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Li W, Lao-Kaim N, Roussakis A, Martin-Bastida A, Loane C, Valle-Guzman N, Kefalopoulou Z, Politis M, Foltynie T, Barker R, Piccini P. Longitudinal comparison of 11C-PE2I and 18F-DOPA pet for assessing severity and rate of disease progression in patients with Parkinson’s disease. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roussakis A, Towey D, Piccini P. Longitudinal single-photon emitted computed tomography (SPECT) study of striatal dopamine transporter (DAT) density: Relevance to levodopa-induced dyskinesias in Parkinson’s disease. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Martin-Bastida A, Lao-Kaim NP, Loane C, Politis M, Roussakis AA, Valle-Guzman N, Kefalopoulou Z, Paul-Visse G, Widner H, Xing Y, Schwarz ST, Auer DP, Foltynie T, Barker RA, Piccini P. Motor associations of iron accumulation in deep grey matter nuclei in Parkinson's disease: a cross-sectional study of iron-related magnetic resonance imaging susceptibility. Eur J Neurol 2016; 24:357-365. [PMID: 27982501 DOI: 10.1111/ene.13208] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/25/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE To determine whether iron deposition in deep brain nuclei assessed using high-pass filtered phase imaging plays a role in motor disease severity in Parkinson's disease (PD). METHODS Seventy patients with mild to moderate PD and 20 age- and gender-matched healthy volunteers (HVs) underwent susceptibility-weighted imaging on a 3 T magnetic resonance imaging scanner. Phase shifts (radians) in deep brain nuclei were derived from high-pass filtered phase images and compared between groups. Analysis of clinical laterality and correlations with motor severity (Unified Parkinson's Disease Rating Scale, Part III, UPDRS-III) were performed. Phase shifts (in radians) were compared between HVs and three PD subgroups divided according to UPDRS-III scores using analysis of covariance, adjusting for age and regional area. RESULTS Parkinson's disease patients had significantly (P < 0.001) higher radians than HVs bilaterally in the putamen, globus pallidus and substantia nigra (SN). The SN contralateral to the most affected side showed higher radians (P < 0.001) compared to the less affected side. SN radians positively correlated with UPDRS-III and bradykinesia-rigidity subscores, but not with tremor subscores. ancova followed by post hoc Bonferroni-adjusted pairwise comparisons revealed that SN radians were significantly greater in the PD subgroup with higher UPDRS-III scores compared to both lowest UPDRS-III PD and HV groups (P < 0.001). CONCLUSIONS Increased nigral iron accumulation in PD appears to be stratified according to disease motor severity and correlates with symptoms related to dopaminergic neurodegeneration. This semi-quantitative in vivo iron assessment could prove useful for objectively monitoring PD progression, especially in clinical trials concerning iron chelation therapies.
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Affiliation(s)
- A Martin-Bastida
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
| | - N P Lao-Kaim
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
| | - C Loane
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK.,Memory Research Group, Nuffield Department of Clinical Neurosciences, Medical Science Division, University of Oxford, Oxford, UK
| | - M Politis
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK.,Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A A Roussakis
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
| | - N Valle-Guzman
- John Van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Z Kefalopoulou
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - G Paul-Visse
- Translational Neurology Group, Department of Clinical Sciences, Wallenberg Neuroscience Centre, Lund University, Lund, Sweden
| | - H Widner
- Division of Neurology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Y Xing
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Nottingham, Nottingham, UK
| | - S T Schwarz
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Nottingham, Nottingham, UK
| | - D P Auer
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Queen's Medical Centre Nottingham, Nottingham, UK
| | - T Foltynie
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - R A Barker
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK.,MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - P Piccini
- Centre for Neurodegeneration and Neuroinflammation, Division of Brain Sciences, Imperial College London, London, UK
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Affiliation(s)
| | - A. Paoletti
- Istituto dì Clinica Ostetrica e Ginecologica, Università di Pisa, Italy
| | - P. Piccini
- Muratorio A. Istituto di Clinica Neurologica
| | - A. Colzi
- Muratorio A. Istituto di Clinica Neurologica
| | - A. Nuti
- Istituto dì Clinica Ostetrica e Ginecologica, Università di Pisa, Italy
| | - G.B. Melis
- Istituto dì Clinica Ostetrica e Ginecologica, Università di Pisa, Italy
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Ruffmann C, Calboli FCF, Bravi I, Gveric D, Curry LK, de Smith A, Pavlou S, Buxton JL, Blakemore AIF, Takousis P, Molloy S, Piccini P, Dexter DT, Roncaroli F, Gentleman SM, Middleton LT. Cortical Lewy bodies and Aβ burden are associated with prevalence and timing of dementia in Lewy body diseases. Neuropathol Appl Neurobiol 2015; 42:436-50. [DOI: 10.1111/nan.12294] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/24/2015] [Accepted: 11/03/2015] [Indexed: 01/16/2023]
Affiliation(s)
- C. Ruffmann
- Neuroepidemiology and Ageing Research Unit; School of Public Health; Imperial College; London UK
- Centro Parkinson; Istituti Clinici di Perfezionamento di Milano; Milano Italy
| | - F. C. F. Calboli
- Neuroepidemiology and Ageing Research Unit; School of Public Health; Imperial College; London UK
| | - I. Bravi
- Division of Brain Sciences; Department of Medicine; Imperial College; London UK
| | - D. Gveric
- Division of Brain Sciences; Department of Medicine; Imperial College; London UK
| | - L. K. Curry
- Neuroepidemiology and Ageing Research Unit; School of Public Health; Imperial College; London UK
| | - A. de Smith
- Genomics of Common Disease; School of Public Health; Imperial College; London UK
- Department of Epidemiology and Biostatistics; University of California, San Francisco; San Francisco CA USA
| | - S. Pavlou
- Genomics of Common Disease; School of Public Health; Imperial College; London UK
- Department of Molecular Virology; Cyprus Institute of Neurology and Genetics; Nicosia Cyprus
| | - J. L. Buxton
- Section of Investigative Medicine; Department of Medicine; Imperial College; London UK
| | - A. I. F. Blakemore
- Section of Investigative Medicine; Department of Medicine; Imperial College; London UK
| | - P. Takousis
- Neuroepidemiology and Ageing Research Unit; School of Public Health; Imperial College; London UK
| | - S. Molloy
- Division of Brain Sciences; Department of Medicine; Imperial College; London UK
| | - P. Piccini
- Division of Brain Sciences; Department of Medicine; Imperial College; London UK
| | - D. T. Dexter
- Division of Brain Sciences; Department of Medicine; Imperial College; London UK
| | - F. Roncaroli
- Institute of Brain Behaviour and Mental Health; University of Manchester; Manchester UK
| | - S. M. Gentleman
- Division of Brain Sciences; Department of Medicine; Imperial College; London UK
| | - L. T. Middleton
- Neuroepidemiology and Ageing Research Unit; School of Public Health; Imperial College; London UK
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Politis M, Wu K, Loane C, Quinn NP, Brooks DJ, Oertel WH, Bjorklund A, Lindvall O, Piccini P. Serotonin Neuron Loss and Nonmotor Symptoms Continue in Parkinson's Patients Treated with Dopamine Grafts. Sci Transl Med 2012; 4:128ra41. [DOI: 10.1126/scitranslmed.3003391] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Wu K, O'Keeffe D, Politis M, O'Keeffe G, Bose S, Brooks DJ, Barker R, Piccini P. 123 In vivo evidence of COMT val158met functional polymorphism modulates different levels of dopamine turnover in Parkinson's disease: an 18F-dopa PET study. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND Multiple Sclerosis (MS) is traditionally considered as a central nervous system (CNS) white matter inflammatory disease. However, recent studies have focused on the neurodegenerative aspects of the disease, which occur early in the pathological process, providing an opportunity for therapeutic intervention and application of neuroprotective strategies. The relationship between neural inflammation and cell death remains controversial. The recent development of new radiolabelled ligands provides positron emission tomography (PET) imaging with a role for studying early aspects of the MS pathology. METHODS We provide an overview of current PET research in MS, particularly focussing on possible applications of new radioligands for studying inflammation and neurodegenerative processes. RESULTS Pathological aspects of neuroinflammation, axonal degeneration and neuronal repair may be explored in vivo with selective PET tracers. Specific radioligands for the cannabinoid system may be applied in MS research to understand the role of this neurotransmitter system in the pathogenesis of the disease. CONCLUSIONS PET imaging represents a promising tool for elucidating controversial aspects of MS pathology and for the assessment of selective and potentially neuroprotective therapies.
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Affiliation(s)
- L Kiferle
- Centre for Neuroscience and MRC Clinical Sciences Centre, Division of Experimental Medicine, Hammersmith Hospital, Imperial College London, London, UK.,Department of Neuroscience, University of Pisa, Pisa, Italy
| | - M Politis
- Centre for Neuroscience and MRC Clinical Sciences Centre, Division of Experimental Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - P A Muraro
- Centre for Neuroscience and MRC Clinical Sciences Centre, Division of Experimental Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - P Piccini
- Centre for Neuroscience and MRC Clinical Sciences Centre, Division of Experimental Medicine, Hammersmith Hospital, Imperial College London, London, UK
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Politis M, Wu K, Loane C, Turkheimer FE, Molloy S, Brooks DJ, Piccini P. Depressive symptoms in PD correlate with higher 5-HTT binding in raphe and limbic structures. Neurology 2010; 75:1920-7. [PMID: 21098407 DOI: 10.1212/wnl.0b013e3181feb2ab] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Depression associated with Parkinson disease (PD) has a different symptom profile to endogenous depression. The etiology of depression in PD remains uncertain though abnormal serotonergic neurotransmission could play a role. OBJECTIVE To assess with PET serotonergic function via in vivo serotonin transporter (5-HTT) availability in antidepressant-naive patients with PD. METHODS Thirty-four patients with PD and 10 healthy matched control subjects had a clinical battery of tests including the patient-report Beck Depression Inventory-II (BDI-II), the clinician-report Hamilton Rating Scale for Depression (HRSD), and the structured clinical interview for DSM-IV Axis I Disorders (SCID-I). They underwent ¹¹C-DASB PET, a selective in vivo marker of 5-HTT binding in humans. RESULTS BDI-II scores correlated with HRSD scores. Ten of 34 patients with PD (29.4%) had BDI-II and HRSD scores above the discriminative cutoff for PD depression though only half of these patients could be classed on SCID-I criteria as having an anxiety/mood disorder. Patients with PD with the highest scores for depression symptoms showed significantly raised ¹¹C-DASB binding in amygdala, hypothalamus, caudal raphe nuclei, and posterior cingulate cortex compared to low score cases, while ¹¹C-DASB binding values in other regions were similarly decreased in depressed and nondepressed patients with PD compared to healthy controls. CONCLUSION Depressive symptoms in antidepressant-naive patients with PD correlate with relatively higher 5-HTT binding in raphe nuclei and limbic structures possibly reflecting lower extracellular serotonin levels. Our data are compatible with a key role of abnormal serotonergic neurotransmission contributing to the pathophysiology of PD depression and justify the use of agents acting on 5-HTT.
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Affiliation(s)
- M Politis
- MRC Clinical Sciences Centre and Centre for Neuroscience, Faculty of Medicine, Imperial CollegeLondon, UK.
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Wu K, O'Sullian S, Politis M, Bose S, Lees A, Piccini P. PAW21 Rewarding visual cues increase dopamine neurotransmission in Parkinson's patients with impulse control disorders: a PET study. Journal of Neurology, Neurosurgery & Psychiatry 2010. [DOI: 10.1136/jnnp.2010.226340.50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Politis M, Wu K, Loane C, Quinn NP, Brooks DJ, Rehncrona S, Bjorklund A, Lindvall O, Piccini P. Serotonergic Neurons Mediate Dyskinesia Side Effects in Parkinson's Patients with Neural Transplants. Sci Transl Med 2010; 2:38ra46. [DOI: 10.1126/scitranslmed.3000976] [Citation(s) in RCA: 241] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wu K, Politis M, Piccini P. Parkinson disease and impulse control disorders: a review of clinical features, pathophysiology and management. Postgrad Med J 2010; 85:590-6. [PMID: 19892894 DOI: 10.1136/pgmj.2008.075820] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Impulse control disorders (ICDs) are a heterogeneous group of conditions involving repetitive, excessive and compulsive activities that interfere with life functioning. Examples are pathological gambling, compulsive shopping and hypersexuality. Over the last decade, ICDs have become increasingly recognised as being associated with Parkinson disease (PD), with the literature highlighting a link between dopamine replacement therapy and the development of ICDs. Patients who develop ICDs in the context of compulsive anti-Parkinsonian drug use are described as having dopamine dysregulation syndrome (DDS), which is associated with repetitive complex stereotyped behaviours called punding. Case-control and observational studies have further noted that patients with PD who develop ICDs are more likely to have younger-onset PD, a history of alcohol dependence, novelty-seeking personality traits and psychiatric comorbidities. The pathophysiology of underlying mechanisms is not fully understood, but recent evidence suggests that dopaminergic drugs, particularly dopamine agonists, coupled with changes in reward pathways involving the ventral striatal and related circuitry, may play a role. Neuroimaging studies using positron emission tomography and functional MRI have provided valuable information in this area: patients with DDS have been found to show enhanced dopamine release in the ventral striatum, suggesting functional abnormalities in the mesolimbic networks. Management of ICDs in patients with PD can be challenging, as they may not be aware of a change in their behaviour or may conceal their symptoms to avoid embarrassment. Currently, there is no clear evidence of an optimal treatment. Management is based on a careful balance of dopaminergic drugs with control of the aberrant behaviour, supported by psychological interventions. This review aims to summarise the current literature on ICDs, their phenomenology, epidemiology, clinical features, pathophysiology and management.
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Affiliation(s)
- K Wu
- Division of Neuroscience & Mental Health, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
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Reuter I, Tai YF, Pavese N, Chaudhuri KR, Mason S, Polkey CE, Clough C, Brooks DJ, Barker RA, Piccini P. Long-term clinical and positron emission tomography outcome of fetal striatal transplantation in Huntington's disease. J Neurol Neurosurg Psychiatry 2008; 79:948-51. [PMID: 18356253 DOI: 10.1136/jnnp.2007.142380] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Two patients with moderate Huntington's disease (HD) received bilateral fetal striatal allografts. One patient demonstrated, for the first time, increased striatal D2 receptor binding, evident with 11C-raclopride positron emission tomography, and prolonged clinical improvement over 5 years, suggesting long term survival and efficacy of the graft. The other patient did not improve clinically or radiologically. Our results indicate that striatal transplantation in HD may be beneficial but further studies are needed to confirm this.
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Affiliation(s)
- I Reuter
- Academic Department of Neuroscience, Kings College Hospital, London, UK
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Politis M, Piccini P, Pavese N, Koh SB, Brooks D. 3.119 Evidence of dopamine dysfunction in the hypothalamus of patients with Parkinson's disease: An in vivo 11 C-raclopride PET study. Parkinsonism Relat Disord 2007. [DOI: 10.1016/s1353-8020(08)70827-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pavese N, Evans AH, Tai YF, Hotton G, Brooks DJ, Lees AJ, Piccini P. Clinical correlates of levodopa-induced dopamine release in Parkinson disease: a PET study. Neurology 2006; 67:1612-7. [PMID: 17101892 DOI: 10.1212/01.wnl.0000242888.30755.5d] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between clinical improvement and in vivo synaptic dopamine (DA) release after a single oral dose of levodopa (LD) in patients with advanced Parkinson disease (PD). METHODS We studied 16 patients with advanced PD with [(11)C]raclopride (RAC) PET. Each patient had RAC PET twice: once when medication had been withdrawn and once after an LD challenge. On the day of the LD challenge scan, oral 250 mg LD/25 mg carbidopa was given before scanning. Unified Parkinson's Disease Rating Scale (UPDRS) motor scores were rated in an "off" state before LD and again at the end of PET. RESULTS All the patients were still in "on" state at the end of their LD challenge RAC PET scans. Following LD, mean caudate and putamen RAC binding potentials (BPs) were significantly lower vs baseline, consistent with increased synaptic DA. Individual LD-induced improvements in UPDRS score correlated significantly with reductions in putaminal BP. Additionally, large putaminal RAC BP changes were associated with higher dyskinesia scores. When motor UPDRS subitems were examined, improvements in rigidity and bradykinesia, but not in tremor or axial symptoms, correlated with putamen DA release. CONCLUSION In advanced Parkinson disease, the improvement of rigidity and bradykinesia and the presence of dyskinesias after a single dose of oral levodopa are governed by the level of dopamine generated at striatal D2 receptors. In contrast, relief of parkinsonian tremor and axial symptoms is not related to striatal synaptic dopamine levels and presumably occurs via extrastriatal mechanisms.
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Affiliation(s)
- N Pavese
- MRC Clinical Sciences Centre and Division of Neurosciences, Faculty of Medicine, Imperial College, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK
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Tai YF, Ahsan RL, de Yébenes JG, Pavese N, Brooks DJ, Piccini P. Characterization of dopaminergic dysfunction in familial progressive supranuclear palsy: an 18F-dopa PET study. J Neural Transm (Vienna) 2006; 114:337-40. [PMID: 16897607 DOI: 10.1007/s00702-006-0536-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Accepted: 06/17/2006] [Indexed: 10/24/2022]
Abstract
We analyzed (18)F-dopa PET data from 11 members of kindreds with familial progressive supranuclear palsy (PSP) to characterize their cerebral dopaminergic dysfunction. Three clinically-affected PSP patients showed reduced (18)F-dopa uptake in the striatum, orbitofrontal cortex and amygdala. One asymptomatic subject exhibited progressive putamen dopaminergic dysfunction. 60% of subjects with abnormal (18)F-dopa scans developed PSP subsequently. This is the first in vivo documentation of cortical dopaminergic deficiency in PSP. Reduced striatal (18)F-dopa uptake in susceptible relatives may predict later clinical disease.
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Affiliation(s)
- Y F Tai
- MRC Clinical Sciences Centre and Division of Neurosciences, Hammersmith Hospital, Imperial College London, United Kingdom
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17
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Pavese N, Gerhard A, Tai YF, Ho AK, Turkheimer F, Barker RA, Brooks DJ, Piccini P. Microglial activation correlates with severity in Huntington disease: a clinical and PET study. Neurology 2006; 66:1638-43. [PMID: 16769933 DOI: 10.1212/01.wnl.0000222734.56412.17] [Citation(s) in RCA: 296] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Huntington disease (HD) is characterized by the progressive death of medium spiny dopamine receptor bearing striatal GABAergic neurons. In addition, microglial activation in the areas of neuronal loss has recently been described in postmortem studies. Activated microglia are known to release neurotoxic cytokines, and these may contribute to the pathologic process. METHODS To evaluate in vivo the involvement of microglia activation in HD, the authors studied patients at different stages of the disease using [(11)C](R)-PK11195 PET, a marker of microglia activation, and [(11)C]raclopride PET, a marker of dopamine D2 receptor binding and hence striatal GABAergic cell function. RESULTS In HD patients, a significant increase in striatal [(11)C](R)-PK11195 binding was observed, which significantly correlated with disease severity as reflected by the striatal reduction in [(11)C]raclopride binding, the Unified Huntington's Disease Rating Scale score, and the patients' CAG index. Also detected were significant increases in microglia activation in cortical regions including prefrontal cortex and anterior cingulate. CONCLUSIONS These [(11)C](R)-PK11195 PET findings show that the level of microglial activation correlates with Huntington disease (HD) severity. They lend support to the view that microglia contribute to the ongoing neuronal degeneration in HD and indicate that [(11)C](R)-PK11195 PET provides a valuable marker when monitoring the efficacy of putative neuroprotecting agents in this relentlessly progressive genetic disorder.
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Affiliation(s)
- N Pavese
- MRC Clinical Sciences Centre and Division of Neuroscience, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, UK
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Piccini P. Reply: Rate of progression determines the clinical outcome after neural transplantation in Parkinson's disease. Brain 2006. [DOI: 10.1093/brain/awl113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Khan NL, Scherfler C, Graham E, Bhatia KP, Quinn N, Lees AJ, Brooks DJ, Wood NW, Piccini P. Dopaminergic dysfunction in unrelated, asymptomatic carriers of a single parkin mutation. Neurology 2005; 64:134-6. [PMID: 15642918 DOI: 10.1212/01.wnl.0000148725.48740.6d] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Parkin disease is usually autosomal recessive; however, two studies have shown that asymptomatic heterozygotes have nigrostriatal dysfunction and even manifest subtle extrapyramidal signs. The authors used 18F-dopa PET to study 13 asymptomatic parkin heterozygotes and found a significant reduction of (18)F-dopa uptake in caudate, putamen, ventral, and dorsal midbrain compared with control subjects. Four had subtle extrapyramidal signs. Parkin heterozygosity is a risk factor for nigrostriatal dysfunction and in some may contribute to late-onset Parkinson disease.
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Affiliation(s)
- N L Khan
- MRC Clinical Sciences Centre, and Division of Neuroscience, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, UK
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Piccini P, Tai YF. IMAGING NEUROSCIENCE: CLINICAL FRONTIERS FOR DIAGNOSIS AND MANAGEMENT. Brain 2004. [DOI: 10.1093/brain/awh238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Positron emission tomography (PET) is a powerful imaging technique which enables in vivo examination of brain functions. It allows non-invasive quantification of cerebral blood flow, metabolism, and receptor binding. In the past PET has been employed mainly in the research setting due to the relatively high costs and complexity of the support infrastructure, such as cyclotrons, PET scanners, and radiochemistry laboratories. In recent years, because of advancements in technology and proliferation of PET scanners, PET is being increasingly used in clinical neurology to improve our understanding of disease pathogenesis, to aid with diagnosis, and to monitor disease progression and response to treatment. This article aims to provide an overview of the principles of PET and its applications to clinical neurology.
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Affiliation(s)
- Y F Tai
- MRC Clinical Sciences Centre and Division of Neuroscience, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, UK
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Nicholl DJ, Vaughan JR, Khan NL, Ho SL, Aldous DEW, Lincoln S, Farrer M, Gayton JD, Davis MB, Piccini P, Daniel SE, Lennox GG, Brooks DJ, Williams AC, Wood NW. Two large British kindreds with familial Parkinson's disease: a clinico-pathological and genetic study. Brain 2002; 125:44-57. [PMID: 11834592 DOI: 10.1093/brain/awf013] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We present the findings of a study of two large unrelated kindreds with autosomal dominant Parkinson's disease. The affected members were assessed clinically and with [(18)F]6-fluorodopa-PET and were indistinguishable from patients with the sporadic form of Parkinson's disease. In one kindred, an affected member was examined subsequently at autopsy and Lewy bodies were present in a distribution typical of sporadic Parkinson's disease. These kindreds are distinct from other Parkinsonian kindreds with identified genetic loci (PARK1-4) and provide further evidence for genetic heterogeneity in familial Parkinson's disease.
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Affiliation(s)
- D J Nicholl
- Department of Neurology, Queen Elizabeth Hospital, Birmingham, UK.
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Piccini P, de Yebenez J, Lees AJ, Ceravolo R, Turjanski N, Pramstaller P, Brooks DJ. Familial progressive supranuclear palsy: detection of subclinical cases using 18F-dopa and 18fluorodeoxyglucose positron emission tomography. Arch Neurol 2001; 58:1846-51. [PMID: 11708994 DOI: 10.1001/archneur.58.11.1846] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is generally considered to be a sporadic disease; however, occasional cases of familial PSP have been described. The rarity of reports of familial PSP may be attributed in part to an inability to detect subclinical disease in affected relatives who subsequently die before symptoms clinically develop. OBJECTIVE To study regional cerebral dopaminergic function and glucose metabolism in members of 2 large kindreds with familial PSP to identify subclinical cases. METHODS Three clinically affected members from the 2 PSP kindreds were scanned with both (18)F-dopa and (18)fluorodeoxyglucose ((18)FDG) positron emission tomography (PET). Fifteen asymptomatic first-degree relatives were scanned with (18)F-dopa PET; 10 of them also underwent a second PET study with (18)FDG. RESULTS All 3 clinically affected PSP patients showed a significant reduction in caudate and putamen (18)F-dopa uptake along with a significant reduction in striatal, lateral, and medial premotor area and dorsal prefrontal cortex glucose metabolism. In 4 of the 15 asymptomatic relatives, caudate and putamen (18)F-dopa uptake was 2.5 SDs lower than the normal mean. These 4 subjects and a fifth asymptomatic relative with normal (18)F-dopa uptake showed a significant reduction of cortical and striatal glucose metabolism in a pattern similar to that of their affected relatives. CONCLUSION (18)F-dopa and (18)FDG PET allowed us to identify 5 cases with subclinical metabolic dysfunction among 15 subjects (33%) at risk for PSP, suggesting that this approach is useful for characterizing the pattern of aggregation in PSP kindreds.
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Affiliation(s)
- P Piccini
- MRC Clinical Science Center, Imperial College School of Medicine, Hammersmith Hospital, DuCane Road, W12 ONN London, England.
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Affiliation(s)
- D J Brooks
- MRC Cyclotron Unit, Hammersmith Hospital, London W12 0NN, UK.
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25
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Piccini P, Lindvall O, Björklund A, Brundin P, Hagell P, Ceravolo R, Oertel W, Quinn N, Samuel M, Rehncrona S, Widner H, Brooks DJ. Delayed recovery of movement-related cortical function in Parkinson's disease after striatal dopaminergic grafts. Ann Neurol 2000; 48:689-95. [PMID: 11079531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Intrastriatal transplantation of dopaminergic neurones aims to repair the selective loss of nigrostriatal projections and the consequent dysfunction of striatocortical circuitries in Parkinson's disease (PD). Here, we have studied the effects of bilateral human embryonic dopaminergic grafts on the movement-related activation of frontal cortical areas in 4 PD patients using H2 15O positron emission tomography and a joystick movement task. At 6.5 months after transplantation, mean striatal dopamine storage capacity as measured by 18F-dopa positron emission tomography was already significantly elevated in these patients. This was associated with a modest clinical improvement on the Unified Parkinson's Disease Rating Scale, whereas the impaired cortical activation was unchanged. At 18 months after surgery, there was further significant clinical improvement in the absence of any additional increase in striatal 18F-dopa uptake. Rostral supplementary motor and dorsal prefrontal cortical activation during performance of joystick movements had significantly improved, however. Our data suggest that the function of the graft goes beyond that of a simple dopamine delivery system and that functional integration of the grafted neurones within the host brain is necessary to produce substantial clinical recovery in PD.
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Affiliation(s)
- P Piccini
- Medical Research Council Clinical Sciences Centre, Imperial College School of Medicine, Hammersmith Hospital, London, UK
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26
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Brundin P, Pogarell O, Hagell P, Piccini P, Widner H, Schrag A, Kupsch A, Crabb L, Odin P, Gustavii B, Björklund A, Brooks DJ, Marsden CD, Oertel WH, Quinn NP, Rehncrona S, Lindvall O. Bilateral caudate and putamen grafts of embryonic mesencephalic tissue treated with lazaroids in Parkinson's disease. Brain 2000; 123 ( Pt 7):1380-90. [PMID: 10869050 DOI: 10.1093/brain/123.7.1380] [Citation(s) in RCA: 229] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Five parkinsonian patients were transplanted bilaterally into the putamen and caudate nucleus with human embryonic mesencephalic tissue from between seven and nine donors. To increase graft survival, the lipid peroxidation inhibitor tirilazad mesylate was administered to the tissue before implantation and intravenously to the patients for 3 days thereafter. During the second postoperative year, the mean daily L-dopa dose was reduced by 54% and the UPDRS (Unified Parkinson's Disease Rating Scale) motor score in 'off' phase was reduced by a mean of 40%. At 10-23 months after grafting, PET showed a mean 61% increase of 6-L-[(18)F]fluorodopa uptake in the putamen, and 24% increase in the caudate nucleus, compared with preoperative values. No obvious differences in the pattern of motor recovery were observed between these and other previously studied cases with putamen grafts alone. The amount of mesencephalic tissue implanted in each putamen and caudate nucleus was 42 and 50% lower, respectively, compared with previously transplanted patients from our centre. Despite this reduction in grafted tissue, the magnitudes of symptomatic relief and graft survival were very similar. These findings suggest that tirilazad mesylate may improve survival of grafted dopamine neurons in patients, which is in agreement with observations in experimental animals.
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Affiliation(s)
- P Brundin
- Section for Neuronal Survival, Division of Neurobiology, Department of Physiological Sciences, Lund University, Sweden
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Piccini P, Brooks DJ, Korpela K, Pavese N, Karlsson M, Gordin A. The catechol-O-methyltransferase (COMT) inhibitor entacapone enhances the pharmacokinetic and clinical response to Sinemet CR in Parkinson's disease. J Neurol Neurosurg Psychiatry 2000; 68:589-94. [PMID: 10766888 PMCID: PMC1736905 DOI: 10.1136/jnnp.68.5.589] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Entacapone is a specific, potent, peripherally acting catechol-O-methyltransferase (COMT) inhibitor. It has been shown to improve the bioavailability of plasma levodopa and extend its clinical effect when used as an adjunct to standard levodopa preparations, but there is little experience of the effect of entacapone on controlled release levodopa preparations. METHODS A double blind, placebo controlled, single dose, randomised, cross over trial was performed in 14 patients with Parkinson's disease with motor fluctuations to investigate the clinical effect of a single dose of entacapone (200 mg) when administered with either standard levodopa-carbidopa (Sinemet) or controlled release levodopa-carbidopa preparations (Sinemet CR). RESULTS When entacapone was administered with standard Sinemet the duration of the clinical response to standard Sinemet was longer in comparison with the response after placebo (p=0.02). Moreover, in the same patients, entacapone significantly increased the duration of the clinical response to Sinemet CR (p=0.05) without prolonging the latency of response or enhancing dyskinesias. CONCLUSIONS These data confirm the clinical efficacy of entacapone-standard Sinemet combination. They also indicate that adding entacapone to controlled release levodopa preparations might provide a useful treatment option in patients with Parkinson's disease with motor fluctuations. A double blind clinical trial with a chronically administered entacapone-Sinemet CR combination is, however, required to verify this viewpoint.
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Affiliation(s)
- P Piccini
- Department of Neurology, Imperial College, School of Medicine, Hammersmith Hospital, London, UK.
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Brooks DJ, Piccini P, Turjanski N, Samuel M. Neuroimaging of dyskinesia. Ann Neurol 2000; 47:S154-8; discussion S158-9. [PMID: 10762143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Dyskinesias are observed in the majority of Parkinson's disease (PD) patients who have been chronically exposed to levodopa, and these may result from supersensitivity of postsynaptic striatal dopamine D1 and D2 receptors following loss of nigral dopaminergic projections. Dyskinetic and nondyskinetic PD patients were studied using 11C-SCH23390 and 11C-raclopride positron emission tomography (PET). No difference in mean putamen or caudate D1 or D2 receptor binding between the two patient subgroups was found, suggesting that dyskinesias are unlikely to arise from a primary disturbance of dopamine receptor availability. When dyskinetic and nondyskinetic patients were studied with 11C-diprenorphine PET, the former showed a significant reduction (p < 0.05) in striatal and thalamic opioid site availability, compatible with the presence of raised levels of endogenous opioid peptides. H2(15)O PET activation studies of patients with focal limb dyskinesias showed that resting levels of regional cerebral blood flow after oral levodopa were increased during dyskinesias in lentiform nuclei, motor, premotor and dorsal prefrontal cortex. These results suggest that dyskinesias are associated with derangement of basal ganglia opioid transmission, resulting in overactivity of basal ganglia-frontal projections.
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Affiliation(s)
- D J Brooks
- MRC Cyclotron Unit, Imperial College School of Medicine, Hammersmith Hospital, London, UK
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29
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Bonuccelli U, Del Dotto P, Lucetti C, Petrozzi L, Bernardini S, Gambaccini G, Rossi G, Piccini P. Diurnal motor variations to repeated doses of levodopa in Parkinson's disease. Clin Neuropharmacol 2000; 23:28-33. [PMID: 10682228 DOI: 10.1097/00002826-200001000-00006] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients with Parkinson's disease (PD) in long-term levodopa therapy often complain of worsening of motor symptoms in the afternoon and evening. The pathophysiology of this phenomenon is not known. We evaluated the motor response to repeated doses of levodopa during a 12-hour period in 52 parkinsonian patients (19 de novo, 20 stable, and 13 wearing-off). On the day of the study, all patients received standard doses of levodopa/carbidopa at 8:00 a.m., 12:00 noon, and 4:00 p.m. Motor measurements such as tapping test, walking time, and tremor score, and blood samples for levodopa and 3-O-methyldopa (3OMD) plasma analysis, were performed hourly. Mean motor scores and pharmacokinetic data, evaluated for a period of 3 hours after each levodopa dose, were compared. In de novo patients, we did not observe diurnal changes in motor score, whereas a progressive daytime worsening was visible in stable and wearing-off patients. No significant difference in levodopa pharmacokinetics after each levodopa dose was observed within each patient group, whereas 3OMD plasma levels significant increased with repeated levodopa administrations. However, no significant correlation between motor scores and 3OMD plasma levels was observed, suggesting that the diminishing motor response to afternoon and evening doses of levodopa in patients in long-term levodopa therapy does not relate to the pharmacokinetics of the drug. It is possible that this phenomenon may be an expression of the occurrence of tolerance to repeated doses of levodopa.
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Affiliation(s)
- U Bonuccelli
- Department of Neuroscience, University of Pisa, Italy
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30
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Piccini P, Brooks DJ, Björklund A, Gunn RN, Grasby PM, Rimoldi O, Brundin P, Hagell P, Rehncrona S, Widner H, Lindvall O. Dopamine release from nigral transplants visualized in vivo in a Parkinson's patient. Nat Neurosci 1999; 2:1137-40. [PMID: 10570493 DOI: 10.1038/16060] [Citation(s) in RCA: 526] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Synaptic dopamine release from embryonic nigral transplants has been monitored in the striatum of a patient with Parkinson's disease using [11C]-raclopride positron emission tomography to measure dopamine D2 receptor occupancy by the endogenous transmitter. In this patient, who had received a transplant in the right putamen 10 years earlier, grafts had restored both basal and drug-induced dopamine release to normal levels. This was associated with sustained, marked clinical benefit and normalized levels of dopamine storage in the grafted putamen. Despite an ongoing disease process, grafted neurons can thus continue for a decade to store and release dopamine and give rise to substantial symptomatic relief.
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Affiliation(s)
- P Piccini
- MRC Cyclotron Unit, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
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31
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Piccini P, Brooks DJ. Etiology of Parkinson's disease: contributions from 18F-DOPA positron emission tomography. Adv Neurol 1999; 80:227-31. [PMID: 10410726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- P Piccini
- Medical Research Council, Hammersmith Hospital, London, United Kingdom
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32
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Hagell P, Schrag A, Piccini P, Jahanshahi M, Brown R, Rehncrona S, Widner H, Brundin P, Rothwell JC, Odin P, Wenning GK, Morrish P, Gustavii B, Björklund A, Brooks DJ, Marsden CD, Quinn NP, Lindvall O. Sequential bilateral transplantation in Parkinson's disease: effects of the second graft. Brain 1999; 122 ( Pt 6):1121-32. [PMID: 10356064 DOI: 10.1093/brain/122.6.1121] [Citation(s) in RCA: 212] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Five parkinsonian patients who had received implants of human embryonic mesencephalic tissue unilaterally in the striatum 10-56 months earlier were grafted with tissue from four to eight donors into the putamen (four patients) or the putamen plus the caudate nucleus (one patient) on the other side, and were followed for 18-24 months. After 12-18 months, PET showed a mean 85% increase in 6-L-[18F]fluorodopa uptake in the putamen with the second graft, whereas there was no significant further change in the previously transplanted putamen. Two patients exhibited marked additional improvements after their second graft: 'on-off' fluctuations virtually disappeared, movement speed increased, and L-dopa could be withdrawn in one patient and reduced by 70% in the other. The improvement in one patient was moderate. Two patients with atypical features, who responded poorly to the first graft, worsened following the second transplantation. These findings indicate that sequential transplantation in patients does not compromise the survival and function of either the first or the second graft. Moreover, putamen grafts that restore fluorodopa uptake to normal levels can give improvements of major therapeutic value.
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Affiliation(s)
- P Hagell
- Division of Neurology, Department of Clinical Neuroscience, University of Lund, Sweden
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Piccini P, Burn DJ, Ceravolo R, Maraganore D, Brooks DJ. The role of inheritance in sporadic Parkinson's disease: evidence from a longitudinal study of dopaminergic function in twins. Ann Neurol 1999. [PMID: 10319879 DOI: 10.1002/1531-8249(199905)45: 5<577: : aid-ana5>3.0.co; 2-o] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Despite the major finding of a genetic defect being responsible for the Parkinson's disease (PD) phenotype in some kindreds with dominantly transmitted PD, the role of inheritance in the cause of the more widespread sporadic form of the disease is still unclear. Twin studies are a classic tool for assessing the influence of hereditary factors in diseases; however, the application of this approach to late-onset illnesses, like PD, poses some problems because of the identification of subclinical cases. In the present longitudinal study we have used [18F]dopa and positron emission tomography to study dopaminergic function in twin pairs at baseline clinically discordant for PD. At baseline, the concordance for subclinical striatal dopaminergic dysfunction was found to be significantly higher in 18 monozygotic than in 16 dizygotic twin pairs (55% vs 18%, respectively). The asymptomatic monozygotic cotwins all showed progressive loss of dopaminergic function over 7 years and 4 developed clinical PD. None of the dizygotic twin pairs became clinically concordant. At follow-up, the combined concordance levels for subclinical dopaminergic dysfunction and clinical PD were 75% in the 12 monozygotic and 22% in the 9 dizygotic twin pairs evaluated twice. Our findings suggest a substantial role for inheritance in sporadic PD.
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Affiliation(s)
- P Piccini
- MRC Cyclotron Unit, Hammersmith Hospital, London, UK
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34
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Abstract
Patients with essential tremor (ET) may not respond to commonly used drugs. Clozapine, an atypical neuroleptic drug, has been reported to improve postural Parkinson's disease tremor clinically resembling ET. The effects of a single dose of 12.5 mg clozapine and placebo were evaluated in a randomized, double-blind, crossover study in 15 drug-resistant patients with ET. Patient responders with more than 50% improvement after a single dose of clozapine subsequently received the drug (39+/-9 mg up to 50 mg) unblinded for a period of 15.8+/-7.7 months. Tremor was effectively reduced by a single dose of clozapine in 13 of 15 patients (p <0.01). Sedation was the only side effect reported during the clozapine test; however, the time course of sedation and of the antitremor effect were not coincident. A significant reduction of tremor was reported with chronic clozapine treatment (p <0.01) with no tolerance to drug antitremor effect, whereas sedation markedly decreased after 6-7 weeks of therapy. No clozapine-induced hematologic side effects were observed in our cohort of patients during long-term treatment. Our results suggest that in selected drug-resistant ET cases, clozapine should be considered before resorting to neurosurgical options.
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Affiliation(s)
- R Ceravolo
- Department of Neurology, Imperial College School of Medicine, Hammersmith Hospital, London, UK
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35
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Piccini P, Burn DJ, Ceravolo R, Maraganore D, Brooks DJ. The role of inheritance in sporadic Parkinson's disease: evidence from a longitudinal study of dopaminergic function in twins. Ann Neurol 1999; 45:577-82. [PMID: 10319879 DOI: 10.1002/1531-8249(199905)45:5<577::aid-ana5>3.0.co;2-o] [Citation(s) in RCA: 210] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite the major finding of a genetic defect being responsible for the Parkinson's disease (PD) phenotype in some kindreds with dominantly transmitted PD, the role of inheritance in the cause of the more widespread sporadic form of the disease is still unclear. Twin studies are a classic tool for assessing the influence of hereditary factors in diseases; however, the application of this approach to late-onset illnesses, like PD, poses some problems because of the identification of subclinical cases. In the present longitudinal study we have used [18F]dopa and positron emission tomography to study dopaminergic function in twin pairs at baseline clinically discordant for PD. At baseline, the concordance for subclinical striatal dopaminergic dysfunction was found to be significantly higher in 18 monozygotic than in 16 dizygotic twin pairs (55% vs 18%, respectively). The asymptomatic monozygotic cotwins all showed progressive loss of dopaminergic function over 7 years and 4 developed clinical PD. None of the dizygotic twin pairs became clinically concordant. At follow-up, the combined concordance levels for subclinical dopaminergic dysfunction and clinical PD were 75% in the 12 monozygotic and 22% in the 9 dizygotic twin pairs evaluated twice. Our findings suggest a substantial role for inheritance in sporadic PD.
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Affiliation(s)
- P Piccini
- MRC Cyclotron Unit, Hammersmith Hospital, London, UK
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36
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Abstract
Levodopa-induced dyskinesias remain a major challenge in the therapeutic management of Parkinson's disease (PD). Their etiology is unknown although dysfunction of striatal opioid transmission has been implicated in experimental models of PD. To determine whether the opioid system is involved in human dyskinetic PD, we measured in vivo opioid receptor binding in PD patients with and without levodopa-induced dyskinesias, using positron emission tomography (PET) and the opioid receptor ligand [11C]diprenorphine. Striatal and thalamic/occipital uptake ratios were calculated using a region of interest (ROI) approach. In addition, we used statistical parametric mapping (SPM) and images reflecting the volume of distribution of [11C]diprenorphine to assess changes in cerebral receptor binding on a voxel-by-voxel basis. By using the ROI approach, we found significantly reduced striatal and thalamic opioid binding in dyskinetic, but not in nondyskinetic, PD patients. The SPM approach confirmed reduced availability in these areas and, in addition, showed decreased cingulate and increased prefrontal opioid receptor binding in the dyskinetic patients. Our findings confirm that altered opioid transmission is part of the pathophysiology of levodopa-induced dyskinesias in PD and support further investigation into the role of opioid agents in the management of these involuntary movements.
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Affiliation(s)
- P Piccini
- MRC Cyclotron Unit, Hammersmith Hospital, London, UK
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37
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Weeks RA, Ceballos-Baumann A, Piccini P, Boecker H, Harding AE, Brooks DJ. Cortical control of movement in Huntington's disease. A PET activation study. Brain 1997; 120 ( Pt 9):1569-78. [PMID: 9313640 DOI: 10.1093/brain/120.9.1569] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Regional cerebral blood flow was measured with H2(15)O PET in seven patients with choreic Huntington's disease and seven age-matched control subjects. Subjects were scanned at rest and when performing paced joystick movements, in freely chosen directions, with the dominant arm. During movement, the patients showed impaired activation of contralateral primary motor, medial premotor, bilateral parietal and bilateral prefrontal areas along with increased activation of bilateral insular areas. The underactivity of frontal areas in Huntington's disease is similar to the pattern of impaired activation in Parkinson's disease and is likely to result from degeneration of basal ganglia to frontal projections. Primary motor underactivity may explain the bradykinesia that these patients exhibit and, if inhibitory neurons are involved, also their chorea.
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Affiliation(s)
- R A Weeks
- MRC Cyclotron Unit, Hammersmith Hospital, London, UK
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38
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Weeks RA, Cunningham VJ, Piccini P, Waters S, Harding AE, Brooks DJ. 11C-diprenorphine binding in Huntington's disease: a comparison of region of interest analysis with statistical parametric mapping. J Cereb Blood Flow Metab 1997; 17:943-9. [PMID: 9307607 DOI: 10.1097/00004647-199709000-00003] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We compare region of interest (ROI) analytical approaches with statistical parametric mapping (SPM) of 11C-diprenorphine positron emission tomography findings in five patients with Huntington's disease (HD) and nine age-matched controls. The ROI were placed on caudate, putamen, and an occipital reference area. Ratios of striatal-occipital uptake from averaged static images centered at 60 minutes showed a mean 20% reduction in caudate (P = 0.034) and 15% reduction in putamen (P = 0.095) receptor binding in the HD patients. Dynamic data from caudate and putamen ROI, together with a plasma tracer input function, were analyzed using spectral analysis to give regional impulse response functions. Regional data at 60 minutes after impulse showed a mean 29% decrease in caudate (P = 0.006) and 23% decrease in putamen (P = 0.029) opioid binding in the HD cohort. Parametric images of tracer binding also were produced with spectral analysis on a voxel basis. The images of the unit impulse response function at 60 minutes showed a mean 31% decrease in caudate (P = 0.005) and a 26% decrease in putamen binding (P = 0.011) in HD. The voxel-based parametric images were transformed into standard stereotactic space, and a between-group comparison (patient versus controls) was performed with SPM. This approach revealed symmetrical decreases in caudate (peak 40% decrease, z score = 4.38) and putamen opioid binding (peak 24% decrease, z score = 4.686) with additional nonhypothesized changes in cingulate, prefrontal, and thalamic areas. The significance and precision of changes measured with spectral analysis applied to dynamic data sets were superior to ROI-based ratio analysis on static images. The SPM replicated the striatal reductions in opioid binding in HD and detected additional nonpredicted changes. This study suggests that SPM is a valid alternative to conventional ROI analytical approaches for determining binding changes with positron emission tomography and may have advantages over region-based analyses in exploratory studies.
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Affiliation(s)
- R A Weeks
- MRC Cyclotron Unit, Hammersmith Hospital, London, United Kingdom
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39
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Piccini P, Morrish PK, Turjanski N, Sawle GV, Burn DJ, Weeks RA, Mark MH, Maraganore DM, Lees AJ, Brooks DJ. Dopaminergic function in familial Parkinson's disease: a clinical and 18F-dopa positron emission tomography study. Ann Neurol 1997; 41:222-9. [PMID: 9029071 DOI: 10.1002/ana.410410213] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There is increasing evidence for familial aggregation in Parkinson's disease (PD). It is possible that some asymptomatic relatives of PD patients have subclinical nigral Lewy body pathology and their identification could help determine the true prevalence of the disease. We used 18F-dopa positron emission tomography to investigate nigrostriatal dopaminergic terminal function in asymptomatic members of 7 unrelated kindreds in which at least 2 members had parkinsonism. Eight (25%) of the 32 asymptomatic relatives showed abnormal putamen 18F-dopa uptake (2.5 standard deviations below the normal mean). When discriminant function analysis was applied, all of these 8 subjects plus another 3 were classified with high probability as having PD. On neurological examination, 5 of the 32 relatives scanned had an isolated mild postural tremor and 2 of these 5 had reduced putamen uptake. Our findings provide further support for a role of inheritance in the etiology of PD and suggest that the penetrance for nigrostriatal dopaminergic dysfunction in familial clusters of PD is higher than the prevalence of clinical parkinsonism reported in epidemiological surveys.
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Affiliation(s)
- P Piccini
- Medical Research Council Cyclotron Unit, Hammersmith Hospital, London, United Kingdom
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40
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Abstract
We have investigated striatal dopamine D1 and D2 receptor binding in asymptomatic subjects from Huntington's disease (HD) families using positron emission tomography. Nineteen adult subjects at risk of developing HD were scanned with 11C-SCH 23390 and 11C-raclopride to calculate the D1 and D2 receptor binding potential, respectively. Eight of the 19 were shown to have the HD mutation; of these, 4 subjects had significant reductions in striatal dopamine receptor binding. Abnormalities were more common in older subjects and were not correlated with the size of the HD mutation. There was a strong coefficient of correlation between individual levels of striatal D1 and D2 binding in subjects with the mutation. Of 6 other cases with a 50% risk of carrying the HD gene, 1 showed subclinical loss of caudate and putamen D2 binding. Our study suggests that both striatal D1 and D2 dopamine receptors are lost in parallel from both caudate and putamen in presymptomatic HD and that dopamine receptor binding provides a sensitive means of detecting subclinical striatal dysfunction.
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Affiliation(s)
- R A Weeks
- MRC Cyclotron Unit, Hammersmith Hospital, London, UK
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Piccini P, Pavese N, Palombo C, Pittella G, Distante A, Bonuccelli U. Transcranial Doppler Ultrasound in Migraine and Tension-Type Headache after Apomorphine Administration: Double-Blind Crossover versus Placebo Study. Cephalalgia 1995. [DOI: 10.1046/j.1468-29821995.1505399.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Piccini P, Pavese N, Palombo C, Pittella G, Distante A, Bonuccelli U. Transcranial Doppler ultrasound in migraine and tension-type headache after apomorphine administration: double-blind crossover versus placebo study. Cephalalgia 1995; 15:399-403. [PMID: 8536300 DOI: 10.1046/j.1468-2982.1995.1505399.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The effect of the dopaminergic agonist apomorphine on blood velocity in the middle cerebral artery has been studied in patients with migraine, tension-type headaches, and healthy subjects by means of transcranial Doppler monitoring. Following the administration of apomorphine, systolic velocity and mean velocity significantly increased and pulsatility index significantly decreased in migraineurs compared to placebo and to the other groups of subjects. These changes were dose-dependent and showed a time-curved compatible with the pharmacokinetic profile of the drug. The different effect of apomorphine in migraineurs compared with controls and tension-type headache patients implies that migraineurs have increased sensitivity to dopaminergic stimuli and suggests that transcranial Doppler monitoring after apomorphine administration could be a useful tool in the evaluation of migraineurs.
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Affiliation(s)
- P Piccini
- Institute of Neurology, University of Pisa, Italy
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Piccini P, Pavese N, Canapicchi R, Paoli C, Del Dotto P, Puglioli M, Rossi G, Bonuccelli U. White matter hyperintensities in Parkinson's disease. Clinical correlations. Arch Neurol 1995; 52:191-4. [PMID: 7848130 DOI: 10.1001/archneur.1995.00540260097023] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To verify recent preliminary data indicating that white matter hyperintensities on magnetic resonance imaging are more abundant in patients with Parkinson's disease (PD) than in healthy subjects and to examine possible correlation between these abnormalities and clinical features of PD. DESIGN Magnetic resonance imaging data on patients with PD and normal subjects were compared as to frequency, extent, and topographic location of white matter hyperintensities; moreover, in the PD group, we studied the possible correlation of white matter hyperintensities with clinical features such as severity, disease duration, and therapy. SETTING The outpatient clinic of the Institute of Clinical Neurology and the Neuroradiology Unit of the University of Pisa (Italy). PATIENTS We studied 102 nondemented patients with idiopathic PD and 68 sex- and age-matched healthy controls, all screened for absence of cerebrovascular risk factors. OUTCOME MEASURES White matter hyperintensities were classified as periventricular hyperintensities and deep hyperintensities. Frequency, extent, and topographic location of both periventricular and deep hyperintensities were evaluated. The clinical parameters examined were disease duration, treatment type, and disease severity (using Hoehn and Yahr staging and the Unified Parkinson's Disease Rating Scale), as well as disease progression index (ratio between Hoehn and Yahr stage and disease duration). RESULTS The frequency and the extent of periventricular hyperintensities were significantly higher in patients with PD than in healthy subjects. Moreover, within the PD group, the patients who had periventricular hyperintensities had significantly shorter disease duration and greater disease severity, ie, a higher disease progression index, than those who did not. CONCLUSION These data suggest that periventricular hyperintensities may represent a marker for a clinical subtype of PD characterized by a more rapid neurodegenerative process.
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Affiliation(s)
- P Piccini
- Institute of Clinical Neurology, University of Pisa, Italy
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Bonuccelli U, Piccini P, Del Dotto P, Rossi G, Corsini GU, Muratorio A. Apomorphine test for dopaminergic responsiveness: a dose assessment study. Mov Disord 1993; 8:158-64. [PMID: 8474482 DOI: 10.1002/mds.870080207] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The clinical diagnosis of idiopathic Parkinson's disease (IPD) remains difficult and is supported by a favorable response to levodopa, while failure to respond represents an exclusion criterion. Recently, the response to subcutaneous apomorphine has been suggested as a tool in predicting levodopa responsiveness in parkinsonian syndromes. We administered apomorphine at doses of 10, 50, and 100 micrograms/kg subcutaneously against placebo over two consecutive days in 37 patients with parkinsonism and evaluated the motor response for 90 min after each dose. Subsequently, we compared the motor response with the follow-up response to levodopa therapy and to a final diagnosis. Twenty-seven patients of 37 showed a positive response to apomorphine, and 10 had a negative response. All positive responses to the apomorphine test were obtained with 50 or 100 micrograms/kg doses. Because of the high frequency of side effects with the dose of 100 micrograms/kg, 50 micrograms/kg seems more useful. After an adequate period of levodopa/carbidopa therapy (12-month follow-up), 29 patients improved; 25 of these had demonstrated a positive response to the apomorphine test. The final diagnosis of IPD, made on the basis of an exhaustive clinical and neuroradiological evaluation and on the response to chronic levodopa therapy, was in good agreement with the response to the apomorphine test (predictivity of diagnosis, 86.4%). Our data indicate that subcutaneous apomorphine at the dose of 50 micrograms/kg is a useful tool in the differential diagnosis of parkinsonian syndromes.
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Affiliation(s)
- U Bonuccelli
- Institute of Clinical Neurology, University of Pisa, Italy
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Bonuccelli U, Piccini P, Del Dotto P, Pavese N, D'Antonio P, Muratorio A. Apomorphine test in de novo Parkinson's disease. Funct Neurol 1992; 7:295-8. [PMID: 1427361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We administered apomorphine, a powerful dopaminergic agonist, subcutaneously to 25 untreated patients with parkinsonian features and evaluated motor response with the aim of discriminating idiopathic Parkinson's disease (IPD) from multiple system atrophy and progressive supranuclear palsy. The response to apomorphine was strongly predictive of responsiveness to subsequent levodopa follow-up and of the final diagnosis, made on the basis of both clinical and instrumental evaluation. Our data confirm that the apomorphine test is helpful in the differential diagnosis of IPD.
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Affiliation(s)
- U Bonuccelli
- Institute of Clinical Neurology, University of Pisa, Italy
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Abstract
We report a case of neuroleptic malignant syndrome (NMS) following abrupt reduction of chronic levodopa treatment in a 71 year old female parkinsonian patient. The NMS resolved within 24 hours of the addition of apomorphine to levodopa therapy.
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Perissin L, Zorzet S, Piccini P, Rapozzi V, Giraldi T. Effects of rotational stress on the effectiveness of cyclophosphamide and razoxane in mice bearing Lewis lung carcinoma. Clin Exp Metastasis 1991; 9:541-9. [PMID: 1752084 DOI: 10.1007/bf01768582] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The effects of conventional vs protected housing, and those caused by the periodic application of a psychological stressor (rotational stress, spatial disorientation) on mice kept in a protected housing, with spontaneous tumor metastasis have been determined in mice implanted with Lewis lung carcinoma as a function of tumor inoculum size and response to treatment with cyclophosphamide and razoxane. With a reduced inoculum size, tumor takes do not occur in mice kept in the protected housing, but do occur with spatial disorientation. With a larger inoculum size, tumor takes occur in all untreated mice, and the weight of spontaneous lung metastasis is significantly increased by spatial disorientation. For mice in protected housing, cyclophosphamide results in the absence of macroscopically detectable tumors in all of the treated mice, whereas the use of spatial disorientation abolishes this therapeutic action. The antimetastatic effects of razoxane are also reduced by rotational stress. These results indicate that housing conditions and a psychological stressor can control tumor takes and metastasis formation. They also indicate that host's antitumor resistance effectors, which are susceptible to neuroendocrine modulation by environmental and psychological stressors, participate to determine the effectiveness of the treatment with a cytotoxic (cyclophosphamide) and antimetastatic (razoxane) antitumor drug.
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Affiliation(s)
- L Perissin
- Institute of Pharmacology, University of Trieste, Italy
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Ghelardoni F, De Iaco G, Ventavoli M, Casagli S, Piccini P, Bonuccelli U. [On the opportunity of treating with hyperbaric oxygenation (hyperbaric oxygen) for the prevention of post-interventional anoxic encephalopathy (delayed neurologic sequelae)]. Minerva Anestesiol 1991; 57:966-7. [PMID: 1961572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- F Ghelardoni
- U.O. 2. di Anestesia e Rianimazione, USL 12, Pisa
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Abstract
The effects of naloxone on side effects provoked by apomorphine (APO) administration in patients with parkinsonian syndrome have been studied. The group under study included eight patients with Parkinson's disease and four with parkinsonism who received 100 micrograms/kg s.c. APO acutely to test dopaminergic responsiveness. All patients were treated with 20 mg domperidone tablets t.i.d. and then for 2 consecutive days (in double blind fashion) were given a 2-hour i.v. saline infusion alone or with naloxone (8 mg) starting 30 min before APO administration. In both groups, naloxone delayed the appearance of sleepiness, and reduced the intensity of yawning, sleepiness, nausea, and vomiting as compared with saline. These findings indicate a potential usefulness of naloxone and other opioid antagonists in preventing acute APO side effects.
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Affiliation(s)
- U Bonuccelli
- Institute of Neurology, University of Pisa, Italy
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