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Neurological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Uncomplicated patients who meet the criteria above do not require investigation. Liver function tests, calcium levels, copper, caeruloplasmin and urinary copper will exclude treatable metabolic causes, and a DATSCAN may demonstrate the characteristic loss of presynaptic dopamine terminals.
Parkinson’s disease
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Bruno V. Gallo, Alisabeth C. Hearron
Identifying patients in the premotor phases of the disease would be very advantageous for the patient. Imaging technologies have emerged, but these require the patient to already have a motor symptom (i.e., tremors) for a dopamine active transport (DAT) scan to be useful. There is active research underway in an effort to develop a synuclein scan, with the goal to diagnose patients without motor symptoms.
Parkinson’s Disease and Rehabilitation
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Biemiller Rachel A., Irene Hegeman Richard
Until recently, the diagnosis of PD was purely clinical, requiring two of the three cardinal symptoms to be present to make the diagnosis. The recent use of the DaTscan, a single photon emission computer tomography (SPECT) nuclear medicine study that uses a radioactive ligand for the dopamine transporter, has enhanced the ability to separate PD from some other conditions [50]. The DaTscan will reflect decreased dopamine uptake in the basal ganglia in patients with PD. It may be helpful to distinguish between such diagnoses as ET and PD or mediation-induced parkinsonism and PD but not at separating PD from other neurodegenerative diseases such as Parkinson’s plus syndromes. The bulk of the diagnosis therefore remains based on clinical judgment [51].
Approaching drug-induced parkinsonism from a neurohospitalist perspective
Published in Expert Review of Neurotherapeutics, 2019
Parkinsonism refers to the clinical combination of bradykinesia, rigidity, tremor and postural instability. The use of neuroleptics, such as typical and atypical antipsychotics (among other drug classes), can cause an acute to subacute drug- induced parkinsonism, can induce a chronic tardive parkinsonism, or may unmask underlying IPD. Symptoms can manifest within days of medication initiation, with the vast majority emerging by 3 months [4]. A second peak of symptom onset at 12 months of exposure has been reported, mainly with the use of calcium channel blockers [5].The parkinsonism tends to be bilateral and symmetric, but this is not a rule. With discontinuation of the offending medication most cases of parkinsonism will reverse within days to months – strongly suggesting DIP [4]. Alternatively, symptoms may persist, worsen, or cease only to recur with time. When symptoms persist or worsen, tardive parkinsonism or IPD should be considered. These two entities can be further differentiated with a dopamine transporter (DAT) scan – which will be normal in tardive parkinsonism [2].
Investigating ioflupane I123 injection and single photon emission tomography as an imaging biomarker for long-term sequelae following mild traumatic brain injury
Published in Brain Injury, 2018
Nicole Reams, Julie Anderson, Reid Perlman, Wei Li, Shaun Walters, Samuel Tideman, Chi Wang, Kelly Simon, Roberta Frigerio, Demetrius M. Maraganore
The neurologist performed a parkinsonism-specific review of systems, The Unified Parkinson’s Disease Rating Scale part III (UPDRS) (25), a standard neurological exam, a neurological diagnoses of interest checklist, and the following if parkinsonism was present: cardinal signs of parkinsonism checklist, Hoehn and Yahr staging (26), differential diagnosis, and final diagnosis of parkinsonism per the Bower criteria(27). Eligible participants were then referred to Nuclear Medicine for DaTscan. Imaging was started 4 hours following intravenous administration of 5 mCi 123I-ioflupane. SPECT imaging was performed with a dual-headed gamma camera (Philips Axis or Brightview). One hundred and twenty images were obtained over 360° in a 128 × 128 matrix at 30 seconds per image. The maximum radius of rotation was 16 cm. Images were reconstructed using the OSEM/MLEM iterative algorithm with 5 iterations and filtered with a Butterworth filter (cutoff 0.5, order 10). Images were evaluated using visual analysis and DaTQUANT software (GE Healthcare). DaTscan images were visually read qualitatively and interpreted by a nuclear medicine physician who was blinded to clinical data. A separate nuclear medicine scientist performed quantitative DaTscan image measures (DaTQUANT) blinded to clinical data and to the qualitative interpretation (28).
Clinical drug development for dementia with Lewy bodies: past and present
Published in Expert Opinion on Investigational Drugs, 2019
Garam Lee, Jeffrey Cummings, Boris Decourt, James B. Leverenz, Marwan N. Sabbagh
Direct biomarkers specific to DLB pathology are not yet available for clinical diagnosis. The revised version of the DLB criteria incorporated the use of indicative and supportive imaging and electrophysiological biomarkers in the diagnosis of DLB [13]. Probable DLB is diagnosed if two or more of the core clinical features are present, with or without the presence of indicative biomarkers; or if only one core clinical feature is present, but with one or more indicative biomarkers [13]. Reduced dopamine transporter (DAT) uptake demonstrated by single-photon emission computed tomography (SPECT)(DaT scan) or positron emission tomography (PET) is an indicative biomarker and remains the best neuroimaging technique to differentiate DLB from AD [25]. Other indicative biomarkers include polysomnographic confirmation of REM sleep without atonia and reduced uptake on 123iodine-metaiodobenzylguanidine (MIBG) myocardial scintigraphy [13], with the latter being used extensively in Japan. Supportive biomarkers, which can help the diagnostic evaluation but without clear diagnostic specificity, include low uptake on SPECT/PET perfusion/metabolism scan with reduced occipital activity ± the cingulate island sign on fluorodeoxyglucose (FDG)-PET; less severe hippocampal atrophy than observed in AD with magnetic resonance imaging (MRI); and prominent posterior slow-wave activity on electroencephalogram (EEG) with periodic fluctuations in the pre-alpha/theta range [13]. The cingulate island sign on FDG-PET shows higher glucose metabolism in the posterior cingulate surrounded by an area of reduced cortical metabolism [26]. Although not included in the diagnostic criteria, relative preservation of amygdala metabolism on FDG-PET could be used in earlier stages of DLB [27]. While these biomarkers are not specific to DLB, combining them with clinical features can increase the accuracy of DLB diagnosis.