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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

BasGan V2 analyses during AC/NMS in 6 patients and at the follow-up 3 to 6 months in the 5 surviving patients. Red dots indicate left putamen/caudate, and green dots indicate right putamen/caudate. AC = akinetic crisis, NMS = neuroleptic malignant syndrome.
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Figure 3: BasGan V2 analyses during AC/NMS in 6 patients and at the follow-up 3 to 6 months in the 5 surviving patients. Red dots indicate left putamen/caudate, and green dots indicate right putamen/caudate. AC = akinetic crisis, NMS = neuroleptic malignant syndrome.

Mentions: FP/CIT SPECT acquisition in patient 4, who died during AC. SPECT is plotted at the maximum saturation level: notice residual activity in areas corresponding to caudate, and the widespread distribution of the ligand, appearing with low levels in extrastiatal areas. Notice that the saturation level of the scale is 1/4 of scales reported in Figure 3, and a 1/5 to 1/4 of Figure 1. Binding uptake shows the typical pattern “burst striatum,” a severe bilateral reduction with almost no uptake in either the putamen or caudate with increased background uptake.28,31. AC = akinetic crisis, SPECT = single-photon emission computerized tomography.


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)

BasGan V2 analyses during AC/NMS in 6 patients and at the follow-up 3 to 6 months in the 5 surviving patients. Red dots indicate left putamen/caudate, and green dots indicate right putamen/caudate. AC = akinetic crisis, NMS = neuroleptic malignant syndrome.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: BasGan V2 analyses during AC/NMS in 6 patients and at the follow-up 3 to 6 months in the 5 surviving patients. Red dots indicate left putamen/caudate, and green dots indicate right putamen/caudate. AC = akinetic crisis, NMS = neuroleptic malignant syndrome.
Mentions: FP/CIT SPECT acquisition in patient 4, who died during AC. SPECT is plotted at the maximum saturation level: notice residual activity in areas corresponding to caudate, and the widespread distribution of the ligand, appearing with low levels in extrastiatal areas. Notice that the saturation level of the scale is 1/4 of scales reported in Figure 3, and a 1/5 to 1/4 of Figure 1. Binding uptake shows the typical pattern “burst striatum,” a severe bilateral reduction with almost no uptake in either the putamen or caudate with increased background uptake.28,31. AC = akinetic crisis, SPECT = single-photon emission computerized tomography.

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