Subclinical nigrostriatal dopaminergic denervation in the cerebellar subtype of multiple system atrophy (MSA-C) |
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Authors: | Esteban Muñoz Alex Iranzo Sebastian Rauek Francisco Lomeña Judith Gallego Doménec Ros Joan Santamaría Eduardo Tolosa |
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Institution: | 1.Parkinson’s Disease and Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències (ICN), Hospital Clínic i Universitari,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED),Barcelona,Spain;2.Sleep Disorders Unit, Neurology Service, ICN, Hospital Clínic i Universitari,IDIBAPS, CIBERNED,Barcelona,Spain;3.Nuclear Medicine Service, Centre de Diagnòstic per la Imatge (CDI), Hospital Clínic i Universitari,Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS),Barcelona,Spain;4.Biophysics Unit, Department of Physiological Sciences I,Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine (CIBERBBN), University of Barcelona,Barcelona,Spain |
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Abstract: | Nigrostriatal involvement is considered an additional feature in the new consensus criteria for the diagnosis of the cerebellar
variant of multiple system atrophy (MSA-C). However, so far, only a few studies, which include a relative small number of
patients, give support to this criterion. Our objective was to assess nigrostriatal dopaminergic innervation in patients with
MSA-C without parkinsonism by use of dopamine transporter single photon emission computed tomography (DAT SPECT). Thirteen
patients that fulfilled criteria for possible or probable MSA-C and presented no parkinsonian signs, and 12 age-matched healthy
controls underwent (123I-2-β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I]FP-CIT) SPECT. Patients were also evaluated through the Unified Multiple System Atrophy Rating Scale (UMSARS) and brain
magnetic resonance imaging (MRI). The mean duration of the cerebellar syndrome was 3.8 ± 1.7 years. DAT SPECT showed a significant
decrease of striatal 123I]FP-CIT uptake ratios in patients (p < 0.001). Radiotracer uptake reduction was 21% in the entire striatum, 19% in putamen, and 24% in caudate nuclei. Striatal
binding ratios were within the normal range in 3 patients. We did not find correlation between striatal uptake and disease
duration, age of patients, UMSARS-II score, and pontine diameter. 123I]FP-CIT SPECT shows that most but not all MSA-C patients without parkinsonism have subclinical nigrostriatal dopaminergic
denervation which is not related to disease duration, cerebellar dysfunction, or pontine atrophy. |
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