Schwarz J, Scherer J, Trenkwalder C, Mozley P D, Tatsch K
Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Germany.
Psychiatry Res. 1998 Jul 15;83(1):23-8. doi: 10.1016/s0925-4927(98)00026-2.
We investigated the availability of dopamine reuptake sites in the striata of two patients with productive symptoms and neuroleptic therapy as well as progressive parkinsonism using the new dopamine transporter ligand [123I]N-(3-iodopropen-2-yl)-2beta-carbo-methoxy-3beta- (4-chlorophenyl)tropane (IPT) and single photon emission computed tomography (SPECT). Normal specific binding in the caudate nucleus was 8.6 +/- 1.2 and in the putamen 6.5 +/- 1.3 (mean +/- S.D.; n = 8; mean age, 56.7 years; range 41-67 years). Patient 1 (age 43) was admitted to our clinic at age 38 because of left-sided parkinsonism. At age 40, she developed paranoid psychosis without change after cessation of L-DOPA and lisuride treatment for 3 months. She was diagnosed as a schizophrenic, paranoid subtype (DSM-III-R). IPT-SPECT showed a loss of dopaminergic nerve terminals (right caudate/putamen, 5.16/2.0; left caudate/putamen, 5.92/2.66). Patient 2 (age, 61 years) had a history of paranoid psychosis for approx. 30 years. He experienced progressive right-sided parkinsonism since age 57 when treated with clozapine. IPT-SPECT showed a marked reduction of striatal dopamine transporter binding (right caudate/putamen, 5.06/1.65; left caudate/putamen, 3.8/1.12). Our findings indicate that patients may suffer contemporaneously from Parkinson's disease and schizophrenia. In these patients, the proof of a nigrostriatal dopaminergic deficit justifies treatment with neuroleptics and dopaminergic drugs. Imaging of dopamine transporters with SPECT and IPT or a related compound represents an attractive alternative to the more complex measurements of fluorodopa uptake with positron emission tomography (PET).
我们使用新型多巴胺转运体配体[123I]N-(3-碘丙烯-2-基)-2β-羧甲氧基-3β-(4-氯苯基)托烷(IPT)及单光子发射计算机断层扫描(SPECT)，研究了两名患有幻觉症状且接受抗精神病药物治疗以及患有进行性帕金森病患者纹状体中多巴胺再摄取位点的情况。正常尾状核的特异性结合为8.6±1.2，壳核为6.5±1.3(均值±标准差；n = 8；平均年龄56.7岁；范围41 - 67岁)。患者1(43岁)38岁时因左侧帕金森病入住我院。40岁时，在停用左旋多巴和利苏立得治疗3个月后，她出现偏执型精神病且无变化。她被诊断为精神分裂症，偏执型(DSM-III-R)。IPT-SPECT显示多巴胺能神经末梢缺失(右侧尾状核/壳核，5.16/2.0；左侧尾状核/壳核，5.92/2.66)。患者2(61岁)有大约30年的偏执型精神病病史。自57岁开始使用氯氮平治疗后，他出现进行性右侧帕金森病。IPT-SPECT显示纹状体多巴胺转运体结合显著减少(右侧尾状核/壳核，5.06/1.65；左侧尾状核/壳核，3.8/1.12)。我们的研究结果表明，患者可能同时患有帕金森病和精神分裂症。在这些患者中，黑质纹状体多巴胺能缺陷的证据证明使用抗精神病药物和多巴胺能药物治疗是合理的。用SPECT和IPT或相关化合物对多巴胺转运体进行成像，是比用正电子发射断层扫描(PET)进行更复杂的氟多巴摄取测量更具吸引力的替代方法。
