Division of Clinical Neurosciences, University of Turku, Turku University Hospital, POB 52, 20521, Turku, Finland.
Department of Neurology, University of Turku, Turku University Hospital, Turku, Finland.
J Neurol. 2019 Apr;266(4):826-834. doi: 10.1007/s00415-019-09202-6. Epub 2019 Jan 28.
Total parkinsonian motor symptom severity correlates with presynaptic striatal dopamine function in patients with Parkinson's disease. There is a lack of studies that have investigated the associations between parkinsonian motor signs and striatal dopaminergic deficiency in patients with parkinsonism of an unknown origin. Identification of specific motor signs associated with the highest likelihood of striatal dopamine deficiency could aid the differential diagnostics of parkinsonian and tremor syndromes.
In this cross-sectional clinical and imaging study, detailed motor examinations were performed for 221 patients with parkinsonism or tremor of an unknown origin immediately before dopamine transporter (DAT) [I-123]FP-CIT SPECT imaging. Region-of-interest and voxel-based methods were used to investigate striatal DAT deficiency in relation to individual motor signs.
Upper extremity rigidity and facial expression were the only motor signs that differentiated patients with normal and abnormal striatal DAT function. The presence of any upper extremity rigidity showed the highest likelihood of DAT deficiency (OR 4.79, 95% CI 1.56-14.75, P = 0.006) followed by reduced facial expression (OR 2.14, 95% CI 1.14-4.00, P = 0.018). In patients with DAT deficits, reduced facial expression was associated with DAT deficiency specifically in the caudate nucleus, and increased upper extremity rigidity was associated with DAT loss in the dorsal putamen (FWE-corrected P < 0.05).
Increased upper extremity muscle tone and hypomimia are independently associated with a higher likelihood of striatal hypodopaminergic imaging finding. This information can be used as a factor when the clinical need of auxiliary investigations, such as DAT SPECT, is considered for patients with parkinsonism.
在帕金森病患者中，总的帕金森运动症状严重程度与纹状体内突触前多巴胺功能相关。目前缺乏研究调查帕金森病起源不明的帕金森患者的运动体征与纹状体内多巴胺能缺乏之间的关系。识别与纹状体内多巴胺缺乏最相关的特定运动体征可能有助于帕金森和震颤综合征的鉴别诊断。
在这项横断面临床和影像学研究中，在进行多巴胺转运体（DAT）[I-123]FP-CIT SPECT 成像之前，立即对 221 名帕金森病起源不明的帕金森或震颤患者进行详细的运动检查。使用感兴趣区和体素方法研究纹状体内 DAT 缺乏与个体运动体征的关系。
上肢僵硬和面部表情是唯一能够区分纹状体内 DAT 功能正常和异常的运动体征。任何上肢僵硬的存在都显示出 DAT 缺乏的最高可能性（OR 4.79，95%CI 1.56-14.75，P=0.006），其次是面部表情减少（OR 2.14，95%CI 1.14-4.00，P=0.018）。在 DAT 缺陷患者中，面部表情减少与尾状核内的 DAT 缺陷有关，而上肢僵硬增加与背侧壳核内的 DAT 丢失有关（FWE 校正后 P<0.05）。
上肢肌肉张力增加和运动不能与纹状体内低多巴胺成像发现的可能性增加独立相关。当考虑辅助检查（如 DAT SPECT）的临床需要时，这些信息可以作为一个因素。
