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Ebina J, Mizumura S, Ishii N, Kobayashi Y, Shibukawa M, Morioka H, Nagasawa J, Yanagihashi M, Hirayama T, Kawabe K, Orimo S, Kano O. Reduced 123I-MIBG uptake in the parotid and submandibular glands in patients with Parkinson's disease identified using a quantitative semi-automatic method. J Neurol 2023; 270:4385-4392. [PMID: 37222842 DOI: 10.1007/s00415-023-11770-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To analyze 123I-metaiodobenzylguanidine (MIBG) uptake in the parotid and submandibular glands in patients with Parkinson's disease (PD) in comparison with controls, and to compare MIBG uptake between those glands and the myocardium. Furthermore, we aimed to identify the relationships between clinical features and MIBG uptake. METHODS We recruited 77 patients with PD and 21 age-matched controls. We assessed MIBG scintigraphy in the major salivary glands and myocardium. We calculated the MIBG uptake ratio in the parotid glands/mediastinum (P/M), submandibular glands/mediastinum (S/M), and heart/mediastinum (H/M) using a quantitative semi-automatic method. We investigated the correlations between MIBG uptake and clinical features. RESULTS The P/M and H/M ratios in the early and delayed phases were significantly reduced in PD patients compared to controls, while the delayed phase S/M ratio was reduced in PD patients compared to controls. The P/M ratio correlated with the S/M ratio, while neither the P/M nor S/M ratio correlated with the H/M ratio. Between PD patients and controls, sensitivity and specificity were 54.8% and 59.1% for the delayed phase P/M ratio, while sensitivity and specificity were 59.5% and 61.0% for the delayed phase S/M ratio, respectively. Furthermore, sensitivity and specificity for the delayed phase H/M ratio were 85.7% and 79.2, respectively. CONCLUSION MIBG uptake in the parotid and submandibular glands was reduced in patients with PD. Furthermore, sympathetic denervation in the major salivary glands and myocardium might progress independently. Our findings suggest a new aspect of the pathological distribution of PD.
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Affiliation(s)
- Junya Ebina
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, Japan
| | - Sunao Mizumura
- Department of Radiology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Nobutomo Ishii
- Central Radiology Division, Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Yukio Kobayashi
- Department of Radiological Technology, Kanto Central Hospital, Tokyo, Japan
| | - Mari Shibukawa
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, Japan
| | - Harumi Morioka
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, Japan
| | - Junpei Nagasawa
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, Japan
| | - Masaru Yanagihashi
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, Japan
| | - Takehisa Hirayama
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, Japan
| | - Kiyokazu Kawabe
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, Japan
| | | | - Osamu Kano
- Department of Neurology, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, Japan.
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Nasri A, Kacem I, Farhat N, Gharbi A, Sakka S, Souissi A, Zidi S, Damak M, Bendjebara M, Gargouri A, Mhiri C, Gouider R. Heart rate variability and sympathetic skin response for the assessment of autonomic dysfunction in leucine-rich repeat kinase 2 associated Parkinson's disease. Neurophysiol Clin 2022; 52:81-93. [DOI: 10.1016/j.neucli.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 12/18/2022] Open
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Jeong YJ, Jeong JE, Cheon SM, Yoon BA, Kim JW, Kang DY. Relationship between the washout rate of I-123 MIBG scans and autonomic function in Parkinson's disease. PLoS One 2020; 15:e0229860. [PMID: 32134983 PMCID: PMC7058312 DOI: 10.1371/journal.pone.0229860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/19/2020] [Indexed: 01/18/2023] Open
Abstract
Purpose We have evaluated the clinical significance of the washout rate (WR) on I-123 MIBG scans through the analysis of the relationship between the I-123 MIBG scans and autonomic status in patients with Parkinson’s disease (PD). Materials and methods Sixty patients with clinical PD who had decreased HMR were enrolled. An autonomic symptom was evaluated using a head-up tilt test and the Composite Autonomic Severity Score (CASS). An I-123 MIBG scan and F-18 FP-CIT positron emission tomography (PET) were performed. All of the patients were classified into three groups according to the WR. The differences in patient characteristics and the imaging parameters among the three groups were evaluated, and a correlation analysis was also performed. Results The frequency of orthostatic hypotension was significantly different among the three groups. The difference in systolic pressure (dSysPr) and the difference in diastolic pressure (dDiaPr) of group 3 was significantly larger than those of groups 1 and 2. From the correlation analysis, it can be seen that age, Hoehn and Yahr (H&Y) stage, dSysPr, and dDiaPr had a weak positive correlation with the WR. The total CASS score was significantly higher in group 3 compared with groups 1 and 2. The WR had a moderate positive correlation with the cardiosympathetic score and the total CASS score. Conclusion The WR is related to autonomic dysfunction. An I-123 MIBG cardiac scan is considered to be a good method to evaluate not only the differential diagnosis of Parkinson's disease but also the degree of autonomic dysfunction.
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Affiliation(s)
- Young Jin Jeong
- Departments of Nuclear Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
- Institute of Convergence Bio-Health, Dong-A University, Busan, Republic of Korea
| | - Ji-Eun Jeong
- Departments of Nuclear Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Sang-Myung Cheon
- Departments of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Byeol-A Yoon
- Departments of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Jae Woo Kim
- Departments of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Do-Young Kang
- Departments of Nuclear Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
- Institute of Convergence Bio-Health, Dong-A University, Busan, Republic of Korea
- * E-mail:
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Werner RA, Kobayashi R, Javadi MS, Köck Z, Wakabayashi H, Unterecker S, Nakajima K, Lapa C, Menke A, Higuchi T. Impact of Novel Antidepressants on Cardiac 123I-Metaiodobenzylguanidine Uptake: Experimental Studies on SK-N-SH Cells and Healthy Rabbits. J Nucl Med 2018; 59:1099-1103. [PMID: 29496989 DOI: 10.2967/jnumed.117.206045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/12/2018] [Indexed: 01/08/2023] Open
Abstract
123I-metaiodobenzylguanidine (123I-MIBG) has independent prognostic value for risk stratification among heart failure patients, but the use of concomitant medication should not affect its quantitative information. We evaluated whether the 4 classes of antidepressants currently most prescribed as first-line treatment for major depressive disorder (MDD) have the potential to alter 123I-MIBG imaging results. Methods: The inhibition effect of desipramine, escitalopram, venlafaxine, and bupropion on 131I-MIBG uptake was assessed by in vitro uptake assays using human neuroblastoma SK-N-SH cells. The half-maximal inhibitory concentration of tracer uptake was determined from dose-response curves. To evaluate the effect of intravenous pretreatment with desipramine (1.5 mg/kg) and escitalopram (2.5 or 15 mg/kg) on 123I-MIBG cardiac uptake, in vivo planar 123I-MIBG scanning of healthy New Zealand White rabbits was performed. Results: The half-maximal inhibitory concentrations of desipramine, escitalopram, venlafaxine, and bupropion on 131I-MIBG cellular uptake were 11.9 nM, 7.5 μM, 4.92 μM, and 12.9 μM, respectively. At the maximum serum concentration (as derived by previous clinical trials), the inhibition rates of 131I-MIBG uptake were 90.6% for desipramine, 25.5% for venlafaxine, 11.7% for bupropion, and 0.72% for escitalopram. A low inhibition rate for escitalopram in the cell uptake study triggered investigation of an in vivo rabbit model: with a dosage considerably higher than used in clinical practice, the noninhibitory effect of escitalopram was confirmed. Furthermore, pretreatment with desipramine markedly reduced cardiac 123I-MIBG uptake. Conclusion: In the present in vitro binding assay and in vivo rabbit study, the selective serotonin reuptake inhibitor escitalopram had no major impact on neuronal cardiac 123I-MIBG uptake within therapeutic dose ranges, whereas other types of first-line antidepressants for MDD treatment led to a significant decrease. These preliminary results warrant further confirmatory clinical trials regarding the reliability of cardiac 123I-MIBG imaging, in particular, if the patient's neuropsychiatric status would not tolerate withdrawal of a potentially norepinephrine-interfering antidepressant.
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Affiliation(s)
- Rudolf A Werner
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany.,Comprehensive Heart Failure Center, University of Wuerzburg, Wuerzburg, Germany
| | - Ryohei Kobayashi
- Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany.,Comprehensive Heart Failure Center, University of Wuerzburg, Wuerzburg, Germany
| | - Mehrbod Som Javadi
- Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zoe Köck
- Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany
| | - Hiroshi Wakabayashi
- Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany.,Comprehensive Heart Failure Center, University of Wuerzburg, Wuerzburg, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Kenichi Nakajima
- Department of Nuclear Medicine, Kanazawa University, Kanazawa, Japan; and
| | - Constantin Lapa
- Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany
| | - Andreas Menke
- Comprehensive Heart Failure Center, University of Wuerzburg, Wuerzburg, Germany.,Department of Psychiatry, Psychosomatics, and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Takahiro Higuchi
- Department of Nuclear Medicine, University of Wuerzburg, Wuerzburg, Germany .,Comprehensive Heart Failure Center, University of Wuerzburg, Wuerzburg, Germany.,Department of Biomedical Imaging, National Cardiovascular and Cerebral Center, Suita, Japan
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McLean G, Hindle JV, Guthrie B, Mercer SW. Co-morbidity and polypharmacy in Parkinson's disease: insights from a large Scottish primary care database. BMC Neurol 2017; 17:126. [PMID: 28666413 PMCID: PMC5493890 DOI: 10.1186/s12883-017-0904-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Parkinson’s disease is complicated by comorbidity and polypharmacy, but the extent and patterns of these are unclear. We describe comorbidity and polypharmacy in patients with and without Parkinson’s disease across 31 other physical, and seven mental health conditions. Methods We analysed primary health-care data on 510,502 adults aged 55 and over. We generated standardised prevalence rates by age-groups, gender, and neighbourhood deprivation, then calculated age, sex and deprivation adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for those with PD compared to those without, for the prevalence, and number of conditions. Results Two thousand six hundred forty (0.5%) had Parkinson’s disease, of whom only 7.4% had no other conditions compared with 22.9% of controls (adjusted OR [aOR] 0.43, 95% 0.38–0.49). The Parkinson’s group had more conditions, with the biggest difference found for seven or more conditions (PD 12.1% vs. controls 3.9%; aOR 2.08 95% CI 1.84–2.35). 12 of the 31 physical conditions and five of the seven mental health conditions were significantly more prevalent in the PD group. 44.5% with Parkinson’s disease were on five to nine repeat prescriptions compared to 24.5% of controls (aOR 1.40; 95% CI 1.28 to 1.53) and 19.2% on ten or more compared to 6.2% of controls (aOR 1.90; 95% CI 1.68 to 2.15). Conclusions Parkinson’s disease is associated with substantial physical and mental co-morbidity. Polypharmacy is also a significant issue due to the complex nature of the disease and associated treatments.
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Affiliation(s)
- Gary McLean
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK
| | | | - Bruce Guthrie
- Population Health Sciences Division, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK
| | - Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK.
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Lee JM, Derkinderen P, Kordower JH, Freeman R, Munoz DG, Kremer T, Zago W, Hutten SJ, Adler CH, Serrano GE, Beach TG. The Search for a Peripheral Biopsy Indicator of α-Synuclein Pathology for Parkinson Disease. J Neuropathol Exp Neurol 2017; 76:2-15. [DOI: 10.1093/jnen/nlw103] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Biomarkers of Nonmotor Symptoms in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:259-289. [DOI: 10.1016/bs.irn.2017.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Giubbini R, Milan E, Marcassa C, Paghera B, Fracassi F, Camoni L, Rodella C, Bertagna F, Motta F, Bertoli M, Campini R. 1-23I-MIBG thyroid uptake: Implications for MIBG imaging of the heart. J Nucl Cardiol 2016; 23:1335-1339. [PMID: 25963285 DOI: 10.1007/s12350-015-0142-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 04/04/2015] [Accepted: 04/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND 123I-MIBG has been widely used in patients with heart failure and neurological disorders. The patients are pre-treated with Lugol's oral solution or potassium perchlorate to prevent thyroid uptake of unlabeled 123I to limit the thyroid radiation exposure. However, despite the inhibition of the iodide pump, the thyroid is frequently visualized. The aim of this study was to study the pattern of thyroid uptake. METHODS We reviewed the 123I-MIBG images of 57 patients studied in three different centers in Italy for cardiac (n = 42) or neurological (n = 15) indications. They were imaged at 15 minutes and 4 hours after injection and in all patients, the thyroid was included in the imaging field of view. In 2 of the 3 centers, the patients were pre-treated with Lugol's oral solution and/or potassium perchlorate (group 1) but in the third center, they were not (group 2). The following imaging parameters were evaluated: heart-to-mediastinum ratio (H/M), thyroid-to-mediastinum ratio (T/M) at 4 hours, and tracer wash out from the heart (HWO) and from the thyroid (TWO). RESULTS In the cardiac patients, the HWO was 22.98 ± 7.16% and TWO was 11.4 ± 11.86% (P < .0001). The TWO was 12.2 ± 13.1% in group 1 and 10.05 ± 8.97% in group 2 (P = NS). In the neurological patients the HWO was 26 ± 8.1% and the TWO was 20.32 ± 6.41 (P < .05). The difference in TWO was statistically significant (P < .01) between cardiac and neurological patients, whereas the HWO was not. The 4-hour H/M was 1.49 ± 0.23 in cardiac patients vs 1.4 ± 0.39 in neurological patients (P = NS). The 4-hour T/M was 1.33 ± 0.3 in cardiac patients vs 1.15 ± 0.13 in neurological patients (P < 0.05). CONCLUSION The thyroid visualization in MIBG imaging is likely an expression of thyroid sympathetic innervation. The differences in TWO and T/M ratio in cardiac and neurological patients probably express differences in thyroid dopaminergic receptors. Thus, pre-treatment with potassium perchlorate or Lugol's solution may not be justified in patients undergoing 123I-MIBG imaging in whom the risk of side effects due to pre-treatment could be higher than the risk due to thyroid radiation exposure.
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Affiliation(s)
- Raffaele Giubbini
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy.
| | - Elisa Milan
- Nuclear Medicine Unit, San Giacomo Apostolo Hospital, Castelfranco Veneto, TV, Italy
| | - Claudio Marcassa
- Cardiology Department, Fondazione Maugeri Centro Medico, Veruno, NO, Italy
| | - Barbara Paghera
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Federica Fracassi
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Luca Camoni
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Carlo Rodella
- Health Physics Department, Spedali Civili, Brescia, Italy
| | - Francesco Bertagna
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Federica Motta
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Mattia Bertoli
- Chair of Nuclear Medicine and Nuclear Medicine Unit, Department of Medical Imaging, University and Spedali Civili, Piazza Spedali Civili, 1, Brescia, Italy
| | - Riccardo Campini
- Nuclear Medicine Unit, Fondazione Maugeri Centro Medico, Veruno, NO, Italy
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Kim JS, Park HE, Park IS, Oh YS, Ryu DW, Song IU, Jung YA, Yoo IR, Choi HS, Lee PH, Lee KS. Normal ‘heart’ in Parkinson's disease: is this a distinct clinical phenotype? Eur J Neurol 2016; 24:349-356. [DOI: 10.1111/ene.13206] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/25/2016] [Indexed: 12/16/2022]
Affiliation(s)
- J.-S. Kim
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - H.-E. Park
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - I.-S. Park
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Y.-S. Oh
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - D.-W. Ryu
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - I.-U. Song
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Y.-A. Jung
- Department of Nuclear Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - I. R. Yoo
- Department of Nuclear Medicine; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - H.-S. Choi
- Department of Radiology; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - P. H. Lee
- Department of Neurology; Yonsei University School of Medicine; Seoul Korea
| | - K.-S. Lee
- Department of Neurology; College of Medicine; The Catholic University of Korea; Seoul Korea
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McDonald C, Newton JL, Burn DJ. Orthostatic hypotension and cognitive impairment in Parkinson's disease: Causation or association? Mov Disord 2016; 31:937-46. [DOI: 10.1002/mds.26632] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 12/24/2022] Open
Affiliation(s)
- Claire McDonald
- Institute of Cellular Medicine; Newcastle University; Newcastle upon Tyne UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle UK
| | - Julia L. Newton
- Institute of Cellular Medicine; Newcastle University; Newcastle upon Tyne UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle UK
| | - David J. Burn
- Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle UK
- Institute of Neuroscience; Newcastle University; Newcastle upon Tyne UK
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Tsujikawa K, Hasegawa Y, Yokoi S, Yasui K, Nanbu I, Yanagi T, Takahashi A. Chronological changes of 123I-MIBG myocardial scintigraphy and clinical features of Parkinson's disease. J Neurol Neurosurg Psychiatry 2015; 86:945-51. [PMID: 25935888 DOI: 10.1136/jnnp-2015-310327] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/09/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The aim of this study was to investigate chronological changes of (123)I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy and its relation to clinical features in patients with Parkinson's disease (PD), and to characterise patients with PD with normal or mildly low MIBG uptakes at their early stages. METHODS The participants were 70 patients with PD who underwent (123)I-MIBG myocardial scintigraphy twice or more. A cluster analysis was performed using parameters calculated from heart to mediastinum (H/M) ratio and washout ratio (WR). RESULTS At baseline, the mean early H/M ratio (H/M(E)), delayed H/M ratio (H/M(D)) and WR were 1.83, 1.69 and 41.7%, respectively. After a mean interval of 3.0 years, follow-up studies showed significantly declined H/M(E) (1.69, p<0.001), declined H/M(D) (1.47, p<0.001) and enhanced WR (43.8%, p=0.007). Our longitudinal observations revealed that there existed heterogeneous changes in MIBG uptakes among patients. The cluster analysis classified the patients into two subgroups: 42 patients with markedly low MIBG uptakes at baseline (group A) and 28 patients with normal or mildly low MIBG uptakes at baseline (group B). Group B showed a significantly higher ratio of females, younger age at onset, lower Hoehn and Yahr stage and less demented, compared with group A. CONCLUSIONS Follow-up studies of MIBG divided the patients with PD into two major subgroups. A subgroup of patients with PD with normal or mildly low MIBG uptakes at the early stages of illness was characterised by female-dominant, young onset, slow progression in motor dysfunctions and preserved cognitive function. TRIAL REGISTRATION NUMBER 1033.
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Affiliation(s)
- Koyo Tsujikawa
- Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yasuhiro Hasegawa
- Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Satoshi Yokoi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keizo Yasui
- Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Ichiro Nanbu
- Department of Radiology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Tsutomu Yanagi
- Obu Dementia Care Research and Training Center, Aichi, Japan
| | - Akira Takahashi
- Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
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