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Parkinsonism Relat Disord. 2018 Aug;53:37-41. doi: 10.1016/j.parkreldis.2018.04.037. Epub 2018 May 5.

DAT-SPECT imaging in cases of drug-induced parkinsonism in a specialty movement disorders practice.

Author information

1
Northwestern University Feinberg School of Medicine, United States.
2
Northwestern University Feinberg School of Medicine, Department of Preventative Medicine, United States.
3
Northwestern University Feinberg School of Medicine, Department of Neurology, United States. Electronic address: danny.bega@nm.org.

Abstract

OBJECTIVE:

Compare clinical characteristics and outcomes in cases where DAT-SPECT imaging is used to distinguish Parkinson's disease from Drug-Induced Parkinsonsim.

BACKGROUND:

Clinical uncertainty in diagnosing Parkinson's disease is common when patients are on dopamine-blocking medications. DAT-SPECT imaging can improve diagnostic certainty but little data are available on clinical characteristics and outcomes associated with normal and abnormal scan results.

METHODS:

Retrospective chart review of patients seen at a movement disorders center between 2011 and 2017 where DAT-SPECT was ordered to distinguish Parkinson's disease from Drug-induced Parkinsonism. Descriptive statistics were calculated for variables of interest and compared by scan result. Chi-squared analyses was carried out for categorical variables and students' t-tests for continuous values.

RESULTS:

51 patients met inclusion criteria with 36 normal scans and 15 abnormal scans. Those with greater than 2 cardinal manifestations (tremor, rigidity, akinesia, postural instability) were more likely to have an abnormal scan (63.89% vs 93.33%, p = 0.04). No other clinical characteristics assessed were associated with scan results. Atypical antipsychotics (aripiprazole 39.21%, olanzapine 31.37%) and mood stabilizers (valproic acid 33.33%, lithium 17.65%) were most commonly associated with suspected Drug-induced Parkinsonism cases. A post-scan change in management occurred in 41.18% of patients. 55.56% of patients with normal scans responded to changes in the offending medication, with 16.66% taking over 3 months to show improvement.

CONCLUSIONS:

Many DAT-SPECT scans at our institution are ordered to distinguish Parkinson's disease from Drug-induced Parkinsonism because clinical characteristics alone are unreliable. DAT-SPECT results lead to changes in management and the outcomes of these changes are consistent with scan results.

KEYWORDS:

DAT-SPECT; Drug-induced parkinsonism; Parkinson's disease

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