Iodine-123-meta-iodobenzylguanidine Myocardial Scintigraphy in Isolated Autonomic Failure: Potential Red Flag for Future Multiple System Atrophy

• Main Authors: Francesca Baschieri, Giovanna Calandra-Buonaura, Annagrazia Cecere, Giorgio Barletta, Manuela Contin, Piero Parchi, Pietro Cortelli
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2017-05-01
• Series: Frontiers in Neurology
• Subjects: autonomic failure; Parkinson’s disease; multiple system atrophy; Iodine-123-meta-iodobenzylguanidine myocardial scintigraphy; orthostatic hypotension
• Online Access: http://journal.frontiersin.org/article/10.3389/fneur.2017.00225/full
• ISSN: 1664-2295

Pure autonomic failure is challenging as it can be the presenting feature of a central nervous system syncleinopathy such as Parkinson’s disease (PD) or multiple system atrophy (MSA). Because the prognosis of MSA and PD is so different, predictive features for a possible conversion can be extremely valuable. In this paper, we report three cases (two with autopsy-proven diagnosis) that had isolated AF for many years before converting to MSA or PD. Of all the tests that were performed during the premotor stage, Iodine-123-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy was predictive of the conversion to MSA. We suggest that MIBG myocardial scintigraphy, when performed in patients with isolated AF, may be a valuable predictor of conversion to MSA. On the contrary, the role of such test in parkinsonian patients irrespective of the presence of AF is still to be clarified.