Decreased striatal dopamine transporter density in JNCL patients with parkinsonian symptoms

• Published in: Neurology Vol. 54; no. 5; pp. 1069 - 1074
• Main Authors: ABERG, L, LIEWENDAHL, K, NIKKINEN, P, AUTTI, T, RINNE, J. O, SANTAVUORI, P
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 14-03-2000
• Subjects: Adolescent; Adult; Biological and medical sciences; Carrier Proteins - analysis; Child; Corpus Striatum - diagnostic imaging; Corpus Striatum - pathology; Dopamine Plasma Membrane Transport Proteins; Errors of metabolism; Female; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Membrane Glycoproteins; Membrane Transport Proteins; Metabolic diseases; Nerve Tissue Proteins; Neuronal Ceroid-Lipofuscinoses - complications; Neuronal Ceroid-Lipofuscinoses - diagnostic imaging; Neuronal Ceroid-Lipofuscinoses - pathology; Parkinson Disease - complications; Proteins and glycoproteins; Tomography, Emission-Computed, Single-Photon; Radionuclide study; Human; Nervous system diseases; Dopamine; Biological transport; Metabolic diseases; Exploration; Lipids; Corpus striatum; Enzymopathy; Photon; Cerebral disorder; Genetic disease; Central nervous system disease; Adolescent; Neuronal ceroid lipofuscinosis; Lipoidosis; Brain (vertebrata); Extrapyramidal syndrome; Emission tomography
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/WNL.54.5.1069

To explore whether striatal dopamine transporters are involved in juvenile neuronal ceroid lipofuscinosis (JNCL) with extrapyramidal signs.
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 2beta-carbomethoxy-3beta-(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.
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.
The observed decrease in the striatal dopamine transporter density in JNCL offers a rational basis for a trial of dopaminergic drugs in this disease.