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Loss of Dopamine-D2 Receptor Binding Sites in Parkinsonian Plus Syndromes

Strahlenklinik und Nuklear medizinische Klinik der Charité der, Humboldt-Universität zu Berlin, Berlin, Germany
Neurologische Klinik der Universität Innsbruck, Innsbruck, Austria

Correspondence: For correspondence or reprints contact: Johannes Hierholzer, MD, Strahlenkilnik, Charté, Campus Virchow-Klinikum, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.

ABSTRACT

This study analyzed temporal changes of striatal dopamine-D2 receptor binding during the course of different extrapyramidal movement disorders using ¹²³I-iodobenzamide (IBZM) SPECT. Methods: Eighteen patients (9 with Parkinson's disease, 9 with parkinsonian plus syndrome) were followed for 11–53 mo. Dopemine-D2 receptor binding was assessed using ¹²³I-IBZM SPECT at the beginning and at the end of the follow-up period. SPECT data were acquired 120 min postinjection of 3–5 mCi ¹²³I-IBZM. A semiautomated algorithm was applied to the raw data for semiquanttitative evaluation of regional cerebral receptor binding. Results: Intraobserver(r = 0.992) and interobserver(r = 0.930) variance was low for the semiautomated interpretation of the SPECT examination of the dopaminergic D2 receptor binding, reflecting a highly reproducible SPECT algorithm. Mean specific dopamine-D2 receptor binding was lower in patients with parkinsonian plus syndrome compared to patients with Parkinson's disease on the initial (p < 0.001) as well as the follow-up study (p < 0.001). In patients with Parkinson's disease, we observed an unaffected receptor binding compared to a reduced binding of radiotracer in patients with parkinsonian plus syndrome during the course of the disease (p < 0.001). Conclusion: During the follow-up, patients with Parkinson's disease showed a constant dopamine-D2 receptor binding. In contrast, patients with parkinsonian plus syndrome revealed a decline of the binding of dopamine-D2 receptor. These findings are in agreement with histopathological data that demonstrated a preserved dopamine-D2 receptor status in patients with Parkinson's disease and a decline of the dopamine-D2 receptors in patients with parkinsonian plus syndrome. SPECT examinations using ¹²³I-IBZM are useful for assessing dynamic changes of dopamine-D2 receptors in extrapyramidal movement disorders. Semiquantitative SPECT evaluations may provide valuable information for clinical management and prognosis of the patient with extrapyramidal movement disorders.

Key Words: Parkinson's disease • parkinsonian plus syndromes • iodine-123-iodobenzamide • SPECT

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