scholarly journals Clinical Differentiation of Essential Tremor and Parkinson's Disease

2013 ◽  
Vol 6 ◽  
pp. CCRep.S11903 ◽  
Author(s):  
Robert Fekete ◽  
Jin Li
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Essential Tremor ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Postural Tremor ◽  
Arm Swing ◽  
Rest Tremor ◽  
Dopaminergic Terminal

We present clinical features and tremor characterization in a patient with Parkinson's disease (PD) as well as in two cases of essential tremor (ET) with some parkinsonian features but no evidence of dopaminergic terminal loss on 123I-FP-CIT Single Photon Emission Computed Tomography (SPECT). Relatively slow frequency rest tremor and bilateral upper extremity bradykinesia without decrementing amplitude were observed in the ET cases, with unilaterally decreased arm swing in case 3. Alternating rest tremor and re-emergent tremor with 13 second latency was confirmed in the PD case. Re-emergent tremor had alternating characteristics, which to our knowledge has not been previously reported. The ET cases had synchronous postural tremor. Alternating re-emergent tremor in PD provides further evidence for re-emergent tremor as an analogue of rest tremor in PD. Two cases of ET with synchronous postural tremor and one to two year history of parkinsonian features had no evidence of dopaminergic terminal loss up to 40 years after the initial onset of ET. Tremor synchronicity characterization can assist in differential diagnosis between the two disorders.

scholarly journals Tremor in Parkinson’s disease and essential tremor: practical aspects of differential diagnosis

2019 ◽  
pp. 46-54 ◽  
Author(s):  
N. V. Titova ◽  
Yu. N. Bezdolny ◽  
I. V. Shtuchny ◽  
D. A. Sibetsky
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Differential Diagnosis ◽  
Essential Tremor ◽  
Single Photon ◽  
Correct Diagnosis ◽  
Photon Emission ◽  
The Body ◽  
Emission Computed Tomography ◽  
Initial Contact

Despite the developed criteria of essential tremor (ET) and Parkinson’s disease (PD), clinical practice shows a high percentage of misdiagnoses, especially in the early stages of the disease and during the patient’s initial contact with a neurologist. In addition, the same patient may have signs of ET and PD at the same time. For a correct diagnosis, a detailed clinical examination is necessary. The specific characteristics of tremor (frequency, amplitude, type, involvement of specific parts of the body), history, associated neurological signs, and concomitant non-motor symptoms help to recognize and distinguish these two diseases. In order to exclude the possible negative effect of concomitant medications on tremor, it is necessary to find out about the medication history. The article offers an algorithm of survey and inspection, as well as the interpretation of the data obtained. In diagnostically complicated cases, «trial» therapy is carried out. Additional information for differential diagnosis can be provided by the results of instrumental methods of investigation of transcranial sonography of black substance and single-photon emission computed tomography (DaTSCAN).

scholarly journals Diagnosis of Parkinson’s Disease. Part 1. The Potential of Functional Neuroimaging

Doctor Ru ◽  
2020 ◽  
Vol 19 (9) ◽  
pp. 6-12
Author(s):  
M.R. Sapronova ◽  
◽  
D.V. Dmitrenko ◽  
N.A. Schnaider ◽  
A.A. Molgachev ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Functional Neuroimaging ◽  
Single Photon ◽  
Photon Emission ◽  
Transcranial Sonography ◽  
Emission Computed Tomography ◽  
Resonance Spectroscopy ◽  
Positron Emission ◽  
Neuroimaging Techniques

Objective of the Review: To describe available functional neuroimaging techniques for use in patients with Parkinson’s disease (PD). Key Points: Parkinson’s disease is a neurodegenerative disorder which affects 2-3% of people older than 65 years. The main neuropathological hallmarks of PD are an accumulation of alpha-synuclein aggregates in the cellular cytoplasm and a loss of neurons in the pars compacta of the substantia nigra, leading to dopamine deficiency. Clinical symptoms of the disease appear when the underlying neural impairment is already advanced, which significantly reduces treatment options. Over the two last decades, functional neuroimaging techniques such as positron emission tomography, single-photon emission computed tomography, proton magnetic resonance spectroscopy, and transcranial sonography have increasingly been used for diagnosing PD during patients’ lifetime and understanding the neuropathological mechanisms and compensatory reactions underlying its symptoms, as well as for monitoring the progression of PD. Conclusion: Modern functional neuroimaging techniques not only facilitate differential diagnosis of PD, but also make it possible to detect the disease at its early/preclinical stage. Keywords: Parkinson’s disease, neuroimaging, positron emission tomography, single-photon emission computed tomography, proton magnetic resonance spectroscopy, transcranial sonography.

scholarly journals Evaluating dopamine transporter imaging as an enrichment biomarker in a phase 2 Parkinson’s disease trial

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
R. Matthew Hutchison ◽  
Karleyton C. Evans ◽  
Tara Fox ◽  
Minhua Yang ◽  
Jerome Barakos ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Clinical Trial ◽  
Parkinson's Disease ◽  
Dopamine Transporter ◽  
Single Photon ◽  
Photon Emission ◽  
Alpha Synuclein ◽  
Emission Computed Tomography ◽  
Phase 2 ◽  
Dat Spect

Abstract Background Dopamine transporter single-photon emission computed tomography (DaT-SPECT) can quantify the functional integrity of the dopaminergic nerve terminals and has been suggested as an imaging modality to verify the clinical diagnosis of Parkinson’s disease (PD). Depending on the stage of progression, approximately 5–15% of participants clinically diagnosed with idiopathic PD have been observed in previous studies to have normal DaT-SPECT patterns. However, the utility of DaT-SPECT in enhancing early PD participant selection in a global, multicenter clinical trial of a potentially disease-modifying therapy is not well understood. Methods The SPARK clinical trial was a phase 2 trial of cinpanemab, a monoclonal antibody against alpha-synuclein, in participants with early PD. DaT-SPECT was performed at screening to select participants with DaT-SPECT patterns consistent with degenerative parkinsonism. Acquisition was harmonised across 82 sites. Images were reconstructed and qualitatively read at a central laboratory by blinded neuroradiologists for inclusion prior to automated quantitative analysis. Results In total, 482 unique participants were screened between January 2018 and May 2019; 3.8% (15/398) of imaged participants were excluded owing to negative DaT-SPECT findings (i.e., scans without evidence of dopaminergic deficit [SWEDD]). Conclusion A smaller proportion of SPARK participants were excluded owing to SWEDD status upon DaT-SPECT screening than has been reported in prior studies. Further research is needed to understand the reasons for the low SWEDD rate in this study and whether these results are generalisable to future studies. If supported, the radiation risks, imaging costs, and operational burden of DaT-SPECT for enrichment may be mitigated by clinical assessment and other study design aspects. Trial registration ClinicalTrials.gov identifier: NCT03318523. Date submitted: October 19, 2017. First Posted: October 24, 2017.

Combined Use of 123i-fp-cit Spect and 123i-mibg Scintigraphy for Differentiation of Progressive Supranuclear Palsy Subtypes and Parkinson's Disease

2020 ◽  
Author(s):  
Keita Sakurai ◽  
Shohei Inui ◽  
Yufuko Saito ◽  
Satoko Sakakibara ◽  
Rina Hashimoto ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Progressive Supranuclear Palsy ◽  
Single Photon ◽  
Photon Emission ◽  
Washout Rate ◽  
Emission Computed Tomography ◽  
Mibg Scintigraphy ◽  
Adaptive Boosting ◽  
Specific Binding Ratio

Abstract Background:This study was undertaken to investigate the utility of 123I-ioflupane (123I-FP-CIT) single photon emission computed tomography (SPECT), 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy and both of these to differentiate among progressive supranuclear palsy (PSP), including typical cases and other subtypes, and Parkinson’s disease (PD).Methods: Twenty-five patients with typical PSP (Richardson's syndrome; PSP-RS), 14 atypical ones (PSP-variants; PSP-V) and 42 PD who underwent both 23I-FP-CIT SPECT and 123I-MIBG scintigraphy within short intervals were enrolled. Specific binding ratio (SBR) of the striatum and midbrain and anteroposterior and asymmetry ratio of the striatal SBR on 123I-FP-CIT SPECT and heart-to-mediastinum (H/M) ratio and washout rate (WR) on 123I-MIBG scintigraphy were used as quantitative measures. The classifier performance based on adaptive boosting was evaluated using five-fold cross-validation for these measures.Results: Midbrain SBR and the striatal anteroposterior ratio were statistically lower in PSP-RS than PD. On the other hand, there were no significant differences in any other quantitative measures among PSP-RS, PSP-V and PD. Striatal and midbrain SBRs and anteroposterior ratio of PSP-V were approximately in-between those of PSP-RS and PD. PD showed the lowest early and delayed H/M ratios and highest WR of any group. The combination of 123I-FP-CIT and 123I-MIBG was useful in discriminating PSP-RS and PSP-V from PD, while 123I-FP-CIT was superior to 123I-MIBG in differentiating PSP-RS from PSP-V.Conclusion: The combination of 123I-FP-CIT SPECT and 123I-MIBG scintigraphy, rather than either alone, may be a useful differential diagnostic tool to differentiate patients with PSP-RS, PSP-V and PD.

scholarly journals [99mTc]-HM-PAO SPECT in Parkinson's Disease

1988 ◽  
Vol 8 (1_suppl) ◽  
pp. S101-S108 ◽  
Author(s):  
G. Pizzolato ◽  
M. Dam ◽  
N. Borsato ◽  
B. Saitta ◽  
C. Da Col ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Single Photon ◽  
Photon Emission ◽  
Tracer Uptake ◽  
Emission Computed Tomography ◽  
Anticholinergic Drugs ◽  
Scanning Procedure ◽  
Subcortical Regions ◽  
Severity Of The Disease

Thirty-six patients affected by Parkinson's disease were studied using single photon emission computed tomography (SPECT) and [99mTc]–HM-PAO as a tracer. The scanning procedure was performed 16–24 h after discontinuation of specific therapy. Tracer activity ratios were determined in 10 pairs of cerebellar, cortical, and subcortical regions. Data were compared with those of 10 age-matched controls. Most of the regions examined did not show any relevant change between parkinsonian and control subjects. Notably, mean activity in striatal regions were similar in the two groups. Increased activity in caudate–putamen was found in patients who were on chronic DOPA therapy. Side-to-side asymmetries in the basal ganglia increased with the severity of the disease. Significant reductions of tracer uptake, from control values, were observed bilaterally in the parietal cortex. These deficits were more pronounced in patients with mental deterioration and in subjects who had been chronically treated with anticholinergic drugs. Parietal perfusion deficits in parkinsonian patients resemble those described in Alzheimer's dementia. These findings suggest that the heterogeneous alterations of regional cerebral blood flow (rCBF) in parkinsonian patients reflect the multifactorial pathophysiology of the disease.

The utility of the combined use of 123I-FP-CIT SPECT and neuromelanin MRI in differentiating Parkinson's disease from other parkinsonian syndromes

2018 ◽  
Vol 60 (2) ◽  
pp. 230-238 ◽  
Author(s):  
Eiji Matsusue ◽  
Yoshio Fujihara ◽  
Kenichiro Tanaka ◽  
Yuki Aozasa ◽  
Manabu Shimoda ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Single Photon ◽  
Photon Emission ◽  
Contrast Ratio ◽  
Emission Computed Tomography ◽  
Specific Information ◽  
Specific Binding Ratio ◽  
Significant Difference ◽  
Dat Spect

Background Neuromelanin magnetic resonance imaging (NmMRI) and 123I-FP-CIT dopamine transporter single photon emission computed tomography (DAT-SPECT) provide specific information that distinguishes Parkinson's disease (PD) from non-degenerative parkinsonian syndrome (NDPS). Purpose To determine whether a multiparametric scoring system (MSS) could improve accuracy compared to each parameter of DAT-SPECT and NmMRI in differentiating PD from NDPS. Material and Methods A total of 49 patients, including 14 with NDPS, 30 with PD, and five with atypical parkinsonian disorder (APD) underwent both NmMRI and DAT-SPECT and were evaluated. The average (Ave) and the asymmetry index (AI) were calculated in the substantia nigra compacta area (SNc-area), SNc midbrain-tegmentum contrast ratio (SNc-CR), and specific binding ratio (SBR). Cut-off values were determined, using receiver operating characteristic (ROC) analysis, for the differentiation of PD from NDPS on the statistically significant parameters. All cases were scored as either 1 (PD) or 0 (NDPS) for each parameter according to its threshold. These individual scores were totaled for each case, yielding a combined score for each case to obtain a cut-off value for the MSS. Results The Ave-SNc-area, Ave-SNc-CR, and Ave-SBR in PD were significantly lower than those in NDPS. The AI-SNc-area and AI-SBR in PD were significantly higher than those in NDPS. Of the five parameters, the highest accuracy was 93% for the Ave-SNc-area. For the MSS, a cut-off value of 3 was the accuracy of 96%. Besides, no significant difference was observed between PD and APD on all parameters. Conclusion An MSS has comparable or better accuracy compared to each parameter of DAT-SPECT and NmMRI in distinguishing PD from NDPS.

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