Objective: To determine whether changes in D 2 receptor availability are present in carriers of genetic mutations for primary dystonia.
Methods:Manifesting and nonmanifesting carriers of the DYT1 and DYT6 dystonia mutations were scanned with [11 C] raclopride (RAC) and PET. Measures of D 2 receptor availability in the caudate nucleus and putamen were determined using an automated region-of-interest approach.Values from mutation carriers and healthy controls were compared using analysis of variance to assess the effects of genotype and phenotype. Additionally, voxel-based whole brain searches were conducted to detect group differences in extrastriatal regions.Results: Significant reductions in caudate and putamen D 2 receptor availability were evident in both groups of mutation carriers relative to healthy controls (p Ͻ 0.001). The changes were greater in DYT6 relative to DYT1 carriers (Ϫ38.0 Ϯ 3.0% vs Ϫ15.0 Ϯ 3.0%, p Ͻ 0.001). By contrast, there was no significant difference between manifesting and nonmanifesting carriers of either genotype. Voxel-based analysis confirmed these findings and additionally revealed reduced RAC binding in the ventrolateral thalamus of both groups of mutation carriers. As in the striatum, the thalamic binding reductions were more pronounced in DYT6 carriers and were not influenced by the presence of clinical manifestations.
Conclusions:Reduced D 2 receptor availability in carriers of dystonia genes is compatible with dysfunction or loss of D 2 -bearing neurons, increased synaptic dopamine levels, or both. These changes, which may be present to different degrees in the DYT1 and DYT6 genotypes, are likely to represent susceptibility factors for the development of clinical manifestations in mutation carriers. Neurology GLOSSARY ANOVA ϭ analysis of variance; BFM ϭ Burke-Fahn-Marsden; CN ϭ caudate nucleus; FWE ϭ family-wise error rate; GPe ϭ external pallidum; GPi ϭ interal pallidum; RAC ϭ raclopride; ROI ϭ region of interest; SOR ϭ striato-occipital ratio; THX ϭ trihexyphenidyl; VL ϭ ventrolateral tier nuclei.Multiple lines of evidence support the role of altered striatal DA neurotransmission in primary dystonia. 1,2 Nonetheless, imaging studies have revealed only minimal reductions in striatal D 2 receptor binding in patients with idiopathic dystonia 3,4 and in nonmanifesting carriers of the DYT1 dystonia mutation.5 Indeed, similar reductions have been described in DYT1 dystonia patients at postmortem.1 It is not known whether similar abnormalities are also present in primary dystonia associated with other genetic mutations.Experimental models of dystonia have yielded varied results with regard to the striatal DA dynamics. Increased striatal DA turnover was found in a transgenic murine DYT1 model regardless of behavioral phenotype. 6,7 However, in this model, striatal DA levels were reduced