Cardiac MIBG scintigraphy in Primary Progressive Freezing Gait

Freezing of gait (FOG) generally occurs as a late manifestation of Parkinson's Disease (PD). FOG, however, can present in isolation, constituting the so-called “Primary Progressive Freezing Gait”(PPFG). Myocardial 123Metaiodiobenzylguanidine (MIBG) enables the assessment of postganglionic sympathetic cardiac nerve terminals. MIBG uptake reflects sympathetic system integrity, and reduced myocardial uptake of the tracer has been observed in nearly all patients with PD. We investigated MIBG uptake in 7 patients with PPFG, 14 patients with mild PD, and 6 patients with advanced PD and FOG (PD-FOG), and 18 control subjects. Our study shows that myocardial MIBG uptake was normal in all patients with PPFG (H/M ratio: mean ± SD, 1.85 ± 0.11 early; 1.71 ± 0.15 delayed) and in the controls (H/M ratio: mean ± SD, 1.94 ± 0.18 early; 2.02 ± 0.19 delayed) whereas it was markedly decreased in the patients with mild and advanced PD (H/M ratio: mean ± SD, PD: 1.17 ± 0.02 early; 1.16 ± 0.02 delayed; PD-FOG: 1.22 ± 0.10 early; 1.08 ± 0.06 delayed). Our findings demonstrate that cardiac sympathetic denervation did not occur in patients with PPFG, confirming that PPFG and PD are distinct diseases.