Journal
ANTIOXIDANTS
Volume 11, Issue 11, Pages -Publisher
MDPI
DOI: 10.3390/antiox11112289
Keywords
carbon monoxide-induced parkinsonism; oxidative stress; Tc-99m TRODAT-1 SPECT; delayed neuropsychiatric syndromes; hyperbaric oxygen therapy
Funding
- Ministry of Science and Technology R.O.C.
- Tri-Service General Hospital [NSTC-111-2314-B-350-004, 111-2314-B-A49-041]
- Taipei Medical University Hospital [TSGH-E-111219]
- [110TMU-TMUH-02-3]
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This study examined the relationship between dopamine transporter (DAT) loss and globus pallidus necrosis in patients with delayed neuropsychiatric syndrome (DNS) after acute carbon monoxide (CO) poisoning. The results showed that Tc-99m TRODAT-1 SPECT and MRI could assist in evaluating the risk of Parkinsonism and indicating DAT availability after hyperbaric oxygen therapy (HBOT) in CO-poisoned patients with DNS.
Background: Delayed neuropsychiatric syndrome (DNS) is characterized by motor dysfunction after acute carbon monoxide (CO) poisoning. We examined the relationship between dopamine transporter (DAT) loss using kit-based Tc-99m-TRODAT-1 (DAT single-photon emission-computed tomography (SPECT) radioligand) and globus pallidus necrosis on MRI, DAT availability before and after hyperbaric oxygen therapy (HBOT), and feasibility of Tc-99m-TRODAT-1 as an index for parkinsonian syndrome in CO poisoning. Methods: Twenty-one CO-intoxicated patients (mean +/- SD age, 38.6 +/- 11.4; range, 20-68 years) with DNS underwent Tc-99m-TRODAT-1 SPECT and MRI before HBOT and follow-up Tc-99m-TRODAT-1 SPECT to assess DAT recovery. Neurological examinations for Parkinsonism were performed after development of DNS. Results: Over 70% (15/21) of DNS patients showed globus pallidus necrosis on MRI. Significantly lower bilateral striatal DAT availability was associated with globus pallidus necrosis (p < 0.005). Moreover, 68.4% (13/19) of DNS subjects with Parkinsonian syndrome had lower bilateral striatal DAT availability vs. non-parkinsonian subjects pre- or post-HBOT. The SURs for both striata increased by similar to 11% post-HBOT in the Parkinsonian group; however, the left striatum presented a significantly higher DAT recovery rate than the right (*** p < 0.005). Conclusions: Coupled Tc-99m TRODAT-1 SPECT and MRI could assist evaluation of Parkinsonism risk and indicate DAT availability after HBOT in CO-poisoned patients with DNS.
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