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Prospective study of relevance of 123I-MIBG myocardial scintigraphy and clonidine GH test to distinguish Parkinson’s disease and multiple system atrophy

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Abstract

Background

123I-MIBG myocardial scintigraphy and clonidine growth hormone test (CGH test) may help to distinguish multiple system atrophy (MSA) from Parkinson’s disease (PD). Their relevance in the first-stage parkinsonism of uncertain etiology is unknown.

Methods

Patients experiencing parkinsonism of ambiguous etiology were clinically classified into the PD group or the MSA group as initial clinical diagnosis (ICD). Then, CGH test and myocardial scintigraphy were performed. Clinical assessment was repeated throughout the disease course until the final clinical diagnosis (FCD) could be established according to the criteria of PD and MSA, respectively.

Results

Twenty-five patients with uncertain diagnosis were included (15 MSA and 10 PD as ICD). At the end of a 6-year follow-up, FCD was MSA in 11/25 patients and PD in 14/25. The CGH test and the scintigraphy showed a sensitivity of 82%, and a specificity of 71 and 93%, respectively, for the diagnosis of MSA. The combination of a normal scintigraphy (i.e., with myocardial MIBG uptake) with genitourinary dysfunction was the most relevant test to diagnose MSA, whereas an abnormal scintigraphy with a levodopa response of > 30% or an abnormal scintigraphy with the absence of OH was the most relevant combinations to diagnose PD. All these combinations had an accuracy superior than 90% and a specificity of 100%.

Conclusion

Combinations of myocardial scintigraphy with genitourinary dysfunction, levodopa response of > 30%, or orthostatic hypotension could be of interest for the distinction between PD and MSA when the clinical diagnosis remains ambiguous at the first stage of the disease.

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Abbreviations

CGH test:

Clonidine growth hormone test

FCD:

Final clinical diagnosis

GH:

Growth hormone

GUD:

Genitourinary dysfunction

H/M ratio:

Heart-to-mediastinum uptake ratio

ICD:

Initial clinical diagnosis

123I-MIBG:

123Iode méta-iodobenzylguanidine

MRI:

Magnetic resonance imaging

MSA:

Multiple system atrophy

OH:

Orthostatic hypotension

OR:

Odd ratio

PD:

Parkinson’s disease

UPDRS III score:

Unified Parkinson’s disease rating scale III score

WR:

Washout rate

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Authors and Affiliations

  1. Département de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    C. Alves Do Rego, O. Lagha-Boukbiza, M. Renaud, C. Tranchant & M. Anheim

  2. Département de Biophysique et Médecine Nucléaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    I. J. Namer

  3. ICube, Université de Strasbourg/CNRS UMR 7357, Strasbourg, France

    I. J. Namer

  4. Cabinet de Neurologie, 46 Avenue de Moka, 35400, Saint-Malo, France

    C. Marcel

  5. Département de Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    F. Lefebvre

  6. Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France

    O. Lagha-Boukbiza, M. Renaud, C. Tranchant & M. Anheim

  7. Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France

    C. Tranchant & M. Anheim

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  1. C. Alves Do Rego
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  3. C. Marcel
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Correspondence to M. Anheim.

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Alves Do Rego, C., Namer, I.J., Marcel, C. et al. Prospective study of relevance of 123I-MIBG myocardial scintigraphy and clonidine GH test to distinguish Parkinson’s disease and multiple system atrophy. J Neurol 265, 2033–2039 (2018). https://doi.org/10.1007/s00415-018-8941-5

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  • DOI: https://doi.org/10.1007/s00415-018-8941-5

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