Can we predict clinical course of Parkinson’s disease on the basis of cardiac scintigraphy?

Sharing a momentOngoing degenerative changes of pigmented neurons in brain are the essence of Parkinson’s disease. Consequently, it leads to deficiency of dopamine which is a neurotransmitter in substantia nigra and striatum. Gradually, disease process involves other brain structures and Lewy bodies can be observed in changed tissues.

Scintigraphy is an imaging test in nuclear medicine. It consists in introduction of chemical substance marked with radioisotope into patient’s body and digital detection of its decay. Depending on type of examination, carrier and isotope are selected in order to gather in a certain organ or tissue. Result of the test is an image of substance distribution in patient’s body.

In Parkinson’s disease cardiac scintigraphy shows disorders in functioning of sympathetic nervous system in areas of postganglionic fibers already in early stage of the disease. Metaiodobenzylguanidine-123I (MIBG-123I), which accumulates in heart tissues, is used during the test. Decrease in marker uptake means sympathetic denervation and is observed in almost all Parkinson’s patients. A group of Japanese scientists wanted to test how the level of marker uptake changes over the years and how it is related to clinical picture of the disease. They were also interested in variant group of patients with initially normal or slightly lowered marker uptake.

70 people were qualified for the research (26 men and 40 women). All of them had to fulfill strict clinical criteria. Also, they had cardiac scintigraphy performed at the beginning of the disease and next one at least 3 years later. Analysis of obtained results showed that maker uptake by the heart muscle gradually decreases in majority of patients in the course of the disease. It was observed that in some patients the decrease was significant and in other patients the level of uptake remained unchanged or was slightly lowered. On that basis, the patients were divided into two groups. In group A the uptake was low not only in the first test, but also in the second one after 3 years. In group B there were no significant changes and the uptake remained normal or slightly lowered.

Among patients from group B the majority were women and the disease manifested itself at younger age than in patients from group A. Patients from group B were motorically efficient for longer period of time, they less frequently developed dementia, depression, anxiety or disorders of urinary system. It can be said that patients with normal or slightly lowered uptake of MIBG-123I during cardiac scintigraphy is a group with majority of women in whom the disease showed at younger age. Probably, its progression will be slower and patients will be longer motorically and mentally efficient.

Written by: Katarzyna Skarbek, Aneta Sobek

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2. Tsujikawa K, et al. Chronological changes of 123I_MIBG myocardial scintigraphy and clinical features of Parkinson’s disease. J Neurol Neurosurg Psychiatry 2015;86:945-951
3. Satoh A, Serita T, Seto M, et al. Loss of 123I_MIBG uptake by the heart in Parkinson’s disease: assessment of cardiac sympathetic denervation and diagnostic value. J Nucl Med 19999;40:371-5
4. Orimo S, OzawaE, Nakade S, et al. (123)I-metaiodobenzylguanidine myocardial scintigraphy In Parkinsons disease. J Neurol Neurosurg Psychiatry 1999;67:189-94

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