Objective: ​​​​​​This was a prospective study to evaluate distinction of trans cranial sonograph(TCS) findings of the SN(sustantia nigra) in patients who were recent-onset of durg induced parkinsonism(DIP) and Parinson’s disease(PD). We emphasize important clinical note for exclude subclinical drug-exacerbated degenerative parkinsonism.

Background: DIP is the most common cause of secondary parkinsonism in the elderly. SN echogenicity can be used as a marker to distinguish patients with PD from those subjects with parkinsonism without evidence of dopaminergic deficit or DIP. More conveniently, TCS has attracted considerable attention as a potentially cheaper and even more widely available diagnostic modality in the work-up of patients presenting with parkinsonian syndromes.

Method: Among the patients who were referred clinically unclear parkinsonism, we enrolled 25 PD(8) and DIP(10) patients. And ten DIP patients followed for 6 months after cessation of the offending drug. Diagnosis of DIP was done if the patient have been taking the medicine that inducing extrapyramidal symptoms(EPS) more than 4 weeks recently, and had a remarkable improvement of EPS after withdrawal of offending drug for 2 weeks. IPD diagnosis was followed by UK Parkinson’s Disease Society Brain Bank criteria. Two patients clinically diagnosed subclinical drug-exacerbated degenerative parkinsonism underwent brain 123I-FP-CIT SPECT at 6 months.

Results: Temporal acoustic windows were insufficient in 7 of 25 patients(28%). Total 18 patients (mean age 66years old, M:F=10:8) were enrolled eventually. There were no significant statistical differences in patients demography.(Fisher’s exact test P>0.05). Interestingly, two of ten DIP patients who persisted or deteriorated symptoms for 6 months followed, received a clinical diagnosis of multi system atrophy(MSA-P) and IPD(akinetic rigid type) with decreased tracer binding in 123I-FP-CIT SPECT.

Conclusion: Temporal acoustic windows seems to be poorer In Korean compare with western people. Looking at our TCS findings though has limitations, TCS of SN have major implications for decisions of differential diagnosis between PD and DIP. Especially for those with subclinical drug-exacerbated degenerative parkinsonism, clinician need to be careful neurologic examination with history taking and follow up for at least 6 months. DAT SPECT may helpful in clinically doubtful cases.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/transcranial-brain-sonography-can-distinguish-drug-induced-parkinsonism-from-idiopathic-parkinsons-disease-in-korean/