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

Jacob Yomtoob, Kimberly Koloms, Danny Bega*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)37-41
Number of pages5
JournalParkinsonism and Related Disorders
Volume53
DOIs
StatePublished - Aug 2018

Funding

Danny Bega, MD, MSCI has received royalties from the British Medical Journal. He serves as a consultant for Teva Pharmaceuticals, ACADIA Pharmaceutical, Inc, Cynapsus Therapeutics, and Us WorldMeds. He has served as a contractor for Medscape, LLC. He is on the speaker's bureau for ACADIA Pharmaceuticals and Teva Pharmaceuticals. He has received grant support from National Parkinson Foundation and the Huntington Disease Society of America. Danny Bega, MD, MSCI has received royalties from the British Medical Journal. He serves as a consultant for Teva Pharmaceuticals, ACADIA Pharmaceutical, Inc, Cynapsus Therapeutics, and Us WorldMeds. He has served as a contractor for Medscape, LLC. He is on the speaker's bureau for ACADIA Pharmaceuticals and Teva Pharmaceuticals. He has received grant support from National Parkinson Foundation and the Huntington Disease Society of America .

Keywords

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

ASJC Scopus subject areas

  • Neurology
  • Geriatrics and Gerontology
  • Clinical Neurology

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