Medicine, Seattle, Washington 98104-1377, USA.
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84
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Quantitative Evaluation of Striatal I-123-FP-CIT Uptake in Essential Tremor and Parkinsonism. Clin Nucl Med 2011; 36:991-6. [DOI: 10.1097/rlu.0b013e3182291a7b] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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85
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Tolosa E, Pont-Sunyer C. Progress in defining the premotor phase of Parkinson's disease. J Neurol Sci 2011; 310:4-8. [DOI: 10.1016/j.jns.2011.05.027] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 04/29/2011] [Accepted: 05/17/2011] [Indexed: 11/25/2022]
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86
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Giza E, Fotiou D, Bostantjopoulou S, Katsarou Z, Gerasimou G, Gotzamani-Psarrakou A, Karlovasitou A. Pupillometry and 123I-DaTSCAN imaging in Parkinson's disease: a comparison study. Int J Neurosci 2011; 122:26-34. [PMID: 21883027 DOI: 10.3109/00207454.2011.619285] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was the evaluation of pupil light reflex (PLR) in patients with Parkinson's disease (PD) by using a modern pupillometry system and the investigation of its potential relationship with dopamine transporter imaging (DaTSCAN), which is an objective method for the evaluation of presynaptic dopaminergic system. PLR was evaluated using pupillometry in 35 patients with PD without clinical evidence of autonomic dysfunction and 44 healthy matched controls. PLR was elicited using a fully automated pupillometry system and six parameters were measured. Dopamine transporter imaging was performed using radioactive ioflupane (123)I-FP-CIT [(123)I-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)-nortropane]. A significant increase in latency and a significant decrease in amplitude, maximum constriction velocity, as well as maximum acceleration were observed in PD patients. There was no significant difference in initial radius and minimum radius values. Investigating the relationship between pupillometry parameters and (123)I-FP-CIT binding values, we correlated values from the semiquantitative analysis of radioligand uptake with pupillometry parameters, but we found no significant correlation. This study demonstrates PLR impairment in patients with PD without overt autonomic dysfunction. This impairment does not seem to correspond to the reduction of radioligand binding in the striatum as the result of presynaptic dopaminergic dysfunction, suggesting a different deterioration rate of these systems.
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Affiliation(s)
- Evangelia Giza
- Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece.
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87
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LeWitt P, Schultz L, Auinger P, Lu M. CSF xanthine, homovanillic acid, and their ratio as biomarkers of Parkinson's disease. Brain Res 2011; 1408:88-97. [PMID: 21784416 PMCID: PMC4120020 DOI: 10.1016/j.brainres.2011.06.057] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 06/22/2011] [Accepted: 06/24/2011] [Indexed: 11/28/2022]
Abstract
Diminished nigrostriatal dopaminergic neurotransmission is a biochemical hallmark of Parkinson's disease. Despite this, a reliable trait biomarker of sporadic Parkinson's disease has not emerged from measurements of cerebrospinal fluid dopamine metabolites. Previous studies have highlighted strong neurochemical relationships between dopamine and various purine compounds. In this study, we analyzed cerebrospinal fluid concentrations of homovanillic acid (the major catabolite of dopamine) and the purine compound xanthine for a comparison of 217 unmedicated Parkinson's disease subjects and 26 healthy controls. These compounds were highly correlated for both the Parkinson's disease subjects (r=0.68) and for controls (r=0.73; both groups, p<0.001). While neither homovanillic acid nor xanthine concentrations differentiated Parkinson's disease from controls, their ratio did. For controls, the mean [xanthine]/[homovanillic acid] quotient was 13.1±5.5 as compared to the Parkinson's disease value of 17.4±6.7 at an initial lumbar CSF collection (p=0.0017), and 19.7±8.7 (p<0.001) at a second CSF collection up to 24 months later. The [xanthine]/[homovanillic acid] ratio in the Parkinson's disease subjects differed as a function of disease severity, as measured by the sum of Unified Parkinson's Disease Rating Scale Activities of Daily Living and Motor Exam ratings. The [xanthine]/[homovanillic acid] ratio also increased between the first and second CSF collections, suggesting that this quotient provides both a state and trait biomarker of Parkinson's disease. These observations add to other neurochemical evidence that links purine metabolism to Parkinson's disease.
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Affiliation(s)
- Peter LeWitt
- Department of Neurology, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
- The Department of Neurology, Wayne State University School of Medicine, 540 East Canfield Street, Detroit, MI 48201, USA
| | - Lonni Schultz
- Department of Biostatistics, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Peggy Auinger
- The Department of Neurology, Center for Human Experimental Therapeutics, University of Rochester School of Medicine and Dentistry, 1351 Mount Hope Avenue, Rochester, NY 14620, USA
| | - Mei Lu
- Department of Biostatistics, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
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88
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Sixel-Döring F, Liepe K, Mollenhauer B, Trautmann E, Trenkwalder C. The role of 123I-FP-CIT-SPECT in the differential diagnosis of Parkinson and tremor syndromes: a critical assessment of 125 cases. J Neurol 2011; 258:2147-54. [DOI: 10.1007/s00415-011-6076-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 04/20/2011] [Indexed: 11/25/2022]
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89
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90
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Muthuraman M, Hossen A, Heute U, Deuschl G, Raethjen J. A new diagnostic test to distinguish tremulous Parkinson's disease from advanced essential tremor. Mov Disord 2011; 26:1548-52. [DOI: 10.1002/mds.23672] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/04/2011] [Accepted: 01/13/2011] [Indexed: 11/12/2022] Open
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91
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Ling H, Braschinsky M, Taba P, Lüüs SM, Doherty K, Hotter A, Poewe W, Lees AJ. Decades of delayed diagnosis in 4 levodopa-responsive young-onset monogenetic parkinsonism patients. Mov Disord 2011; 26:1337-40. [DOI: 10.1002/mds.23563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Revised: 11/01/2010] [Accepted: 11/08/2010] [Indexed: 11/11/2022] Open
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92
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Taghva A, Khalessi AA, Kim PE, Liu CY, Apuzzo MLJ. From atom to brain: applications of molecular imaging to neurosurgery. World Neurosurg 2010; 73:477-85. [PMID: 20920931 DOI: 10.1016/j.wneu.2010.02.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 02/20/2010] [Indexed: 02/06/2023]
Abstract
Molecular imaging is a field born out of the happy marriage of molecular biology and radiology. The first installment of this two-part series on molecular imaging demonstrated basic principles for practitioners in the field of the neurosciences. This installment seeks to provide some illustrative examples, insights, and specific applications to the neurosciences. The fields of functional neurosurgery including the treatment of neuropsychiatric disorders, novel treatments and imaging of tumors, neuroregenerative medicine, and nanotechnology in vascular disorders are covered. Finally, we give some parting thoughts on the future of molecular imaging, including advances in the imaging of neurodegenerative disorders.
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Affiliation(s)
- Alexander Taghva
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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93
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Choi CB, Kim SY, Lee SH, Jahng GH, Kim HY, Choe BY, Ryu KN, Yang DM, Yim SV, Choi WS. Assessment of metabolic changes in the striatum of a MPTP-intoxicated canine model: in vivo ¹H-MRS study of an animal model for Parkinson's disease. Magn Reson Imaging 2010; 29:32-9. [PMID: 20980117 DOI: 10.1016/j.mri.2010.03.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 12/29/2009] [Accepted: 03/11/2010] [Indexed: 01/16/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by the progressive loss of the dopaminergic neurons in the substantia nigra pars compacta, which projects to the striatum. We induced a selective loss of nigrostriatal dopamine neurons, by infusing the mitochondrial complex 1 inhibitor 1-methyl 4-phenyl 1,2,3,6-tetrahydropyridine (MPTP) into adult beagle dogs (N=5). Single voxel ¹H water suppressed magnetic resonance spectroscopy (¹H-MRS) at 3 T was used to assess the metabolic changes in the striatum of canine before and after MPTP intoxication. The metabolite spectra obtained from the striatum (voxel size: 2 cm³) showed a lower N-acetyl aspartate to total creatine (creatine+phosphocreatine) ratio after MPTP intoxication. There were no significant differences in other metabolite ratios such as glutamate+glutamine, choline-containing compounds (glycerophosphocholine+phophorylcholine and myo-inositol). Our findings indicated that ¹H-MRS is a sensitive, noninvasive measure of neural toxicity and biochemical alterations of the striatum in a canine model of PD, and further studies are needed to confirm brain metabolic changes in association with progression of MPTP-intoxication.
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Affiliation(s)
- Chi-Bong Choi
- Department of Radiology, Kyung Hee University Medical Center, School of Medicine, Kyung Hee University, Seoul 130-702, Republic of Korea
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94
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Abstract
The dopamine transporter (DAT) is responsible for clearance of dopamine from the synaptic cleft after its release. Imaging DAT availability provides a measure of dopamine terminal function and a method for detecting striatal dopamine deficiency states present in idiopathic Parkinson’s disease and atypical neurodegenerative Parkinsonian disorders such as multiple system atrophy and progressive supranuclear palsy. DAT imaging with PET or single photon emission computed tomography can be used to support a diagnosis of dopamine-deficient parkinsonism in cases where this is suspected and rationalize the use of dopaminergic agents as therapy. It can also detect subclinical dopaminergic dysfunction when present in subjects at risk of Parkinson’s disease, such as relatives of patients, susceptibility gene mutation carriers, and subjects with late-onset hyposmia or sleep disorders. Finally, the presence of normal DAT availability on imaging can help exclude nondopamine-deficient syndromes, such as dystonic and severe essential tremors, drug-induced and psychogenic parkinsonism that, on occasion, mimic Parkinson’s disease.
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Affiliation(s)
- David J Brooks
- Department of Medicine, Imperial College London, Cyclotron Building, Hammersmith Hospital, Du Cane Road, W12 0NN, UK
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95
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Frasier M, Chowdhury S, Eberling J, Sherer T. Biomarkers in Parkinson’s disease: a funder’s perspective. Biomark Med 2010; 4:723-9. [DOI: 10.2217/bmm.10.89] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Therapeutic development in Parkinson’s disease is hampered by the paucity of well-validated biomarkers that can assist with diagnosis and/or tracking the progression of the disease. Since its inception, the Michael J Fox Foundation for Parkinson’s Research has invested heavily in biomarker research and continues to prioritize discovery and development efforts. This article summarizes the history and evolution of the Michael J Fox Foundation’s role in supporting biomarker research and lays out the current challenges in successfully developing markers that can be used to test therapies, while also providing a vision of future funding efforts in Parkinson’s disease biomarkers.
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Affiliation(s)
| | - Sohini Chowdhury
- Michael J Fox Foundation for Parkinson’s Research, 90 Broad Street, NY 07030, USA
| | - Jamie Eberling
- Michael J Fox Foundation for Parkinson’s Research, 90 Broad Street, NY 07030, USA
| | - Todd Sherer
- Michael J Fox Foundation for Parkinson’s Research, 90 Broad Street, NY 07030, USA
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96
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Cubo E. Pharmacotherapy in the management of early Parkinson's disease: cost-effectiveness and patient acceptability. CLINICOECONOMICS AND OUTCOMES RESEARCH 2010; 2:127-34. [PMID: 21935322 PMCID: PMC3169957 DOI: 10.2147/ceor.s11996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Indexed: 11/23/2022] Open
Abstract
In the absence of a cure, the primary goals in managing Parkinson's disease (PD) are to preserve functionality and health-related quality of life (HRQoL). Current therapeutic strategies for PD include symptomatic treatment and are primarily focused on replacing dopamine in the brain. Dopamine agonists can be used as an alternative initial levodopa therapy, to delay the onset of motor complications, but at the expense of more dopaminergic adverse effects; poorer control of motor symptoms; and increased cost. In PD, treatment effects and costs accumulate over time; hence the choice of time horizon in cost-effectiveness analysis can be particularly important. Pharmaceutical expenditures have grown rapidly in recent decades and now total nearly 10% of all health care costs. The main approach to treat PD at the present time is to advance knowledge of the efficacy, to reduce long-term complications associated with treatment, and to improve patient HRQoL and society burden. The implementation of cost-effectiveness studies, including the societal perspective, should be considered as an outcome of new therapy strategies, which would be helpful to health care decision makers.
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Affiliation(s)
- Esther Cubo
- Neurology Department, Hospital General Yagüe, Burgos, Spain
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97
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Schwingenschuh P, Ruge D, Edwards MJ, Terranova C, Katschnig P, Carrillo F, Silveira-Moriyama L, Schneider SA, Kägi G, Palomar FJ, Talelli P, Dickson J, Lees AJ, Quinn N, Mir P, Rothwell JC, Bhatia KP. Distinguishing SWEDDs patients with asymmetric resting tremor from Parkinson's disease: a clinical and electrophysiological study. Mov Disord 2010; 25:560-9. [PMID: 20131394 DOI: 10.1002/mds.23019] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Approximately 10% of patients diagnosed clinically with early Parkinson's disease (PD) have normal dopaminergic functional imaging (Scans Without Evidence of Dopaminergic Deficit [SWEDDs]). An important subgroup of SWEDDs are those with asymmetric rest tremor resembling parkinsonian tremor. Clinical and pathophysiological features which could help to distinguish SWEDDs from PD have not been explored. We therefore studied clinical details including non-motor symptoms in 25 tremulous SWEDDs patients in comparison to 25 tremor-dominant PD patients. Blinded video rating was used to compare examination findings. Electrophysiological tremor parameters and also response to a cortical plasticity protocol using paired associative stimulation (PAS) was studied in 9 patients with SWEDDs, 9 with tremor-dominant PD (with abnormal dopamine transporter single photon emission computed tomography findings), 8 with segmental dystonia, and 8 with essential tremor (ET). Despite clinical overlap, lack of true bradykinesia, presence of dystonia, and head tremor favored a diagnosis of SWEDDs, whereas re-emergent tremor, true fatiguing or decrement, good response to dopaminergic drugs, and presence of non-motor symptoms favored PD. A single tremor parameter could not differentiate between groups, but the combination of re-emergent tremor and highest tremor amplitude at rest was characteristic of PD tremor. SWEDDs and segmental dystonia patients exhibited an abnormal exaggerated response to the PAS protocol, in contrast to a subnormal response in PD and a normal response in ET. We conclude that despite clinical overlap, there are features that can help to distinguish between PD and SWEDDs which may be useful in clinical practice. The underlying pathophysiology of SWEDDs differs from PD but has similarities with primary dystonia.
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Affiliation(s)
- Petra Schwingenschuh
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, Queen Square, London, United Kingdom
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98
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Reduced dopamine transporter density in the ventral striatum of patients with Parkinson's disease and pathological gambling. Neurobiol Dis 2010; 39:98-104. [DOI: 10.1016/j.nbd.2010.03.013] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 03/11/2010] [Accepted: 03/12/2010] [Indexed: 11/21/2022] Open
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99
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Mo SJ, Linder J, Forsgren L, Larsson A, Johansson L, Riklund K. Pre- and postsynaptic dopamine SPECT in the early phase of idiopathic parkinsonism: a population-based study. Eur J Nucl Med Mol Imaging 2010; 37:2154-64. [PMID: 20593284 DOI: 10.1007/s00259-010-1520-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 06/03/2010] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this study was to assess the diagnostic contribution of pre- and postsynaptic dopamine SPECT in drug-naïve patients with early idiopathic parkinsonism and to investigate possible differences between idiopathic Parkinson's disease (PD) and atypical parkinsonian syndromes (APS) and possible differences in motor subtypes of parkinsonism. METHODS A group of 128 newly diagnosed idiopathic parkinsonian patients and 48 healthy controls was studied. Presynaptic baseline SPECT with (123)I-FP-CIT was performed in all patients and in 120 patients also a baseline postsynaptic SPECT with (123)I-IBZM. Clinical diagnoses were reassessed after 12 months. RESULTS Presynaptic uptake in the putamen and caudate was significantly reduced in patients compared to controls. Presynaptic uptake ratios were not different between PD patients and patients with APS, and postsynaptic uptake in APS was not significantly reduced compared to PD or controls. In half of the APS patients both pre- and postsynaptic uptake ratios were reduced on the same side in the striatum. Impaired motor performance was associated with decreased presynaptic uptake in the putamen in PD. The postural instability and gait difficulty (PIGD) subtype of PD had lower presynaptic uptake ratios than patients with tremor-dominated (TD) symptoms. CONCLUSION Not only presynaptic putamen uptake ratios, but also caudate ratios were reduced in a majority of the patients in our study. At baseline scan, i.e. in an early stage of the disease, the accuracy of excluding APS in the whole study population was 85% using a combination of pre- and postsynaptic SPECT. Already at baseline, lower presynaptic SPECT ratios were seen in PD with PIGD at onset compared to those with TD subtype.
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Affiliation(s)
- Susanna Jakobson Mo
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, 901 85, Umeå, Sweden.
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100
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Hennecke G, Scherzer CR. RNA biomarkers of Parkinson's disease: developing tools for novel therapies. Biomark Med 2010; 2:41-53. [PMID: 20477362 DOI: 10.2217/17520363.2.1.41] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
By 2030 the number of individuals with Parkinson's disease (PD) will nearly double to approximately 9.3 million because of aging populations. No medications have been approved that address the progressive neurodegeneration that underlies the disease and existing symptomatic treatments are only partially effective. Reliance on insensitive and confounded clinical assessments has obstructed the development of novel therapeutics designed to prevent, delay or slow the disease. While PD symptoms reflect preferential neuronal death, DNA, RNA and biochemical traits of the disease are detectable in blood cells. To systematically search for lead RNA biomarkers of PD, genome-wide expression changes in the blood of patients with early-stage PD and controls have been probed by microarray. This scan identified a candidate gene signature, as well as lead single gene biomarkers associated with PD. Efforts are underway to refine and develop these hits into biomarkers that will enable risk-modifying therapies. This development process will progress through discovery, cross-sectional and prospective clinical biomarker studies, to Phase III clinical trials.
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Affiliation(s)
- Gerrit Hennecke
- Harvard Medical School and Brigham and Women's Hospital, Laboratory for Neurogenomics, Center for Neurologic Diseases, 65 Landsdowne Street, Cambridge, MA 02139, USA
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