가톨릭대 / 이지은, 김중석*
Abstract
Recent studies have suggested that preserved cardiac sympathetic denervation may be associated with a small motor burden in Parkinson disease (PD) and serve as a good marker, which is not associated with other nonmotor symptoms. We sought to investigate whether cardiac sympathetic denervation increases the risk of the early wearing-off phenomenon in PD. Methods: This hospital-based prospective study enrolled 266 de novo patients with PD who underwent 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy on initial evaluation. The patients visited the outpatient clinic every 2-6 mo and were followed for a minimum of 18 mo from the time they began taking dopaminergic medication. Each patient was assessed for the wearing-off phenomenon on the basis of the clinical assessments and symptom diaries. Clinical events were analyzed from the date of evaluation by 123I-MIBG scintigraphy until the date of the first occurrence of the wearing-off phenomenon, or until the last follow-up date without wearing-off. Results: During a mean follow-up period of 30.4 ± 14.8 mo, 71 patients developed wearing-off. The wearing-off phenomenon occurred more in patients with decreased 123I-MIBG uptake. A Cox regression analysis revealed that both low 123I-MIBG uptake and early onset age significantly predicted the development of wearing-off. Conclusion: Our study suggests that a reduction in myocardial 123I-MIBG uptake in PD patients may be associated with a subsequent increased risk for the wearing-off phenomenon. Findings strongly support that PD patients with normal cardiac sympathetic innervation might have less involvement of the midbrain dopaminergic circuitry and a concomitant reduced risk for motor complications, such as wearing-off.
Author information
Lee JE1, Kim JS2, Ryu DW1, Oh YS1, Yoo IR3, Lee KS1.
1
Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; and.
2
Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; and neuronet@catholic.ac.kr.
3
Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
편집위원
I-123 MIBG 심근 섭취로 Parkinson disease의 병리적 상태와 향후 운동관련 합병증 발생을 예측할 수 있음을 보여준 임상 연구임. 이 연구 결과는 I-123 MIBG 스캔의 추가적인 임상적 활용법을 보여 준 연구로 심장핵의학 및 신경핵의학 연구 활성화에 기여할 수 있음.
2018-12-14 16:53:37