Differentiation of Parkinson's Disease and Essential Tremor on I-123 IPT(I-123-N-(3-iodopropen-2-yl)-2beta-carbomethoxy-3beta(4-cholorophenyl) tropane) Brain SPECT / 핵의학분자영상

PURPOSE: The study was to assess I-123-N-(3-iodopropen-2-yl)-2[beta]-carbomethoxy-3[beta]-(4-cholorophenyl) tropane (IPT) SPECT in differential diagnosis among early stage of Parkinson's disease(PD) and essential tremor(ET) and normal control(NL) groups quantitatively. MATERIALS AND METHODS: I-123 IPT brain SPECT of 50 NL, 20 early PD, 30 advanced PD, and 20 ET were performed at 20 minutes and 2 hours. Specific/nonspecific binding of striatum was calculated by using right and left striatal specific to occipital non-specific uptake ratio (striatum-OCC/OCC). RESULTS: Mean value of specific/nonspecific binding ratio was significantly different between advanced PD group and NL group. However, significant overlap of striatal specific/nonspecific binding ratio was observed between PD group and ET group. Bilateral striatal specific/nonspecific binding ratios were decreased in advanced PD. Lateralized differences in the striatal uptake of I-123 IPT correlated with asymmetry in clinical findings in PD group. CONCLUSION: I-123 IPT SPECT may be a useful method for the diagnosis of PD and objective evaluation of progress of clinical stages. Care should be made in the differential diagnosis of early stage of PD and other motor disturbances mimicking PD such as ET in view of significant overlap in striatal I-123 specific/nonspecific binding ratio.

Levosulpiride-induced Parkinsonim

The present report discusses four cases of chronic renal failure, which developed symptoms of parkinsonism in response to levosulpiride. The temporal relationship between levosulpiride discontinuation and the disappearance of parkinsonism suggests a causal link. In addition, decreased striatal dopamine transporter bindings assessed by [I-123] IPT SPECT were observed in two patients suggesting that a dopamine blocking agent causes the dysfunction of nigrostriatal dopaminergic neurons and that such injury may be involved in the pathogenesis of drug-induced parkinsonism.

Dopamine Transporter Density of the Basal Ganglia Assessed with I-123 IPT SPECT in Patients with Obsessive-Compulsive Disorder / 신경정신의학

OBJECTIVES: It has been suggested that dopamine as well as serotonin were related to the pathophysiology of obsessive-compulsive disorder (OCD). Thus, many studies were performed to nivestigate brain regions and their association with dopamine in OCD patients. Recently, we have been able to monitor the density of the dopamine transporter (DAT) in the basal ganglia using I-123N-(3-iodopropen-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl) tropane (I-123 IPT) SPECT, to evaluate the activity of the presynaptic dopamine function. In present study, we investigated the DAT density of the basal ganglia using I-123 IPT SPECT in patients with OCD. METHODS: Fifteen patients with OCD and nineteen normal control group were included in this study. We performed brain SPECT 2 hours after the intravenous administration of I-123N-(3-iodopropen-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl) tropane (I-123 IPT) and carried out both quantitative and qualitative analyses using the SPECT, which were reconstructed for the assessment of the specific/nonspecific DAT binding ratio in basal ganglia. We then investigated the correlation between the severity of OCD symptoms assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the specific/nonspecific DAT binding ratio of basal ganglia. RESULTS: Patients with OCD showed a significantly increased specific/nonspecific DAT binding ratio in right basal ganglia compared with normal controls and did not show a significantly increased specific/nonspecific DAT binding ratio, and an increased tendency in the specific/nonspecific DAT binding ratio in left basal ganglia (Rt:Z=2.584, P=0.009, Lt:=1.873, P=0.060). We found no significant correlation between the total scores of the Y-BOCS and the specific/nonspecific DAT binding ratio of basal ganglia. CONCLUSIONS: The data of this study suggest that dopamine in basal ganglia plays an important role in fronto-subcortical circuit, which are already known as a site of the pathophysiological mechanism of OCD.

Dopamine Transporter Density of the Basal Ganglia in Children with Attention Deficit Hyperactivity Disorder Assessed with I-123 IPT SPECT / 대한정신약물학회지

OBJECTIVE: ADHD has been known as a psychiatric disorder in childhood associated with dopamine dysregulation. In the present study, we investigated dopamine transporter (DAT) density using I-123N-(3-iodopropen-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl) tropane (I-123-IPT)-SPECT in children with ADHD on the hypothesis that alterations of DAT density in the basal ganglia were suggestive of dopaminergic dysfunction in children with ADHD. METHODS: Nine drug-naive children with ADHD and six normal children were included in the study. We performed brain SPECT two hours after the intravenous administration of I-123-IPT and made both quantitative and qualitative analyses using the obtained SPECT data, which were reconstructed for the assessment of specific/nonspecific DAT binding ratios in the basal ganglia. We then investigated the correlation between ADHD Rating Scale (ARS) scores of children with ADHD and specific/nonspecific DAT binding ratios in the basal ganglia. RESULTS: Children with ADHD had significantly greater specific/nonspecific DAT binding ratio of the basal ganglia comparing to normal children. However, no significant correlation were found between ARS scores of children with ADHD and specific/nonspecific DAT binding ratio of basal ganglia in children with ADHD. CONCLUSION: These findings support the complex dysregulation of the dopaminergic neurotransmitter system in children with ADHD.

Dopamine Transporter Density of the Basal Ganglia Assessed with 123IIPT SPECT in Drug-Naive Children with Tourette's Disorder / 신경정신의학

OBJECTIVES: Previous studies in patients with Tourette's disorder suggested presynaptic dopaminergic dysfunction, demonstrating increased dopamine densities. In present study, we investigated dopamine transporter densities using I-123N-(3-iodopropen-2-yl)-2beta-carbomethoxy-3beta-(4-chlorophenyl)tropane(I-123-IPT)-SPECT in drug-naive children with Tourette's disorder and postulated that dopamine transporter density reflected dopamine concentrations. METHODS: Eight drug-naive children with Tourette's disorder and six normal children were included in the with the brain SPECT 2 hours after an intravenous administration of I-123-IPT. Obtained SPECT data were reconstructed for the assessment of specific/nonspecific dopamine transporter binding ratio of basal ganglia and were evaluated both quantitatively and qualitatively. We investigated correlation between total tic severity of children with Tourette's disorder assessed with YGTSS and specific/nonspecific binding ratio of basal ganglia. RESULTS: Drug-naive children with Tourette's disorder had a significantly greater increase of speciffic/nonspecific dopamine transporter binding ratio of left basal ganglia than normal children. However, no significant differences in specific/nonspecific dopamine transporter binding ratio of right basal ganglia were found between children with Tourette's disorder and normal children. Also, we found no significant correlation between total tic severity of children with Tourette's disorder and specific/ nonspecific binding ratio of basal ganglia. CONCLUSION: These findings support the hypothesis of dopamine dysregulation in presynaptic dopamine function of the basal ganglia in the pathophysiology of Tourette's disorder.

Striatal dopamine transporter changes in patients with essential tremor and idiopathic Parkinson's disease

BACKGROUNDS: There have been controversies about the association between essential tremor (ET) and Parkinson's disease. To examine the nigrostriatal dopaminergic neurons in patients with ET, we measured the striatal dopamine transporter levels with [123I] N-(3-iodopropene-2-yl)-2?-carbomethoxy-3?-(4-chlorophenyl) tropane(IPT) single photon emission computed tomography (SPECT). METHODS: This study included nine patients with postural tremor, six patients with postural and rest tremor, 11 patients with idiopathic Parkinson's disease, and 21 age matches controls. Using triple headed gamma camera, brain SPECT scans were performed at 115 and 120 minutes after the injection of 6.23?1.37mCi(range 5-10mCi) of I123 labeled IPT. We averaged two images. Regions of interest were drawn on the middle set image at the level of basal ganglia (BG) for each subject. Amounts of striatal dopamine transporter were measured by calculating the ratio between the average counts of the basal ganglia minus occipital cortex (OCC) and the counts of the OCC((BG-OCC)/OCC). RESULTS: The mean of (BG-OCC)/OCC ratios of 9 isolated postural tremor patients (3.60?0.83) was not statistically different from that of the controls (P>0.05). However, the mean of (BG-OCC)/OCC ratios of 4 patients with postural and rest tremor (2.61?0.18) was significantly lower than that of the controls (P<0.01). Four of the six patients with postural and rest tremor had mean ratios lower than 2.0 standard deviations from the mean of the controls. CONCLUSION: In their later clinical courses, some patients with postural tremor may develop rest tremor in association with a damage in the nigrostriatal dopaminergic system.