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Dopamine transporter single-photon emission computerized tomography supports diagnosis of akinetic crisis of parkinsonism and of neuroleptic malignant syndrome.

Martino G, Capasso M, Nasuti M, Bonanni L, Onofrj M, Thomas A - Medicine (Baltimore) (2015)

Bottom Line: One was diagnosed as having NMS because of exposure to risperidone.During AC or NMS, BP values in caudate and putamen were reduced by 95% to 80%, to noise level with a nearly complete loss of striatum dopamine transporter-binding, corresponding to the "burst striatum" pattern.No binding effects of apomorphine were observed.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Radiology and Radiotherapy, Nuclear Medicine University G. d'Annunzio of Chieti-Pescara (GM, MN); Neurology Clinic, State Hospital (MC, LB, MO, AT); and Department of Neuroscience and Imaging and Aging Research Center, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy (LB, MO, AT).

ABSTRACT
Akinetic crisis (AC) is akin to neuroleptic malignant syndrome (NMS) and is the most severe and possibly lethal complication of parkinsonism. Diagnosis is today based only on clinical assessments yet is often marred by concomitant precipitating factors. Our purpose is to evidence that AC and NMS can be reliably evidenced by FP/CIT single-photon emission computerized tomography (SPECT) performed during the crisis. Prospective cohort evaluation in 6 patients. In 5 patients, affected by Parkinson disease or Lewy body dementia, the crisis was categorized as AC. One was diagnosed as having NMS because of exposure to risperidone. In all FP/CIT, SPECT was performed in the acute phase. SPECT was repeated 3 to 6 months after the acute event in 5 patients. Visual assessments and semiquantitative evaluations of binding potentials (BPs) were used. To exclude the interference of emergency treatments, FP/CIT BP was also evaluated in 4 patients currently treated with apomorphine. During AC or NMS, BP values in caudate and putamen were reduced by 95% to 80%, to noise level with a nearly complete loss of striatum dopamine transporter-binding, corresponding to the "burst striatum" pattern. The follow-up re-evaluation in surviving patients showed a recovery of values to the range expected for Parkinsonisms of same disease duration. No binding effects of apomorphine were observed. By showing the outstanding binding reduction, presynaptic dopamine transporter ligand can provide instrumental evidence of AC in Parkinsonism and NMS.

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Related in: MedlinePlus

FP/CIT SPECT acquisition during AC/NMS, and after recovery, in patient 1 and 6. Notice almost complete disappearance of binding during the crises (“burst striatum”) and recovery (A), 3 months after the crises (B), with appearance of an “egg shape” pattern in patient 1 and a “mixed type” pattern in patient 6. Notice that saturation level scales are 4 times higher than the scales reported in figure 1. AC = akinetic crisis, NMS = neuroleptic malignant syndrome, SPECT = single-photon emission computerized tomography.
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Figure 2: FP/CIT SPECT acquisition during AC/NMS, and after recovery, in patient 1 and 6. Notice almost complete disappearance of binding during the crises (“burst striatum”) and recovery (A), 3 months after the crises (B), with appearance of an “egg shape” pattern in patient 1 and a “mixed type” pattern in patient 6. Notice that saturation level scales are 4 times higher than the scales reported in figure 1. AC = akinetic crisis, NMS = neuroleptic malignant syndrome, SPECT = single-photon emission computerized tomography.

Mentions: 123-I FP-CIT SPECTs were performed in all patients 48 to 72 hours after onset of the AC (Figures 2 and 3A) and 95 ± 2.8 days after recovery in survivors (Figure 3B), with GE, INFINIA double head gamma camera and evaluated according EANM procedure guidelines23,24 by Nuclear Medicine specialists blinded to diagnosis. All patients/caregivers gave informed consent before SPECT acquisition. This observational study received approval by our local ethical committee, according to the declaration of Helsinki and subsequent revisions.


Dopamine transporter single-photon emission computerized tomography supports diagnosis of akinetic crisis of parkinsonism and of neuroleptic malignant syndrome.

Martino G, Capasso M, Nasuti M, Bonanni L, Onofrj M, Thomas A - Medicine (Baltimore) (2015)

FP/CIT SPECT acquisition during AC/NMS, and after recovery, in patient 1 and 6. Notice almost complete disappearance of binding during the crises (“burst striatum”) and recovery (A), 3 months after the crises (B), with appearance of an “egg shape” pattern in patient 1 and a “mixed type” pattern in patient 6. Notice that saturation level scales are 4 times higher than the scales reported in figure 1. AC = akinetic crisis, NMS = neuroleptic malignant syndrome, SPECT = single-photon emission computerized tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554017&req=5

Figure 2: FP/CIT SPECT acquisition during AC/NMS, and after recovery, in patient 1 and 6. Notice almost complete disappearance of binding during the crises (“burst striatum”) and recovery (A), 3 months after the crises (B), with appearance of an “egg shape” pattern in patient 1 and a “mixed type” pattern in patient 6. Notice that saturation level scales are 4 times higher than the scales reported in figure 1. AC = akinetic crisis, NMS = neuroleptic malignant syndrome, SPECT = single-photon emission computerized tomography.
Mentions: 123-I FP-CIT SPECTs were performed in all patients 48 to 72 hours after onset of the AC (Figures 2 and 3A) and 95 ± 2.8 days after recovery in survivors (Figure 3B), with GE, INFINIA double head gamma camera and evaluated according EANM procedure guidelines23,24 by Nuclear Medicine specialists blinded to diagnosis. All patients/caregivers gave informed consent before SPECT acquisition. This observational study received approval by our local ethical committee, according to the declaration of Helsinki and subsequent revisions.

Bottom Line: One was diagnosed as having NMS because of exposure to risperidone.During AC or NMS, BP values in caudate and putamen were reduced by 95% to 80%, to noise level with a nearly complete loss of striatum dopamine transporter-binding, corresponding to the "burst striatum" pattern.No binding effects of apomorphine were observed.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Radiology and Radiotherapy, Nuclear Medicine University G. d'Annunzio of Chieti-Pescara (GM, MN); Neurology Clinic, State Hospital (MC, LB, MO, AT); and Department of Neuroscience and Imaging and Aging Research Center, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy (LB, MO, AT).

ABSTRACT
Akinetic crisis (AC) is akin to neuroleptic malignant syndrome (NMS) and is the most severe and possibly lethal complication of parkinsonism. Diagnosis is today based only on clinical assessments yet is often marred by concomitant precipitating factors. Our purpose is to evidence that AC and NMS can be reliably evidenced by FP/CIT single-photon emission computerized tomography (SPECT) performed during the crisis. Prospective cohort evaluation in 6 patients. In 5 patients, affected by Parkinson disease or Lewy body dementia, the crisis was categorized as AC. One was diagnosed as having NMS because of exposure to risperidone. In all FP/CIT, SPECT was performed in the acute phase. SPECT was repeated 3 to 6 months after the acute event in 5 patients. Visual assessments and semiquantitative evaluations of binding potentials (BPs) were used. To exclude the interference of emergency treatments, FP/CIT BP was also evaluated in 4 patients currently treated with apomorphine. During AC or NMS, BP values in caudate and putamen were reduced by 95% to 80%, to noise level with a nearly complete loss of striatum dopamine transporter-binding, corresponding to the "burst striatum" pattern. The follow-up re-evaluation in surviving patients showed a recovery of values to the range expected for Parkinsonisms of same disease duration. No binding effects of apomorphine were observed. By showing the outstanding binding reduction, presynaptic dopamine transporter ligand can provide instrumental evidence of AC in Parkinsonism and NMS.

Show MeSH
Related in: MedlinePlus