87IMPACT OF DATSCAN IN THE CLINICAL EVALUATION OF PATIENTS WITH DIAGNOSTICALLY UNCERTAIN PARKINSONISM

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Abstract

Introduction: Functional imaging of presynaptic dopamine transporter using DaTscan defines the integrity of the dopaminergic system in the niagrostriatum. It is considered to be a valuable diagnostic adjunct to supplement clinical findings in diagnosing clinically uncertain parkinsonian syndrome. We studied the role of DaTscan in the diagnosis and management of patients with clinically uncertain parkinsonism in our clinical practice.

Methods: We conducted a retrospective audit with case note review. Details of patients undergoing DaTscan over a period of 2 years (April 2009–11) were obtained from nuclear medicine department. We looked for indications of requesting DaTscan, any change in the diagnosis and management following DaTscan and complications related to it.

Results: Sixty-two patients had DaTscan over this period and majority were elderly male (63%). Main source of referral for DaTscan was neurology clinics (55, 88.7%). Only five (8%) were referred from elderly medicine. All but one patient presented with features of parkinsonism. Tremor was the predominant symptom (67.7%). Commonest indication for requesting DaTscan was to confirm or exclude a diagnosis of Parkinson's disease (47, 75.8%). DaTscan was inappropriately requested in 8% cases. DaTscan was abnormal in 37(60%) cases. Commonest pre-DaTscan diagnosis was Parkinson's disease (16, 25.8%), followed by essential tremor (12, 19.3%) and drug-induced parkinsonism (10, 16.1%). DaTscan confirmed the pre-DaTscan diagnosis in 37 (59.6%). There was a change in post-DaTscan diagnosis in 22 (35.4%) and the increase in the diagnosis of parkinsonian syndrome was by 12.9%. DaTscan led to a change in management in 39 cases (62.9%). No minor or major side-effects related to DaTscan were noted.

Conclusion: DaTscan proves to be an important objective tool in the clinical evaluation of diagnostically uncertain parkinsonism which could support a clinical diagnosis and rationalise the appropriate management. It seems to be an under-utilised tool in elderly medicine.

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