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Decreased striatal dopamine transporter density in JNCL patients with parkinsonian symptoms

From the Hospital for Children and Adolescents, Pediatric Neurology (Drs. Åberg and Santavuori), Laboratory Department, Division of Nuclear Medicine (Drs. Liewendahl and Nikkinen), and the Department of Radiology (Dr. Autti), the University of Helsinki; and the Department of Neurology and Turku PET Centre (Dr. Rinne), University of Turku, Finland.

Address correspondence and reprint requests to Dr. Laura Åberg, Hospital for Children and Adolescents, Pediatric Neurology, PL 280, 00029 HYKS, Finland; e-mail: laura.aberg{at}Helsinki.fi

OBJECTIVE: To explore whether striatal dopamine transporters are involved in juvenile neuronal ceroid lipofuscinosis (JNCL) with extrapyramidal signs.

METHODS: Seventeen patients with JNCL entered the study (mean age, 15 years; age range, 10 to 31 years). For clinical evaluation, the authors used the motor section of the Unified Parkinson’s Disease Rating Scale (UPDRS). For studying the density of dopamine transporters in the striatum, they employed iodine-123-labeled 2ß-carbomethoxy-3ß-(4-iodophenyl) tropane as a SPECT tracer. The SPECT images were evaluated visually, and tracer accumulation was semiquantified from transverse slices as striatum-to-cerebellum activity ratios. MRI (1.5-T) signal intensities of the striatum were measured and compared with those of the thalamus.

RESULTS: The mean UPDRS score was 20 (range, 2 to 41). On SPECT, the mean striatum-to-cerebellum uptake ratio was lower in patients than in control subjects (3.1 ± 0.6 versus 6.8 ± 1.0; p < 0.001), with the decrease being more pronounced in the putamen than in the caudate nucleus. On MRI, the mean striatum-to-thalamus signal intensity ratio was higher in patients than in control subjects (1.14 ± 0.02 versus 1.08 ± 0.02; p < 0.001). There was a negative correlation between uptake ratios in SPECT and UPDRS scores, and a positive correlation between the MRI ratios and UPDRS. The SPECT and MRI ratios also correlated significantly, providing additional evidence for the contributions of nigrostriatal, striatal, and thalamic dysfunction to the parkinsonian symptoms.

CONCLUSIONS: The observed decrease in the striatal dopamine transporter density in JNCL offers a rational basis for a trial of dopaminergic drugs in this disease.

Key words: Juvenile neuronal ceroid lipofuscinosis—SPECT—MRI—Basal ganglia.

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