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Detection of preclinical Parkinson's disease with PET

From the MRC Cyclotron Unit, Hammersmith Hospital, London, UK.

Address correspondence and reprint requests to Dr. David J. Brooks, MRC Cyclotron Unit, Hammersmith Hospital, London W12 OHS, UK.

Abstract.

Putamen ¹⁸F-dopa uptake of patients with Parkinson's disease (PD) is reduced by at least 35% at onset of symptoms; therefore, positron-emission tomography (PET) can be used to detect preclinical disease in clinically unaffected twins and relatives of patients with PD. Three out of 6 monozygotic and 2 out of 3 dizygotic unaffected PD co-twins have shown reduced putamen ¹⁸F-dopa uptake to date. In addition, an intact sibling and a daughter of 1 of 4 siblings with PD both had low putamen ¹⁸F-dopa uptake. These preliminary findings suggest there may be a familial component to the etiology of PD. PET can also be used to detect underlying nigral pathology in patients with isolated tremor and patients who become rigid taking dopamine-receptor blocking agents (DRBAs). Patients with familial essential tremor have normal, and those with isolated rest tremor have consistently low, putamen ¹⁸F-dopa uptake. Drug-induced parkinsonism is infrequently associated with underlying nigral pathology.