Pathology, Prevention and Therapeutics of Neurodegenerative Disease
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Kinetic Modeling in Positron Emission Tomography
Ch23.qxd 28/8/04 2:05 PM Page 499 CHAPTER 23 Kinetic Modeling in Positron Emission Tomography EVAN D. MORRIS,* CHRISTOPHER J. ENDRES,† KATHLEEN C. SCHMIDT,‡ BRADLEY T. CHRISTIAN,§ RAYMOND F. MUZIC JR.,¶ RONALD E. FISHER|| *Departments of Radiology and Biomedical Engineering, Indiana University School of Medicine, Indianapolis, Indiana †Department of Radiology, Johns Hopkins University, Baltimore, Maryland ‡Laboratory of Cerebral Metabolism, NIMH, Bethesda, Maryland §Wright State University, Kettering Medical Center, Dayton, Ohio ¶Departments of Radiology, Oncology and Biomedical Engineering, Case Western Reserve University, Nuclear Medicine, University Hospitals Cleveland, Cleveland, Ohio ||The Methodist Hospital and Department of Radiology and Neuroscience, Baylor College of Medicine, Houston, Texas I. Introduction used in the two most ubiquitous applications of PET: imag- II. The One-Compartment Model: Blood Flow ing of blood flow and glucose metabolism. We also examine III. Positron Emission Tomography Measurements of the use of PET to image specific receptor molecules, which Regional Cerebral Glucose Use capitalizes on the unique specificity of PET. IV. Receptor–Ligand Models Supplied with single (static) PET images and no kinetic V. Model Simplifications model to aid in their interpretation, one is confined to asking VI. Limitations to Absolute Quantification questions that can be answered only on the basis of spatial VII. Functional Imaging of Neurochemistry—Future Uses information such as: Where is glucose being used? Where VIII. A Generalized Implementation of the Model are particular receptor molecules located within the brain or Equations the heart? With the acquisition of dynamic (time-sequence) imaging data and the application of kinetic models, one can pose many additional quantitative questions based on temporal I. -
M2021: Pharmacogenetic Testing
Pharmacogenetic Testing Policy Number: AHS – M2021 – Pharmacogenetic Prior Policy Name and Number, as applicable: Testing • M2021 – Cytochrome P450 Initial Presentation Date: 06/16/2021 Revision Date: N/A I. Policy Description Pharmacogenetics is defined as the study of variability in drug response due to heredity (Nebert, 1999). Cytochrome (CYP) P450 enzymes are a class of enzymes essential in the synthesis and breakdown metabolism of various molecules and chemicals. Found primarily in the liver, these enzymes are also essential for the metabolism of many medications. CYP P450 are essential to produce many biochemical building blocks, such as cholesterol, fatty acids, and bile acids. Additional cytochrome P450 are involved in the metabolism of drugs, carcinogens, and internal substances, such as toxins formed within cells. Mutations in CYP P450 genes can result in the inability to properly metabolize medications and other substances, leading to increased levels of toxic substances in the body. Approximately 58 CYP genes are in humans (Bains, 2013; Tantisira & Weiss, 2019). Thiopurine methyltransferase (TPMT) is an enzyme that methylates azathioprine, mercaptopurine and thioguanine into active thioguanine nucleotide metabolites. Azathioprine and mercaptopurine are used for treatment of nonmalignant immunologic disorders; mercaptopurine is used for treatment of lymphoid malignancies; and thioguanine is used for treatment of myeloid leukemias (Relling et al., 2011). Dihydropyrimidine dehydrogenase (DPD), encoded by the gene DPYD, is a rate-limiting enzyme responsible for fluoropyrimidine catabolism. The fluoropyrimidines (5-fluorouracil and capecitabine) are drugs used in the treatment of solid tumors, such as colorectal, breast, and aerodigestive tract tumors (Amstutz et al., 2018). A variety of cell surface proteins, such as antigen-presenting molecules and other proteins, are encoded by the human leukocyte antigen genes (HLAs). -
Management of Side Effects of Antipsychotics
Management of side effects of antipsychotics Oliver Freudenreich, MD, FACLP Co-Director, MGH Schizophrenia Program www.mghcme.org Disclosures I have the following relevant financial relationship with a commercial interest to disclose (recipient SELF; content SCHIZOPHRENIA): • Alkermes – Consultant honoraria (Advisory Board) • Avanir – Research grant (to institution) • Janssen – Research grant (to institution), consultant honoraria (Advisory Board) • Neurocrine – Consultant honoraria (Advisory Board) • Novartis – Consultant honoraria • Otsuka – Research grant (to institution) • Roche – Consultant honoraria • Saladax – Research grant (to institution) • Elsevier – Honoraria (medical editing) • Global Medical Education – Honoraria (CME speaker and content developer) • Medscape – Honoraria (CME speaker) • Wolters-Kluwer – Royalties (content developer) • UpToDate – Royalties, honoraria (content developer and editor) • American Psychiatric Association – Consultant honoraria (SMI Adviser) www.mghcme.org Outline • Antipsychotic side effect summary • Critical side effect management – NMS – Cardiac side effects – Gastrointestinal side effects – Clozapine black box warnings • Routine side effect management – Metabolic side effects – Motor side effects – Prolactin elevation • The man-in-the-arena algorithm www.mghcme.org Receptor profile and side effects • Alpha-1 – Hypotension: slow titration • Dopamine-2 – Dystonia: prophylactic anticholinergic – Akathisia, parkinsonism, tardive dyskinesia – Hyperprolactinemia • Histamine-1 – Sedation – Weight gain -
Deutetrabenazine
PATIENT & CAREGIVER EDUCATION Deutetrabenazine This information from Lexicomp® explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider. Brand Names: US Austedo Warning This drug may raise the chance of depression and suicidal thoughts or actions in people with Huntington’s disease. If you have ever had depression or suicidal thoughts or actions, talk with your doctor. This drug may not be right for you. People who take this drug must be watched closely. Call your doctor right away if you have signs like depression, nervousness, restlessness, grouchiness, panic attacks, or any other changes in feelings, mood, or behavior. Call your doctor right away if you have any thoughts or actions of suicide. What is this drug used for? It is used to treat disabling involuntary movements in Huntington’s chorea. It is used to treat tardive dyskinesia. What do I need to tell my doctor BEFORE I take this drug? If you are allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had. If you have or have ever had depression or thoughts of suicide. Deutetrabenazine 1/6 If you have liver disease. If you have ever had a long QT on ECG or other heartbeat that is not normal. If you have taken certain drugs for depression or Parkinson’s disease in the last 14 days. This includes isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. -
Natural History, MRI Morphology, and Dopamine Receptor Imaging with 123IBZM-SPECT
J7ournal ofNeurology, Neurosurgery, and Psychiatry 1994;57:1047-1056 1047 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.57.9.1047 on 1 September 1994. Downloaded from Multiple system atrophy: natural history, MRI morphology, and dopamine receptor imaging with 123IBZM-SPECT J B Schulz, T Klockgether, D Petersen, M Jauch, W Muiller-Schauenburg, S Spieker, K Voigt, J Dichgans Abstract of the intermediolateral cell columns of the Sixteen patients with a clinical diagnosis spinal cord. All of these changes are not neces- of probable multiple system atrophy sarily found in each patient with MSA. In (MSA) were examined clinically by MRI some patients, degeneration affects mainly the and by 523I-iodobenzamide single photon basal ganglia, whereas in others the ponto- emission computed tomography (IBZM- cerebellar system or the spinal cord are more SPECT). The clinical records of another affected. Therefore, evidence of cell degenera- 16 patients were also analysed retrospec- tion and gliosis in at least three of the following tively. On the basis of their clinical pre- anatomical structures is thought to be suffi- sentation, patients were subdivided into cient for the neuropathological diagnosis of those with prominent parkinsonism MSA: striatum, substantia nigra, Purkinje (MSA-P, n = 11) and those with promi- cell layer of the cerebellar cortex, pontine nent cerebellar ataxia (MSA-C, n = 21). nuclei, inferior olives, and intermediolateral Autonomic symptoms were present in all cell columns of the spinal cord.'4 Striatum or patients and preceded the onset of motor substantia nigra must be one of these areas.5 symptoms in 63% of patients. -
Brain Imaging
Publications · Brochures Brain Imaging A Technologist’s Guide Produced with the kind Support of Editors Fragoso Costa, Pedro (Oldenburg) Santos, Andrea (Lisbon) Vidovič, Borut (Munich) Contributors Arbizu Lostao, Javier Pagani, Marco Barthel, Henryk Payoux, Pierre Boehm, Torsten Pepe, Giovanna Calapaquí-Terán, Adriana Peștean, Claudiu Delgado-Bolton, Roberto Sabri, Osama Garibotto, Valentina Sočan, Aljaž Grmek, Marko Sousa, Eva Hackett, Elizabeth Testanera, Giorgio Hoffmann, Karl Titus Tiepolt, Solveig Law, Ian van de Giessen, Elsmarieke Lucena, Filipa Vaz, Tânia Morbelli, Silvia Werner, Peter Contents Foreword 4 Introduction 5 Andrea Santos, Pedro Fragoso Costa Chapter 1 Anatomy, Physiology and Pathology 6 Elsmarieke van de Giessen, Silvia Morbelli and Pierre Payoux Chapter 2 Tracers for Brain Imaging 12 Aljaz Socan Chapter 3 SPECT and SPECT/CT in Oncological Brain Imaging (*) 26 Elizabeth C. Hackett Chapter 4 Imaging in Oncological Brain Diseases: PET/CT 33 EANM Giorgio Testanera and Giovanna Pepe Chapter 5 Imaging in Neurological and Vascular Brain Diseases (SPECT and SPECT/CT) 54 Filipa Lucena, Eva Sousa and Tânia F. Vaz Chapter 6 Imaging in Neurological and Vascular Brain Diseases (PET/CT) 72 Ian Law, Valentina Garibotto and Marco Pagani Chapter 7 PET/CT in Radiotherapy Planning of Brain Tumours 92 Roberto Delgado-Bolton, Adriana K. Calapaquí-Terán and Javier Arbizu Chapter 8 PET/MRI for Brain Imaging 100 Peter Werner, Torsten Boehm, Solveig Tiepolt, Henryk Barthel, Karl T. Hoffmann and Osama Sabri Chapter 9 Brain Death 110 Marko Grmek Chapter 10 Health Care in Patients with Neurological Disorders 116 Claudiu Peștean Imprint 126 n accordance with the Austrian Eco-Label for printed matters. -
(Xenazine); Deutetrabenazine (Austedo); Valbenazine
tetrabenazine (Xenazine ®); deutetrabenazine (Austedo ™); valbenazine (Ingrezza ™) EOCCO POLICY Po licy Type: PA/SP Pharmacy Coverage Policy: EOCCO157 Description Tetrabenazine (Xenazine), deutetrabenazine (Austedo) and valbenazine (Ingrezza) are reversible vesicular monoamine transporter 2 (VMAT2) inhibitors that act by regulating monoamine uptake from the cytoplasm to the synaptic vesicle. Its mechanism of action in Tardive dyskinesia or chorea-reduction is unknown . Length of Authorization Initial (Tardive dyskinesia): Three months Initial (Chorea associated with Huntington’s disease): 12 months Renewal: 12 months Quantity limits Product Name Dosage Form Indication Quantity Limit 12.5 mg Chorea associated with 60 tablets/30 days 25 mg Huntington’s disease Chorea associated with tetrabenazine (Xenazine) Huntington’s disease, 25 mg genotyped extensive 120 tablets/30 days and intermediate metabolizers 12.5 mg Chorea associated with 60 tablets/30 days 25 mg Huntington’s disease Chorea associated with generic tetrabenazine Huntington’s disease, 25 mg genotyped extensive 120 tablets/30 days and intermediate metabolizers 6 mg Tardive dyskinesia in adults; Chorea 30 tablets/30 days deutetrabenazine (Austedo) 9 mg associated with 12 mg Huntington’s disease 120 tablets/30 days 40 mg 30 capsules/30 days; valbenazine (Ingrezza) Tardive Dyskinesia 80 mg 4-week Initiation Pack Initial Evaluation I. Tetrabenazine (Xenazine), deutetrabenazine (Austedo) and valbenazine (Ingrezza) may be considered medically necessary when the following criteria below are met: A. Member is 18 years of age or older; AND B. Medication is prescribed by, or in consultation with, a neurologist or psychiatrist; AND C. Medication will not be used in combination with another VMAT2 inhibitor [e.g. tetrabenazine (Xenazine), deutetrabenazine (Austedo) valbenazine (Ingrezza)], monoamine oxidase inhibitor (MAOI) [e.g. -
Radiotracers for SPECT Imaging: Current Scenario and Future Prospects
Radiochim. Acta 100, 95–107 (2012) / DOI 10.1524/ract.2011.1891 © by Oldenbourg Wissenschaftsverlag, München Radiotracers for SPECT imaging: current scenario and future prospects By S. Adak1,∗, R. Bhalla2, K. K. Vijaya Raj1, S. Mandal1, R. Pickett2 andS.K.Luthra2 1 GE Healthcare Medical Diagnostics, John F Welch Technology Center, Bangalore, India 560066 2 GE Healthcare Medical Diagnostics, The Grove Centre, White Lion Road, Amersham, HP7 9LL, UK (Received October 4, 2010; accepted in final form July 18, 2011) Nuclear medicine / 99m-Technetium / 123-Iodine / ton emission computed tomography (SPECT or less com- Oncological imaging / Neurological imaging / monly known as SPET) and positron emission tomogra- Cardiovascular imaging phy (PET). Both techniques use radiolabeled molecules to probe molecular processes that can be visualized, quanti- fied and tracked over time, thus allowing the discrimination Summary. Single photon emission computed tomography of healthy from diseased tissue with a high degree of con- (SPECT) has been the cornerstone of nuclear medicine and today fidence. The imaging agents use target-specific biological it is widely used to detect molecular changes in cardiovascular, processes associated with the disease being assessed both at neurological and oncological diseases. While SPECT has been the cellular and subcellular levels within living organisms. available since the 1980s, advances in instrumentation hardware, The impact of molecular imaging has been on greater under- software and the availability of new radiotracers that are creating a revival in SPECT imaging are reviewed in this paper. standing of integrative biology, earlier detection and charac- The biggest change in the last decade has been the fusion terization of disease, and evaluation of treatment in human of CT with SPECT, which has improved attenuation correction subjects [1–3]. -
Austedo (Deutetrabenazine)
Market Applicability/Effective Date FL & FL FL Market GA KS KY LA MD NJ NV NY TN TX WA FHK MMA LTC Applicable X N/A N/A X N/A X X X X X X N/A N/A NA *FHK- Florida Healthy Kids Austedo (deutetrabenazine) Override(s) Approval Duration Prior Authorization 1 year Medications Quantity Limit Austedo (deutetrabenazine) May be subject to quantity limit APPROVAL CRITERIA Initial requests for Austedo (deutetrabenazine) may be approved for individuals who meet the following criteria: I. Individual is 18 years of age or older; AND II. Individual has a diagnosis of chorea associated with Huntington’s disease; OR III. Individual has a diagnosis of tardive dyskinesia (TD) confirmed by the following (DSM-5): A. At least 60 days of stable (drug, dose) medication exposure (either typical or first generation antipsychotic agents [such as, chlorpromazine, haloperidol, fluphenazine], atypical or second-generation antipsychotic agents [such as, clozapine, risperidone, olanzapine, quetiapine, aripiprazole], or certain dopamine receptor-blocking drugs used in treatment of nausea and gastroparesis [such as, prochlorperazine, promethazine, metoclopramide]); AND B. Presence of involuntary athetoid or choreiform movements lasting at least 30 days. Requests for continuation of therapy for Austedo (deutetrabenazine) may be approved for individuals who meet the following criteria: I. Individual has experienced an improvement in symptoms deemed to be clinically significant by the provider. Requests for Austedo (deutetrabenazine) may not be approved for individuals who meet the following criteria: I. Individual is suicidal or has untreated/inadequately treated depression; OR II. Individual has hepatic impairment; OR III. Individual is currently utilizing monoamine oxidase inhibitors (MAOIs), reserpine, or tetrabenazine. -
Drug-Induced Movement Disorders
Medical Management of Early PD Samer D. Tabbal, M.D. May 2016 Associate Professor of Neurology Director of The Parkinson Disease & Other Movement Disorders Program Mobile: +961 70 65 89 85 email: [email protected] Conflict of Interest Statement No drug company pays me any money Outline So, you diagnosed Parkinson disease .Natural history of the disease .When to start drug therapy? .Which drug to use first for symptomatic treatment? ● Levodopa vs dopamine agonist vs MAOI Natural History of Parkinson Disease Before levodopa: Death within 10 years After levodopa: . “Honeymoon” period (~ 5-7 years) . Motor (ON/OFF) fluctuations & dyskinesias: ● Drug therapy effective initially ● Surgical intervention by 10-15 years - Deep brain stimulation (DBS) therapy Motor Response Dyskinesia 5-7 yrs >10 yrs Dyskinesia ON state ON state OFF state OFF state time time Several days Several hours 1-2 hour Natural History of Parkinson Disease Prominent gait impairment and autonomic symptoms by 20-25 years (Merola 2011) Behavioral changes before or with motor symptoms: . Sleep disorders . Depression . Anxiety . Hallucinations, paranoid delusions Dementia at anytime during the illness . When prominent or early: diffuse Lewy body disease Symptoms of Parkinson Disease Motor Symptoms Sensory Symptoms Mental Symptoms: . Cognitive and psychiatric Autonomic Symptoms Presenting Symptoms of Parkinson Disease Mood disorders: depression and lack of motivation Sleep disorders: “acting out dreams” and nightmares Early motor symptoms: Typically Unilateral . Rest tremor: chin, arms or legs or “inner tremor” . Bradykinesia: focal and generalized slowness . Rigidity: “muscle stiffness or ache” Also: (usually no early postural instability) . Facial masking with hypophonia: “does not smile anymore” or “looks unhappy all the time” . -
2009 Paris, France the Movement Disorder Society’S 13Th International Congress of Parkinson’S Disease and Movement Disorders
FINAL PROGRAM The Movement Disorder Society’s 13th International Congress OF PARKINSon’S DISEASE AND MOVEMENT DISORDERS JUNE 7-11, 2009 Paris, France The Movement Disorder Society’s 13th International Congress of Parkinson’s Disease and Movement Disorders Claiming CME Credit To claim CME credit for your participation in the MDS 13th International Congress of Parkinson’s Disease and Movement Disorders, International Congress participants must complete and submit an online CME Request Form. This Form will be available beginning June 10. Instructions for claiming credit: • After June 10, visit www.movementdisorders.org/congress/congress09/cme • Log in following the instructions on the page. You will need your International Congress Reference Number, located on the upper right of the Confirmation Sheet found in your registration packet. • Follow the on-screen instructions to claim CME Credit for the sessions you attended. • You may print your certificate from your home or office, or save it as a PDF for your records. Continuing Medical Education The Movement Disorder Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Credit Designation The Movement Disorder Society designates this educational activity for a maximum of 30.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Non-CME Certificates of Attendance were included with your on- site registration packet. If you did not receive one, please e-mail [email protected] to request one. The Movement Disorder Society has sought accreditation from the European Accreditation Council for Continuing Medical Education (EACCME) to provide the following CME activity for medical specialists. -
Review of Deutetrabenazine: a Novel Treatment for Chorea Associated with Huntington’S Disease
Journal name: Drug Design, Development and Therapy Article Designation: Review Year: 2018 Volume: 12 Drug Design, Development and Therapy Dovepress Running head verso: Dean and Sung Running head recto: Review of deutetrabenazine for treatment of chorea in HD open access to scientific and medical research DOI: http://dx.doi.org/10.2147/DDDT.S138828 Open Access Full Text Article REVIEW Review of deutetrabenazine: a novel treatment for chorea associated with Huntington’s disease Marissa Dean Abstract: Deutetrabenazine was recently approved for the treatment of chorea in Huntington’s Victor W Sung disease (HD) and is the first deuterated medication that has been US Food and Drug Adminis- tration (FDA)-approved for therapeutic use. In this article, we review deutetrabenazine’s drug Department of Neurology, Division of Movement Disorders, University of design, pharmacokinetics, drug interactions, efficacy, adverse events, comparison with tetra- Alabama at Birmingham, Birmingham, benazine, dosage, and administration. Deutetrabenazine is a deuterated form of tetrabenazine AL, USA and is a vesicular monoamine transporter 2 (VMAT2) inhibitor. The substitution of deuterium for hydrogen at key positions in the tetrabenazine molecule allows a longer drug half-life and less frequent daily dosing. Deutetrabenazine is administered twice daily up to a maximum daily dose of 48 mg, which corresponds to a similar daily dose of 100 mg of tetrabenazine. In a Phase III clinical trial (First-HD), there was a statistically significant improvement of chorea in HD subjects, as well as improvements in global impression of change as assessed by both patients and clinicians. This improvement was seen without significant adverse effects as the overall tolerability profile of deutetrabenazine was similar to placebo.