The following appeared in Medscape this week as a "Hot Topic in Neurology". If we can make an early diagnosis of PSP (etc), then assessing research treatments becomes more useful.
"Functional Imaging in Movement Disorders
The role of imaging biomarkers to study neurodegenerative and movement disorders was the focus of the talk by David Eidelberg, MD, Investigator and Head of the Susan and Leonard Feinstein Center for Neurosciences at North Shore-LIJ Health System. His research focuses on the use of functional imaging and spatial covariance analysis to detect abnormal functional networks in neurologic diseases.
Using fludeoxyglucose PET, Dr. Eidelberg and his colleagues looked for specific patterns of glucose utilization associated with specific neurologic conditions. In a study of 167 patients, for example, they found that metabolic brain imaging could accurately discriminate patients with Parkinson disease, multiple system atrophy, and progressive supranuclear palsy 3 years before a definitive clinical diagnosis was made. The findings have been replicated by other investigators.
These results suggest that functional imaging and spatial covariance analysis can identify patients with specific parkinsonian syndromes early, leading to timely discussions about prognosis and treatment. These findings also have implications for optimizing clinical trial design, because functional imaging can ensure that trials enroll patients with the target disease, even in the early stages, and can be used to understand the factors that affect the placebo response."
Amen. This is so badly needed. And yet too often neurogists are reticent to order this test, I suspect, for insurance payment reasons. And so, greater costs to patient, family, and to healthcare systems are incurred later on down the inevitable paths of these debilitating diseases.
"INDICATIONS AND USAGE: DaTscan is a radiopharmaceutical indicated for striatal dopamine transporter visualization using single photon emission computed tomography (SPECT) brain imaging to assist in the evaluation of adult patients with suspected Parkinsonian syndromes (PS). DaTscan may be used to help differentiate essential tremor from tremor due to PS (idiopathic Parkinson’s disease, multiple system atrophy and progressive supranuclear palsy). DaTscan is an adjunct to other diagnostic evaluations. DaTscan was not designed to distinguish among PD, MSA, and PSP. The effectiveness of DaTscan as a screening or confirmatory test and for monitoring disease progression or response to therapy has not been established."
So the DaTscan does not claim to do what the PET scan (as originally described) can do in differentiating between PD, MSA and PSP.
The "hummingbird sign" can only be seen with a MRI scan. It is the result of midbrain atrophy and will identify PSP in most cases when symptoms are well established (it is not a definitive test but it can be useful in diagnosis, although PSP can be mimicked in a few rare cases where this midbrain atrophy occurs but on autopsy it is not PSP).
many thanks for this info. If there is ever to be a strategy to halt progressive neurological damage then early detection is a key stage. By discrimination between atypical parkinsonism syndromes, what did they look for; regional glucose utilisation? Im guessing, but by analogy with parkinson's, when overt symptoms are evident, it is likely that most key neurones have already been lost?
best wishes
jmbb
in reply to
Hi jmbb....sorry for delay in answering. 18F-FDG is only a glucose analogue but was one of the first PET scan radiopharmaceuticals. It is useful in identifying hypermetabolism in many cancers (especially for metastases and staging of cancer). Then in certain neurological conditions it shows up hypometabolism. With such conditions as PD and PSP there is neuron damage and loss which shows on PET scans (with FDG) as low glucose turnover compared with the normal brain tissue.
The research has shown good statistical evidence that there is hypometabolism in...
IPD in bilateral parietal region
MSA-P in bilateral putamen
MSA-C in bilateral cerebellum region
PSP in midbrain and middle frontal cortex
CBD in asymmetrical cortex and basal ganglia
DLB in bilateral occipital/parietal regions
(Of course, there are now many other positron emitting compounds used in neurological disorder research, plus other radiopharmaceuticals for brain imaging in th Nuclear Medicine setting of SPECT/CT scanning).
Cheers
T
Thanks, as always. Is there any way of selecting individuals other than early symptoms for this sort of scanning approach?
jmbb
in reply to
Hi jmbb
As you know, diagnosing PSP/CBD from clinical symptoms is often difficult even for some neurologists, especially in the early stages when it might look like Parkinson's or even early Alzheimer's (or other more rarer conditions). So, sadly, selecting individuals for such scans other than "early symptoms" seems improbable. Additionally, it would really be a sort of "screening" and the medical profession do not take this approach because of cost and the difficult logistics (although PET scanning is becoming available in large medical and private centres, orphan diseases like PSP, take a very low or no priority).
While there are no biomarkers of significance for PSP at the moment, there are some for Alzheimer's (in CSF) but the medical profession is not about to "screen" for early Alzheimer's detection by having people undergo a lumbar puncture (with it's risks) and the general population would probably not want to go through such an invasive procedure.
Even if PSP could be detected much earlier in a general population, we need to have some good therapeutics in place to stop it in its tracks or slow the progression. Unfortunately, everything that has been tried so far in human trials has failed .....!
All the best
T.
Dear Strelly, Thanks for your advice and knowledge. I kinda realised that wide scale screening is unlikely. Is it not possible to advocate a set of early neurological symptoms which would then lead to scanning and possibly early diagnosis for a range of neurological illnesses. This would mean more referrals, and scanning. Do you think this could be advocated? I do realise that that another question is what to do with people once they have an early diagnosis. This will vary country to country.
One thing in my mind was that on this site the PSPA surveys are all about diagnosis, how long it took, how many times with neurologist, how many times with GP etc. What would be useful to know is how much information was given at the point of diagnosis. From my previous work with Bipolar disorder, I would guess very little information is given. If neurologists had a set of information from PSPA to give out, that would be an advance. Can we not survey the folk on this site, or would we have to get the PSPA and site administrator agreement.
Thanks Strelley for your info here. I am currently having ''allergic' reactions to Pate - had 621 =635 in it - found after reading label! I have now read to avoid any additive with the 6 number. All very well after the event. My husband bought the Pate to take to a Drinks do this pm. I will not be eating it nor drinking the white wine with cabinet sauvignon + can only drink riesling & some chArdonnay . Cheers Mary
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