Objective: To give a comprehensive literature overview of alterations in regional cerebral glucose metabolism, measured using [¹⁸F]FDG PET, in hyperkinetic movement disorders. In addition, correlations between glucose metabolism and clinical variables, as well as the effect of treatment on glucose metabolism are discussed.

Background: [¹⁸F]FDG PET enables non-invasive measurements of regional glucose metabolism in the brain. Previous reviews on [¹⁸F]FDG PET in movement disorders have focused primarily on hypokinetic movement disorders, but changes in glucose metabolism also have been studied extensively in hyperkinetic movement disorders. The underlying pathophysiology of most hyperkinetic movement disorders is not exactly known.

Method: A systematic literature search was performed according to PRISMA guidelines. Studies concerning tremor, tics, dystonia, ataxia, chorea, myoclonus, functional movement disorders or mixed movement disorders due to autoimmune or metabolic aetiologies were eligible for inclusion. A PubMed search was performed up to November 2021.

Results: Of 1240 studies retrieved in the original search, 105 articles were included. Most articles concerned patients with chorea (n=27), followed by ataxia (n=25), dystonia (n=20), tremor (n=8), metabolic disease (n=7), myoclonus (n=6), tics (n=6) and autoimmune disorders (n=6). No papers on functional movement disorders were included. Altered glucose metabolism was detected in various brain regions in all movement disorders, with dystonia-related hypermetabolism of the lentiform nuclei and both hyper- and hypometabolism of the cerebellum; pronounced cerebellar hypometabolism in ataxia; and striatal hypometabolism in chorea (dominated by Huntington disease). Correlations between clinical characteristics and glucose metabolism were often described. [¹⁸F]FDG PET showed normalization of metabolic alterations after treatment in tremor, ataxia and chorea.

Conclusion: In all hyperkinetic movement disorders hypo- or hypermetabolism in multiple, partly overlapping, brain regions were found and clinical characteristics often correlated with glucose metabolism. For some movement disorders [18F]FDG PET metabolic changes reflected effect of treatment.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/18ffdg-pet-in-hyperkinetic-movement-disorders-a-systematic-review/