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[123I] FP-CIT spect study in vascular parkinsonism and Parkinson's disease

Authors

  • Jan Zijlmans MD, PhD,

    1. National Hospital for Neurology and Neurosurgery, London, United Kingdom
    2. Reta Lila Weston Institute of Neurological Studies, University College London, United Kingdom
    3. Department of Neurology, Amphia Hospital, Breda, The Netherlands
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  • Andrew Evans MD,

    1. National Hospital for Neurology and Neurosurgery, London, United Kingdom
    2. Reta Lila Weston Institute of Neurological Studies, University College London, United Kingdom
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  • Flavia Fontes MD,

    1. Institute of Nuclear Medicine, UCL, London, United Kingdom
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  • Regina Katzenschlager MD,

    1. National Hospital for Neurology and Neurosurgery, London, United Kingdom
    2. Reta Lila Weston Institute of Neurological Studies, University College London, United Kingdom
    3. Department of Neurology, Donauspital/ SMZ Ost, Vienna, Austria
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  • Svetoslav Gacinovic MSc,

    1. Institute of Nuclear Medicine, UCL, London, United Kingdom
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  • Andrew J Lees MD, FRCP,

    Corresponding author
    1. National Hospital for Neurology and Neurosurgery, London, United Kingdom
    2. Reta Lila Weston Institute of Neurological Studies, University College London, United Kingdom
    • Reta Lila Weston Institute of Neurological Studies, Royal Free and University College London Medical School, Windeyer Building, 46 Cleveland St., London W1T 4JF, UK
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  • Durval Costa MD, PhD, FRCR

    1. Institute of Nuclear Medicine, UCL, London, United Kingdom
    2. HPP Medicina Molecular, SA, Porto, Portugal
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Abstract

There is substantial evidence to support a role for small vessel disease (SVD) as a cause for vascular parkinsonism (VP). Using [123I] FP-CIT SPECT (single photon emission computed tomography), we have tried to determine whether VP patients have pre-synaptic dopaminergic function similar to PD patients, and whether the severity of parkinsonian symptoms as well as the levodopa response in VP patients are correlated with pre-synaptic dopaminergic dysfunction. Thirteen patients fulfilling operational clinical criteria for VP had [123I] FP-CIT scans. Mean [123I] FP-CIT uptake in the basal ganglia was significantly lower in VP patients than in healthy controls, and the asymmetry index was not significantly different between these groups. In contrast, compared with the PD group, only the mean asymmetry index was significantly lower in VP patients. None of the parameters measured was significantly different between VP patients who had an insidious onset of parkinsonism (VPi) and those who had an acute onset (VPa). There was a significant correlation between the bilateral basal ganglia FP-CIT uptake reduction in the VP patients and UPDRS motor scores, but not with the mean % reduction in motor UPDRS after levodopa. We suggest that in the majority of VP patients, pre-synaptic dopaminergic function is reduced. The presence of a rather symmetrical FP-CIT uptake in the basal ganglia may help to distinguish VP from PD and could therefore be used as a criterion for the clinical diagnosis of VP. © 2007 Movement Disorder Society

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