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Brain, Vol. 116, No. 4, 853-867, 1993
© 1993 Guarantors of Brain

research-article

Asymmetrical pre-synaptic and post-synaptic changes in the striatal dopamine projection in dopa naïve parkinsonism

Diagnostic implications of the D2 receptor status

Guy V. Sawle1,2, E. Diane Playford1, David J. Brooks1,2, Niall Quinn2 and Richard S. J. Frackowiak1,2

1Clinical Sciences Section, Medical Research Council Cyclotron Unit, Hammersmith Hospital London, UK 2Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery London, UK

Correspondence to: Correspondence to Dr G. V. Sawle, MRC Cyclotron Unit, Hammersmith Hospital, 150 DuCane Road, London W12 OHS, UK

Nine L-dopa naïve patients with clinically diagnosed parkinsonism were studied using positron emission tomography with 6-L-[18F]fluorodopa ([18F]dopa, a pre-synaptic tracer) and [11C]raclopride (which binds to D2 receptors). Putamen [18F]dopa uptake was reduced in all patients, confirming a loss of function affecting the nigrostriatal projection. In eight patients the putamen with the lowest [18F]dopa uptake (always contralateral to the clinically most affected side) had the highest [11C]raclopride binding, suggesting upregulation of the post-synaptic D2 receptors. In the ninth patient [11C]raclopride binding was lower in the putamen with the lowest [18F]dopa uptake, indicating an additional post-synaptic deficit. All nine patients were shown to be L-dopa responsive. The subsequent clinical course of the former eight patients has been typical of idiopathic Parkinson's disease, whilst the ninth patient has developed postural hypotension, Urinary incontinence and respiratory stridor typical of multiple system atrophy. Reduced [11C]raclopride binding in L-dopa naïve parkinsonian patients might serve as a useful early marker of this condition.

Received September 16, 1992. Revised January 12, 1993. Accepted February 16, 1993.


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