Suja Sadasivan1, Joseph H Friedman2. 1. Department of Neurology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA. 2. Movement Disorders Program, Butler Hospital, Division of Movement Disorders, Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA. Electronic address: joseph_friedman@brown.edu.
Abstract
BACKGROUND: The accuracy of a clinical diagnosis of Parkinson's disease varies with the criteria employed and the population. Misdiagnosis of Parkinson's disease can lead to inappropriate long-term medication use and exposure to their potentially harmful side effects. Functional imaging of the dopamine transporter (DaT) defines integrity of the striatal dopaminergic system and provides a marker for presynaptic neuronal degeneration. DaT imaging is abnormal even in the earliest clinical presentations of parkinsonism associated with nigrostriatal degeneration and a normal scan suggests an alternative diagnosis such as essential tremor, dystonic tremor, drug-induced parkinsonism, or psychogenic parkinsonism. OBJECTIVE: The main objective of our study was to determine the impact of DaT imaging on the clinical diagnosis and management of patients with clinically uncertain parkinsonian syndromes, especially in patients with exposure to neuroleptics, in our tertiary movement disorders referral center. METHODS: We performed a retrospective chart review of all 65 patients who had DaTscans from August 2011 to December 2012. RESULTS: Our management changed in 63% of patients as a result of the DaTscan. Imaging also increased the confidence in diagnosis. CONCLUSIONS: We conclude that DaTscan can have a significant impact on the clinical management of patients with clinically uncertain parkinsonian syndromes in a tertiary referral center.
BACKGROUND: The accuracy of a clinical diagnosis of Parkinson's disease varies with the criteria employed and the population. Misdiagnosis of Parkinson's disease can lead to inappropriate long-term medication use and exposure to their potentially harmful side effects. Functional imaging of the dopamine transporter (DaT) defines integrity of the striatal dopaminergic system and provides a marker for presynaptic neuronal degeneration. DaT imaging is abnormal even in the earliest clinical presentations of parkinsonism associated with nigrostriatal degeneration and a normal scan suggests an alternative diagnosis such as essential tremor, dystonic tremor, drug-induced parkinsonism, or psychogenic parkinsonism. OBJECTIVE: The main objective of our study was to determine the impact of DaT imaging on the clinical diagnosis and management of patients with clinically uncertain parkinsonian syndromes, especially in patients with exposure to neuroleptics, in our tertiary movement disorders referral center. METHODS: We performed a retrospective chart review of all 65 patients who had DaTscans from August 2011 to December 2012. RESULTS: Our management changed in 63% of patients as a result of the DaTscan. Imaging also increased the confidence in diagnosis. CONCLUSIONS: We conclude that DaTscan can have a significant impact on the clinical management of patients with clinically uncertain parkinsonian syndromes in a tertiary referral center.
Authors: Ralph Buchert; Carsten Buhmann; Ivayla Apostolova; Philipp T Meyer; Jürgen Gallinat Journal: Dtsch Arztebl Int Date: 2019-11-01 Impact factor: 5.594