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Cardiac sympathetic denervation in Parkinson’s disease patients with SWEDDs

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Abstract

Dopamine transporter scans of some patients who have been clinically diagnosed with Parkinson’s disease (PD) fail to reveal abnormal dopaminergic functioning and are referred to as scans without evidence of dopaminergic deficits (SWEDDs). In this study, we investigated the differences between SWEDDs patients and PD patients using 123I-metaiodobenzylguanidine (MIBG) scans. This study enrolled 20 patients with SWEDDs, 30 patients with early PD and 50 healthy controls. Cardiac 123I-MIBG scans were performed on all subjects, and parameters including the early and delayed heart-to-mediastinum ratios (H/M) and the washout rate were compared among the three groups. The mean delayed H/M ratio in the PD group (mean ± standard deviation, 1.45 ± 0.23) was the lowest of the three groups, and the scans in the group without evidence of dopaminergic deficits exhibited a lower mean delayed H/M ratio (2.15 ± 0.48) than the control group (2.56 ± 0.55) (p < 0.05). The intermediate status of cardiac MIBG uptake in the SWEDDs patients in our study may have been due to the heterogeneity of the SWEDDs patients; some of these patients had Parkinsonism with unknown characteristics, some may have had early PD with false-negative dopamine transporter imaging, and some have had primary dystonia that was misdiagnosed as PD. These uncharacterised SWEDDs patients accounted for a larger proportion of the heterogeneous SWEDDs than observed in previous studies, but our results suggest that cardiac 123I-MIBG scans may help to differentiate patients with SWEDDs from patients with PD.

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Acknowledgments

This work was supported by a grant from the Korean Health Technology R&D Project, Ministry for Health Welfare & Family Affairs, Republic of Korea (A101712).

Conflict of interest

The authors have no conflict of interest to disclose.

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Authors and Affiliations

  1. Department of Neurology, College of Medicine, Hanyang University, 17 Haengdangdong, Seongdong-gu, Seoul, 133-792, Korea

    Wooyoung Jang & Hee-Tae Kim

  2. Department of Neurology, Catholic University College of Medicine, Seoul, Korea

    Joong-Seok Kim

  3. Department of Neurology, Samsung Medical Center, Seoul, Korea

    Jin Whan Cho

  4. Department of Nuclear Medicine, Hanyang University College of Medicine, Seoul, Korea

    Young Hwan Kim, Ji Young Kim & Yun Young Choi

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  1. Wooyoung Jang
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  2. Joong-Seok Kim
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  3. Jin Whan Cho
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  4. Young Hwan Kim
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  5. Ji Young Kim
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  6. Yun Young Choi
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  7. Hee-Tae Kim
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Correspondence to Hee-Tae Kim.

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10072_2012_1244_MOESM4_ESM.jpg

Supplementary Fig. 1 Images of FP-CIT PET/CT at the level of the striatum in a SWEDDs patient. (A): Initial image, (B): Follow-up image after 3 years (JPG 176 kb)

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Jang, W., Kim, JS., Cho, J.W. et al. Cardiac sympathetic denervation in Parkinson’s disease patients with SWEDDs. Neurol Sci 34, 1375–1382 (2013). https://doi.org/10.1007/s10072-012-1244-1

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  • DOI: https://doi.org/10.1007/s10072-012-1244-1

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