Differences in nigro‐striatal impairment in clinical variants of early Parkinson’s disease: evidence from a FP‐CIT SPECT study

Rossi, C. A.; Frosini, Daniela; Volterrani, Duccio; Feo, P De; Unti, Elisa; Nicoletti, Valentina; Kiferle, Lorenzo; Bonuccelli, Ubaldo; Ceravolo, Roberto

doi:10.1111/j.1468-1331.2009.02898.x

Cited by 83 publications

(83 citation statements)

References 28 publications

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“…The reason for this significantly differing striatal 123 I-FP-CIT uptake in the subtypes of PD remains yet unclear. However, it is worth noting that a recent paper has confirmed the lower 123 I-FP-CIT striatal binding in ART compared to TDT (25). Neverthless, in the present study differences in nigrostriatal impairment in the clinical variants of early PD were found by SPECT only in the putamen contralateral to the most clinically affected side that showed a lower 123 I-FP-CIT uptake in ART compared to TDT patients.…”

Section: Discussioncontrasting

confidence: 39%

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Different patterns of nigrostriatal degeneration in tremor type versus the akinetic-rigid and mixed types of Parkinson's disease at the early stages: Molecular imaging with 123I-FP-CIT SPECT

Schillaci¹

2011

Int J Mol Med

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Abstract. The various associations of motor and non-motor symptoms, the onset of motor complications, the cognitive disorder's appearance and other factors make Parkinson's disease (PD) a heterogeneous syndrome with multiple phenotypes. The necessity of discriminating between different forms of PD could have a role in understanding the pathophysiology of extrapyramidal signs with clinical implications. The aim of this study was to evaluate if there is a relationship between the clinical motor phenotypes of PD and the scintigraphic pattern of 123 I-FP-CIT single photon emission computed tomography (SPECT). We examined 47 patients with early idiopathic PD (25 males; 22 females; mean age 58±2 years) and subdivided them in different clinical forms on the basis of dominance of resting tremor (n=20), bradykinesia plus rigidity (n=20) and the presence of both clinical signs [mixed type (MT, n=7)]. We correlated this status with the semi-quantitative analysis of SPECT with 123 I-FP-CIT. Tremor type patients showed a lower reduction of 123 I-FP-CIT uptake compared to akineticrigid type patients in contralateral caudate (P=0.0139) and putamen (P=0.0028) nuclei. 123I-FP-CIT uptake was higher in the ipsilateral caudate (P=0.0050) and putamen (P=0.0012) of tremor type patients compared to akinetic-rigid type patients. Comparisons of the striatal uptake in the tremor type and akinetic-rigid type patients with the MT patients revealed significant differences only in the ipsilateral and contralateral caudate. Our data indicate that in akinetic-rigid patients the dopaminergic system is more involved compared to that in the tremor type patients and that this difference is present from the initial stage of the disease. Moreover, our results suggest that PD phenotypes could be related not only to the dopaminergic involvement but also to other systems. IntroductionThe relationships between movement disorders and the dopaminergic system have been extensively investigated, both in terms of presynaptic and postsynaptic processes (1). The particular interest in the dopamine active transporter (DAT) is related to the assessment of dopaminergic neuron loss in Parkinson's disease (PD) (2,3) and movement disorders (2,4,5). 123I-FP-CIT is a radiopharmaceutical highly selective for the DAT on the presynaptic processes of the nigrostriatal neurons (6). DAT is located on the plasma membrane of nerve terminals in a small number of neurons in the brain, especially in the striatum and nucleus accumbens, but also in the globus pallidus, cingulate cortex, olfactory tubercle, amygdala and midbrain (7).In idiopathic PD (IPD), 50% of patients complain of slowing up at presentation. The slowness of IPD involves both initiation and execution of movements, particularly sequential and volitional actions (8). About 40% of patients will complain of tremulousness of hands at rest, which improves with action and 80% of them will have an asymmetrical 3-5 Hz rest tremor evident on examination (9). A variant of IPD based on the clinical course is the mixed type (...

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Section: Discussioncontrasting

confidence: 39%

“…I-FP-CIT striatal uptake values significantly correlate with bradykinesia and rigidity but not with tremor (21,25,29). Defining subgroups of patients with IPD can be useful to delineate the natural history, prognosis, and treatment options, especially the optimal therapy for the specific motor and cognitive symptoms.…”

mentioning

confidence: 99%

Different patterns of nigrostriatal degeneration in tremor type versus the akinetic-rigid and mixed types of Parkinson's disease at the early stages: Molecular imaging with 123I-FP-CIT SPECT

Schillaci¹

2011

Int J Mol Med

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“…Different patterns of dopamine loss may r eflect a var iety of neuropathological features [17]. Tremordominant patients compared to akineticrigid patients showed a higher iodine-123 fluoropropyl-carbomethoxy (FP-CIT) uptake, which meant increased dopamine transportor (DAT) [18]. These data were confirmed by Eggers and colleagues during the clinical course and quantitative analyses of iodine-123 FP-CIT SPECT [ 19 ].…”

Section: Discussionsupporting

confidence: 72%

Clinical Features of Levodopa-Induced Dyskinesia in Patients With Parkinson’s Disease

Mansurova¹,

Prokhorova²

2017

J. res. health sci.

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In Parkinson's disease, one of the most troublesome dillemas is the treatment of levodopa-induced dyskinesia. The time-to-onset and severity of this motor complication show large variability according to disease duration, long-term use of levodopa and other factors. PD patients were enrolled to study based on UK brain bank diagnostic criteria and underwent examination on motor evaluation with help of UPDRS part III and presence of dyskinesia by UPDRS IV, to assess the severity of disease based on modified Hoehn and Yahr Scale. Considering the motor symptoms at onset, PD patients were divided into three subgroups: tremor-dominant, akinetic-rigid and mixed type. 208 patients (105 men) were recruited in the study of who had advanced stage of PD. 105 (50,4%) were classified as tremor-dominant, 87 (41,9%) as akinetic-rigid and 16 (7,7%) as mixed type. Patients in the tremor -dominant subtype were somewhat older (p=0,027). Approximately all patients were treated with L-dopa and 81,2% were in combination with dopamine agonist. Almost half patients received treatment with amantadine. In terms of disease duration and developing of wearing off , there was significantly difference according to clinical phenotype. AR and mix subtype of PD develop wearing off earlier within 3 years compare to TD ( P<0,05). 72,4% TD type develop wearing off after 6 years and further while AR and Mix type develop earlier. (OR was 0.43; 95 % CI 0.24-0.89, RR was 0,69). It should be also noted that when gender was included in the analysis we didn't found a positive association with wearing off as well as LID (wearing off= OR was 0,78; 95% CI 0,43-1.41; p value 0,45; LID= OR was 0.73; 95 % CI 0.42-1.26; RR=0,85, p value 0.27). Dyskinesias were predominantly peak dose in 64%. The same no association with average LED with LID (p=0,26). We may conclude that tremor dominant type of PD may predict slower progression of LID.

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“…Slower progression of the disease and less cognitive decline are observed in tremor-dominant patients. These clinical observations have been confirmed by neuroimaging and clinic-pathologic findings describing a more favorable outcome in tremor-dominant patients than in akinetic-rigid subjects, in concordance with different brain biochemical abnormalities (Rossi et al 2010;Eggers et al 2011;Lewis et al 2011). Moreover, PD is often hampered by the appearance of non-motor symptoms (NMS), which in recent years are gaining increasing attention (Langston 2006;Chaudhuri et al 2006).…”

Section: Introductionmentioning

confidence: 81%

Heart rate variability shows different cardiovascular modulation in Parkinson’s disease patients with tremor dominant subtype compared to those with akinetic rigid dominant subtype

et al. 2015

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Parkinson's disease (PD) can present with different motor subtypes depending on the predominant symptoms (tremor or rigidity/bradykinesia). Slower disease progression and less cognitive decline are observed in tremor-dominant patients compared to those with akinetic-rigid subtype. Autonomic cardiovascular disorders have been described in parkinsonian patients, although the definite correlations with different subtypes of PD are not clear. In this context, heart rate variability (HRV) analysis represents a non-invasive and established tool in assessing cardiovascular autonomic modulation. We investigate cardiovascular autonomic modulation in PD patients with tremor dominant subtype in comparison to akinetic rigid dominant subtype subjects using HRV analysis. Twenty-eight PD patients (17 with tremor dominant subtype and 11 with akinetic rigid dominant subtype) were enrolled and compared to 17 age and sex-matched healthy controls. HRV was analyzed in time- and frequency-domains. Low-frequency (LF) values were significantly lower in the akinetic rigid dominant subtype than in the tremor dominant group [LF 41.4 ± 13.6 vs 55.5 ± 11.6 (p < 0.007)] indicating that the disease led to a more evident impairment of the baroreflex modulation of the autonomic outflow mediated by both sympathetic and parasympathetic systems in the first class of patients. These findings support the biological relevance of clinical subtypes supporting the idea of a different pathophysiological process between these subtypes. These differences also suggest that different subtypes may also result in different responses to therapy or in the possible development of cardiovascular side effects of dopaminergic drugs in these different populations.

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Differences in nigro‐striatal impairment in clinical variants of early Parkinson’s disease: evidence from a FP‐CIT SPECT study

Cited by 83 publications

References 28 publications

Different patterns of nigrostriatal degeneration in tremor type versus the akinetic-rigid and mixed types of Parkinson's disease at the early stages: Molecular imaging with 123I-FP-CIT SPECT

Different patterns of nigrostriatal degeneration in tremor type versus the akinetic-rigid and mixed types of Parkinson's disease at the early stages: Molecular imaging with 123I-FP-CIT SPECT

Clinical Features of Levodopa-Induced Dyskinesia in Patients With Parkinson’s Disease

Heart rate variability shows different cardiovascular modulation in Parkinson’s disease patients with tremor dominant subtype compared to those with akinetic rigid dominant subtype

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