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J Neurol Neurosurg Psychiatry 84:122-129 doi:10.1136/jnnp-2012-302618
  • Movement disorders
  • Research paper

Clinical features and 123I-FP-CIT SPECT imaging in vascular parkinsonism and Parkinson's disease

  1. Pablo Mir1,3
  1. 1Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
  2. 2Servicio de Medicina Nuclear, UDIM, Hospital Universitario Virgen del Rocío, Seville, Spain
  3. 3Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain
  1. Correspondence to Dr Pablo Mir, Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Hospital Universitario Virgen del Rocío, Avda, Manuel Siurot s/n, 41013 Sevilla, Spain; pablo.mir.sspa{at}juntadeandalucia.es
  1. Contributors SB-R, PM: substantial contributions to conception and design, acquisition of data, analysis and interpretation of data, drafting the article, revising it critically for important intellectual content, final approval of the version to be published. VAM-O, FJG-G, AMO: analysis and interpretation of data, revising the article critically for important intellectual content, final approval of the version to be published. DG-S: substantial contributions to conception and design, analysis and interpretation of data, revising the article critically for important intellectual content, final approval of the version to be published. IH-F: acquisition of data, analysis and interpretation of data, revising the article critically for important intellectual content, final approval of the version to be published. SJ, MTC, FC, MC: acquisition of data, revising the article critically for important intellectual content, final approval of the version to be published.

  • Received 5 March 2012
  • Revised 20 July 2012
  • Accepted 1 August 2012
  • Published Online First 20 August 2012

Abstract

Objectives To analyse the differences in the clinical features and characteristics of 123I-labelled 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) single photon emission CT (SPECT) imaging among patients with vascular parkinsonism (VP) and Parkinson's disease (PD).

Methods We performed a case–control study to compare clinical features and qualitative and semi-quantitative analyses of 123I-FP-CIT SPECT images between 106 patients with VP and 280 patients with PD. A case series study was used to search for clinical features related to SPECT or neuroimaging findings among patients with VP.

Results Patients with VP had a higher age at symptom onset and lower disease duration than patients with PD. The most frequent symptom at onset was gait disorder in VP and tremor in PD. Gait disorder, postural instability and falls were more frequent in VP. Rest and mixed tremor were more prevalent in PD. Of the patients who received levodopa treatment in the VP group, only about half had a good response. Qualitatively 123I-FP-CIT SPECT images were normal in 32.5% of patients with VP and abnormal in all patients with PD. The use of different visual score patterns showed higher ability to differentiate VP from PD. Semi-quantitative analysis showed significantly higher uptake in the striatum, caudate and putamen in VP. The asymmetry index was higher in patients with PD. Among patients with VP, falls were the only clinical feature that demonstrated a correlation with the SPECT visual pattern.

Conclusion Our data contribute to the confirmation that VP and PD are two different clinical entities. Neurological signs, response to treatment and qualitative and semi-quantitative 123I-FP-CIT SPECT analyses may help to make the diagnosis.

Footnotes

  • Funding IH-F, SJ, MTC, FC, MC and MP received support in the form of grants from the Ministerio de Ciencia e Innovación de España (SAF2007-60700); the Instituto de Salud Carlos III (PI10/01674); the Consejería de Innovación, Ciencia y Empresa de la Junta de Andalucía (CVI-02526, CTS-7685); the Consejería de Salud de la Junta de Andalucía (PI-0377/2007, PI-0741/2010), the Sociedad Andaluza de Neurología and the Jaques and Gloria Gossweiler Foundation.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the local ethics committee of Hospital Universitario Virgen del Rocio.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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