Abstract Details

Title Peripheral Synucleinopathy in Patients Diagnosed with Drug-induced Parkinsonism with Normal Dopamine Transporter Imaging

Topic Movement Disorders

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-018

Background

DIP is the second most common cause of parkinsonism after Parkinson's disease (PD). DIP and PD can coexist in the elderly. Dopamine transporter (DAT) imaging is used to differentiate between DIP and PD, being normal in DIP and abnormal in PD. We describe results of cutaneous P-SYN biopsy in elderly patients diagnosed with DIP.

Objective

To describe results of skin biopsy for phosphorylated alpha synuclein (P-SYN biopsy) in patients with drug-induced parkinsonism (DIP).

Design/Methods

We retrospectively reviewed records from the Movement Disorders Center of Arizona from 2012-2023 for patients with DIP who underwent P-SYN skin biopsy because of concern for possible overlapping PD.

Results

We identified 16 patients with DIP with P-SYN biopsy; 11/16 were females. Average age at time of biopsy was 68.5±9.2 yrs (range=57-81). Causative drugs included aripiprazole (6), olanzapine (2), amiodarone (2), valproate (1), ziprasidone (1), risperidone (1), or combination of drugs (4). DAT scans were performed in 14/16(88%): 10/14(71%) were normal and 4/14(29%) were abnormal. Of the 10 with normal DAT scans, 6/10(60%) were P-SYN(+). Of the 4 with abnormal DAT scans, 3/4(75%) were P-SYN(+). Of the 16 DIP patients, 8/16(50%) were P-SYN(+): 7/8(88%) had P-SYN only in the neck, 1/8(12%) had P-SYN only in the distal leg. 7/8 (88%) had reduced intraepidermal nerve fiber density (IENFD) in the distal thigh and distal leg, and 1/9(12%) had reduced IENFD in the distal leg only. RBD was present in 3/16(19%) of DIP patient. 3/4 DAT(+) patients were tried on levodopa: 2/3(67%) were levodopa-responsive. 7/10(70%) of DAT(-) patients were tried on levodopa: 5/7(71%) were levodopa-responsive. 5/8 P-SYN(+) patients were tried on levodopa: 3/5(60%) were levodopa-responsive.

Conclusions

Skin biopsy for P-SYN may be more sensitive than DAT scan in identifying DIP patients who may be at risk for developing PD or some other synucleinopathy.

Authors/Disclosures
Virgilio Gerald H. Evidente, MD, FAAN (Movement Disorders Center of Arizona) PRESENTER	Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Revance. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Evidente has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Teva. Dr. Evidente has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Ipsen. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neurocrine. The institution of Dr. Evidente has received research support from Neuraly. The institution of Dr. Evidente has received research support from CND. The institution of Dr. Evidente has received research support from Aptinyx. The institution of Dr. Evidente has received research support from Aeon. The institution of Dr. Evidente has received research support from Bukwang Pharmaceuticals. The institution of Dr. Evidente has received research support from Jazz Pharmaceuticals. The institution of Dr. Evidente has received research support from Scion Neurostim. The institution of Dr. Evidente has received research support from Theravance Biopharma. Dr. Evidente has received research support from Cerevance. Dr. Evidente has received research support from Ipsen.
Roy L. Freeman, MD (Beth Israel Deaconess Hosp)	Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Regenacy. Dr. Freeman has received personal compensation in the range of $100,000-$499,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurobo. Dr. Freeman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vertex. Dr. Freeman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli-Lilly. Dr. Freeman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Theravance. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Inhibikase. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Freeman has stock in Neurobo. Dr. Freeman has stock in Cutaneous NeuroDiagnostics. The institution of Dr. Freeman has received research support from NIH. The institution of Dr. Freeman has received research support from Theravance. The institution of Dr. Freeman has received research support from Biohaven. The institution of Dr. Freeman has received research support from Lundbeck.
Todd D. Levine, MD (Honor Health)	Dr. Levine has received personal compensation for serving as an employee of CND life sciences . Dr. Levine has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Nufactor. Dr. Levine has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Grifols. Dr. Levine has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for PNA. Dr. Levine has stock in CND Life Sciences. Dr. Levine has stock in Corinthian reference lab.
Danica Evidente	No disclosure on file
Julia Phillips (Movement Disorders Center of Arizona)	No disclosure on file
Christopher H. Gibbons, MD, FAAN (Beth Israel Deaconess Medical Center)	Dr. Gibbons has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Autonomic Neuroscience. Dr. Gibbons has stock in CND Life Sciences. Dr. Gibbons has received publishing royalties from a publication relating to health care. Dr. Gibbons has received personal compensation in the range of $5,000-$9,999 for serving as a Expert Advisor with Department of Justice.