Multiple System Atrophy and Progressive Supranuclear Palsy

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Abstract
• Objective. —To measure D2dopamine receptors in the striatum in patients with multiple system atrophy and progressive supranuclear palsy by I 3-iodo-6-methoxybenzamide labeled with iodine I 123 (123I-IBZM) single photon emission computed tomography and differentiate them from control subjects. Design. —Survey with the following as retrospective criterion standards: (1) parkinsonism, (2) negative apomorphine test, and (3) no or only slight reaction to dopaminergic medication. Setting. —Ambulatory or hospitalized care in an academic referral center. Patients and Control Subjects. —Twenty-one patients with parkinsonism not responding to dopaminergic medication (17 with multiple system atrophy and four with progressive supranuclear palsy) and 21 control subjects without parkinsonism. Intervention. —In vivo imaging by single photon emission computed tomography using the D2dopamine receptor specific radioligand123I-IBZM. Main Outcome Measure. —Striatum/occipital cortex ratio of count rate density as semiquantitative measurement for striatal D2dopamine receptor density. Results. —A highly significant loss of striatal uptake of123I-IBZM was observed in the patients in comparison to the control subjects with little or no overlap between values. Conclusions. —The hypothesized loss of D2receptors in multiple system atrophy has been confirmed. Use of123I-IBZM single photon emission computed tomography may be a cost-effective alternative to positron emission tomography in the differential diagnosis of parkinsonism and in the selection of patients for dopaminergic therapy.