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. 2015 Jul 5;128(13):1765-71.
doi: 10.4103/0366-6999.159352.

Heterogeneity of Monosymptomatic Resting Tremor in a Prospective Study: Clinical Features, Electrophysiological Test, and Dopamine Transporter Positron Emission Tomography

Hua-Guang Zheng, Rong Zhang, Xin Li, Fang-Fei Li, Ya-Chen Wang, Xue-Mei Wang, Ling-Long Lu, Tao Feng  1
Affiliations

Heterogeneity of Monosymptomatic Resting Tremor in a Prospective Study: Clinical Features, Electrophysiological Test, and Dopamine Transporter Positron Emission Tomography

Hua-Guang Zheng et al. Chin Med J (Engl). .

Abstract

Background: The relationship between monosymptomatic resting tremor (mRT) and Parkinson's disease (PD) remains controversial. In this study, we aimed to assess the function of presynaptic dopaminergic neurons in patients with mRT by dopamine transporter positron emission tomography (DAT-PET) and to evaluate the utility of clinical features or electrophysiological studies in differential diagnosis.

Methods: Thirty-three consecutive patients with mRT were enrolled prospectively. The Unified Parkinson's Disease Rating Scale and electromyography were tested before DAT-PET. Striatal asymmetry index (SAI) was calculated, and a normal DAT-PET was defined as a SAI of <15%. Scans without evidence of dopaminergic deficits (SWEDDs) were diagnosed in patients with a subsequent normal DAT-PET and structural magnetic resonance imaging.

Results: Twenty-eight mRT patients with a significant reduction in uptake of DAT binding in the striatum were diagnosed with PD, while the remained 5 with a normal DAT-PET scan were SWEDDs. As for UPRDS, the dressing and hygiene score, walking in motor experiences of daily living (Part II) and motor examination (Part III) were significant different between two groups (P < 0.05 and P < 0.01, respectively). Bilateral tremor was more frequent in the SWEDDs group (P < 0.05). The frequency of resting tremor and the amplitude of postural tremor tend to be higher in the SWEDDs group (P = 0.08 and P = 0.05, respectively).

Conclusions: mRT is heterogeneous in presynaptic nigrostriatal dopaminergic degeneration, which can be determined by DAT-PET brain imaging. Clinical and electrophysiological features may provide clues to distinguish PD from SWEDDs.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Positron emission tomography (PET) to distinguish scans without evidence of dopaminergic deficits (SWEDDs) from Parkinson's disease (PD) and tremor analysis between groups. Transaxial slices of PET/tremor analysis of a patient with SWEDDs (left) and another patient with right-sided PD (right).
Figure 2
Figure 2
Dopamine transporter positron emission tomography help to distinguish scans without evidence of dopaminergic deficits from Parkinson's disease in monosymptomatic resting tremor patients.
Figure 3
Figure 3
Dopamine transporter positron emission tomography help to identify Parkinson's disease in the early age in monosymptomatic resting tremor patients.
See this image and copyright information in PMC

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