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Combined use of DAT‐SPECT and cardiac MIBG scintigraphy in mixed tremors
Author(s) -
Novellino Fabiana,
Arabia Gennarina,
Bagnato Antonio,
Cascini Giuseppe Lucio,
Salsone Maria,
Nicoletti Giuseppe,
Messina Demetrio,
Morelli Maurizio,
Paglionico Sandra,
Giofrè Laura,
Restuccia Antonino,
Torchia Giusi,
Condino Francesca,
Quattrone Aldo
Publication year - 2009
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.22771
Subject(s) - parkinsonism , essential tremor , parkinson's disease , medicine , nuclear medicine , scintigraphy , single photon emission computed tomography , dopamine transporter , spect imaging , central nervous system disease , cardiology , dopamine , disease , dopaminergic , psychiatry
The cooccurrence of rest and postural tremor (mixed tremor) as the predominant clinical manifestation in patients who do not fulfill diagnostic established criteria for essential tremor (ET) or Parkinson's disease (PD) poses a clinical diagnostic challenge. Twenty‐two patients with mixed tremor and additional mild extrapyramidal features, such as bradykinesia and rigidity, 20 patients with probable PD, 10 patients with probable ET, and 18 controls were investigated through the combined use of dopamine transporter 123 I‐FP‐CIT‐single‐photon emission tomography (DAT‐SPECT) and cardiac 123 metaiodobenzylguanidine (MIGB) scintigraphy. Six of the 22 mixed‐tremor patients had normal DAT‐SPECT, a condition usually found in patients with ET, whereas 16 patients showed damage to the nigrostriatal system. Cardiac MIBG allowed further differentiation between these 16 patients because eight of them had decreased tracer uptakes (heart/mediastinum [H/M] ratio in delayed image, H/M ratio delayed: 1.16 ± 0.11, P < 0.001 vs controls), indicating a PD, whereas the remaining eight had normal cardiac tracer uptakes, a finding suggestive of a parkinsonian syndrome (H/M ratio delayed: 1.90 ± 0.13). Both DAT‐SPECT and cardiac MIBG scintigraphies were abnormal in the 20 patients with probable PD, whereas these were normal in both the patients with probable ET as well as in the controls. Our study suggests that the combined use of both DAT‐SPECT and MIBG scintigraphy in mixed tremors with additional extrapyramidal features can help distinguish patients with ET from those with PD and parkinsonism. © 2009 Movement Disorder Society