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Iodine- 123-Iodobenzamide Binding in Parkinsonism: Reduction by Dopamine Agonists but Not L-Dopa

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Iodine- 123-Iodobenzamide Binding in Parkinsonism: Reduction by Dopamine Agonists but Not L-Dopa abnormalities, or both, may be considered candidates for either fantile spasms. I. PET identifies focal cortical dysgenesis in cryptogenic cases for surgical treatment. Ann Neurol 1990;27:406—413. hemispherectomy or callosotomy. Both interventions have 6. Harvey AS, Bowe JM, Hopkins IJ, Shield LK, Cook DJ, Berkovic SF. Ictal proved to be successful strategies (21). Ictal rCBF SPECT, in @“Tc-HMPAOsingle-photon emission computed tomography in children with tem particular, showed focal to lobal hyperperfusion in all our poral lobe epilepsy. Epilepsia 1993;34:869—877. 7. Adams C, Hwang PA, Gilday DL, et al. Comparison of SPECT, EEG, CT, MRI and patients. On the basis of the small number of patients, this pathology in partial epilepsy. Pediatr Neurol 1992;8:97—I03. finding cannot be considered a recommendation for lobectomy 8. KuhI DE, Engel J, Phelps ME, 5dm C. Epileptic patterns oflocal cerebral metabolism as an alternative approach; however, larger study populations and perfusion in humans determined with emission computed tomography of ‘‘FDG and ‘3NH3.Ann Neurol I980;8:348—360. might show the ability of ictal SPECT to identify some patients 9. Gloor P. Contributions of electroencephalography and electrocorticography in the who might also benefit from more restrictive surgery. neurosurgical treatment ofepilepsies. New York: Raven Press; 1987:553—571. 10. GrOnwald F, Menzel C, Pavics L, et al. Ictal and intenctal brain SPECT imaging in epilepsy using technetium-99m-ECD. J Nuci Med I994;35: 1896—1901. CONCLUSION I 1. Menzel C, GrOnwald F, Pavics L, et al. Brain single-photon emission tomography Technetium-99m-ECD is a valuable tool for the investigation using technetium-99m-bicisate (ECD) in a case ofcomplex partial seizure. EurJNucl of childhood epilepsy, and application of the tracer appears to Med 1994;21:1243—l246. 12. GrOnwaldF, Durwen HF, Bockisch A, et al. Iechnetium-99m-HMPAO brain SPECT be safe. Generally, both interictal and ictal rCBF SPECT should in medically intractable temporal lobe epilepsy: a postoperative evaluation. JNucl Med be performed whenever possible. In childhood epilepsy, there I991;32:388—394. are two major indications for the application of rCBF SPECT if 13. Newton MR. Austin MC, Chan G, McKay Wi, Rowe CC, Bercovic SF. Ictal SPECT using technetium-99m-HMPAO: methods for rapid preparation and optimal deploy the intent is to identify only the epileptogenic area: (a) the ment of tracer during spontaneous seizures. J Nuci Med 1993;34:666—670. acceleration of ECoG application in patients with normal MRI 14. Weisner PS, Bower GR, Dollimore LA, Forster AM, Higley B, Storey AE. A method for stabilizing technetium-99m-exametazime prepared from a commercial kit. Eur scan results or low seizure frequency, or both, to shorten the J Nuci Med 1993;20:661—666. hospital period of the child; and (b) to avoid ECoG in patients 15. Radtke RA, Hanson MW, Hoffman JM, et aI. Temporal lobe hypometabolism on PET: with focal MRI abnormalities that match ictal hyperperfusion predictor ofseizure control after temporal lobectomy. Neurology I993;43:1088—1092. 16. Kuikka iT, Mervaala E, v@inen E, KilviãinenR. Does technetium-99m-bicisate seen on rCBF SPECT. Furthermore, interictal 99mTc..ECD image local brain metabolism in late ictal temporal lobe epilepsy. Eur J Nuci Med SPECT might prove helpful in estimating postsurgical clinical 1994;21:1247—1251. outcome (e.g., seizure frequency or memory impairment) (12). 17. Feistel H, SchülerP. Neubauer U, Stefan H, Wolf F. Frontal lobe seizures—focus localization with ictal @“Tc-HMPAOSPECT [Abstract]. J Nuci Med I993;34 (suppl):207P. REFERENCES 18. Alksne JF, Tecoma E, Iragui-Madoz v, et al. Development of a device to facilitate 1. O'Donohue NV. Epilepsies ofchildhood. London: Butterworths; 1981. routine ictal SPECT studies. Epilepsia 1993;34 (suppl 6):I39. 2. Gomez MR. Klass DW. Epilepsies of infancy and childhood. Ann Neurol 1983;I3: 19. Leveille J, Demonceau 0, Walovitch RC. Intrasubject comparison between techne I13—127. tium-99m-ECD and technetium-99m-HMPAO in healthy human subjects. JNucI Med 3. Niedermeyer E. The Lennox-Gastaut syndrome and its frontiers. Clin Electroencepha I992;33:480—484. Iogr1986;I7:117—126. 20. Moretti JL, Defer G, Cinotti L, Cesaro P, ving@on N, Pethe C. Comparative 4. Grattan-SmithJD, HarveyAs, DesmondPM, Chow CW. Hippocampalsclerosisin tomoscintigraphic study of strokes using @“Tc-ECD,@“Tc-HMPAOand ‘231-IMP children with intractable temporal lobe epilepsy: detection with MR imaging. AJR Am [Abstract]. EurJNuclMed l988;l2:311. JRoentgenol 1993;161:I045—1048. 21. vigevano F, Bertini E, Boldrini R, et al. Hemimegalencephaly and intractable 5. Chugani HI, Shields WD, 5hewmon DA, Olson DM, Phelps ME, Pearson Wi. In epilepsy: benefits of hemispherectomy. Epilepsia l989;30:833—843. Iodine- 123-Iodobenzamide Binding in Parkinsonism: Reduction by Dopamine Agonists but Not L-Dopa Johannes Schwarz, Wolfgang H. Oertel and Klaus Tatsch Departments ofNeurology and Nuclear Medicine, Klinikum Grosshadern, Ludwig Maximilians University and German Ministry for Research and Technology Research Program Munich “Parkinson‘sDisease and Other Basal Ganglia Disorders, “Munich, Germany unchanged in 10 patients treated with L-Dopa alone. However, after The aim of the present study was to investigatethe effect of treatment with a dopamine agonist there was a significant decline in treatment with L-Dopa or a dopamine agonist, or both, on specific specffic r@[email protected] (p < 0.05). After treatment with a corn striatal 1@I-iodobenzamide (IBZM)binding using an intraindividual bination of L-Dopa and a dopamine agonist, specific r23wBzM longitudinaldesign. Method: We prospectivelystudied the effectof binding was reduced without reaching a level of significance (p = dopaminomimetic treatment on specific r23wBzM binding mea 0.08).Conclusion: Short-term treatment with a dopamine agonist sured by SPECT in 29 patients with a clinical diagnosis of Parkin but not with L-Dopa reduces specific r23I]IBzM binding. Therefore, son's disease, none of whom had previousiy received dopaminomi before performing an r23olBzM SPECT scan in patients previously metic drugs. The patients had been Selected on the basis of normal treated with dopaminomimetic drugs, dopamine agonists should be subsequent specific r23wBzM binding, semiquantitatively calcu discontinued. lated as the basal ganglia/frontal cortex ratio, and a positive re Key Words Parkinson's disease; diagnosis; iodine-123-iodobenz sponse to the dopamine agonist apomorphine before initiation of amide; SPECT; L-Dopa; dopamine agonist dopaminomimetic therapy. A second 1@I-IBZMSPECT invest@a tion was performed after 3-6 mo of treatment with L-Dopa or a J Nuci Med 1996;37:1112-1115 dopamine agonist, or both. Results: Specific r23olBzM bindingwas Iodine-123-iodobenzamine (IBZM) SPECT is a predictor of Received May 18, 1995; revision accepted Aug. 18, 1995. For correspondenceer reprintscontact Johannes Schwarz, MD,Departhientof dopaminergic responsiveness in previously untreated patients Neurology, University of Ulm, RKU, Oborer Eselsberg 65, 84081 UIm, Germany. with parkinsonism (1 ). This capacity may also help to differ 1112 THEJOURNALOFNUCLEARMEDICINE•Vol. 37 •No. 7 •July 1996 entiate patients with Parkinson's disease (PD) from those with before treatment: 40 ±12; during treatment 38 ±11 [mean ± related basal ganglia disorders, such as multiple-system atrophy s.d.]; p = ns. by Wicoxon Signed Rank). A computer program for (MSA) with predominant parkinsonism (MSA of the striatoni superimposing MM and SPECT images was not available; such a gral type) (2,3) or progressive supranuclear palsy (PSP) (4). In program would have enabled more accurate determination of the the latter patients, in contrast to those with PD, the striatum is ROIs. We did not observe any adverse reactions to intravenous affected, and response to dopaminomimetic drugs is usually injections of [‘23I]IBZM. poor (5). Normal specific [‘231]IBZMbinding was assessed in 14 control There are conflicting reports concerning the effect of dopami subjects and measured as 1.54 ±0.05. nomimetic drugs on dopamine-D2 receptor binding in vivo as The diagnosis of PD is supported by a clear improvement in measured by PET or SPECT (6—9). clinical signs under dopaminomimetic therapy. The response to Therefore, we prospectively investigated the effect of L apomorphine, a potent dopamine agonist, predicts this benefit from Dopa or a dopamine agonist, or both, on specific [123I}IBZM oral dopaminomimetic therapy (12,13). binding after 3—6mo of treatment in previously untreated Testing with the dopamine agonist apomorphine was performed patients with clinically diagnosed PD. after [‘231]IBZMSPECT, as previously described (12—14).Patients were rated clinically using part III of the Unified Parkinson's MATERIALS AND METhODS Disease Rating Scale (UPDRS) before and 30 mm after subcuta neous injection of 2—5mg apomorphine. Apomorphine test results Patients were considered positive in the case of a reduction in UPDRS Twenty-nine previously untreated patients (Hoehn and Yahr stages I to III) were investigated. All patients presented with scores by at least 20% and negative for a reduction of less than clinical signs compatible with Parkinson's disease according to the 10%. If the reduction in UPDRS scores was between 10% and 20%, or if sideeffectsprecludedanadequaterating,thetestresults United Kingdom (Parkinson's Disease Society) brain bank criteria (10). These patients had normal [‘23I]IBZMbinding and a positive were considered equivocal. Testing with apomorphine was gener response to apomorphine before the initiation of oral therapy with ally well tolerated. The investigator (JS) performing the apomor L-Dopa, lisuride, bromocriptine or pramipexole. Lisuride, bro phine test had no knowledge of the [‘231]IBZMSPECT results. Likewise, the investigator (KT) calculating the basal ganglia/ mocnptine and pramipexole are all dopamine agomsts that act mainly by stimulation of the dopamine-D2 receptor. Ten patients frontal cortex (BG/FC) ratios had no knowledge ofthe clinical data and the results ofthe apomorphine test.
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