Zur klinischen Wertigkeit der zerebralen Dopamin-D₂-Rezeptorszintigraphie

 

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Zusammenfassung

Die vorliegende Arbeit gibt eine Übersicht über Befunde und klinische Indikationen zur Dopamin-D₂-Rezeptorszintigraphie. Methoden zur Untersuchung der D₂-Rezeptoren sind die Positronen-Emissions-Tomographie (PET) mit ¹¹C- oder ¹⁸F-markierten Butyrophenonen oder Benza- miden oder die Einzelphotonen-Emissions-Tomographie (SPECT) mit ¹²³l-lodobenzamid (IBZM). Die wichtigste neurologische Indikation ist die Differentialdiagnose des Parkinsonismus: In frühen Stadien des Morbus Parkinson findet sich eine Erhöhung der Striatalen D₂-Rezeptorbin- dung (D₂-RB) im Vergleich zu gesunden Normalpersonen. Patienten mit einem Steele-Richardson-Olszewski-Syndrom oder einer Multisystem- atrophie hingegen, die therapeutisch schwierig einzustellen sind, zeigen eine Verringerung der striatalen D₂-RB. Das ebenfalls abzugrenzende medikamentös induzierte Parkinson-Syndrom beruht auf einer Blockade der D₂-Rezeptoren, die durch die Dopamin-D₂-Rezeptorszintigraphie nachgewiesen werden kann. Weitere mögliche Indikationen bestehen in der Psychiatrie: Bei schizophrenen Patienten, die mit Neuroleptika behandelt werden, ist die Bestimmung der »Receptor Occupancy« sinnvoll, um die optimale Medikamentendosis zu bestimmen. Außerdem ermöglicht die D₂-Rezeptorszintigraphie bei diesen Patienten die Differentialdiagnose zwischen dem malignen Neuroleptikasyndrom und der febrilen Katatonie. Bei Suchterkrankungen könnte die Methode möglicherweise zur Prädiktion und Verlaufskontrolle neurochemischer Veränderungen im Rahmen einer Entwöhnungsbehandlung genutzt werden. Bei der Depression schließlich kann die Bestimmung der D₂-RB die Wahl der Therapie für den Kliniker vereinfachen: Neue klinische Befunde deuten an, daß Patienten mit niedriger D₂-RB gut auf eine medikamentöse Therapie ansprechen, während bei Patienten mit hoher D₂-RB u.a. eine Schlafentzugsbehandlung aussichtsreich ist.

Summary

The present review describes findings and clinical indications for the dopamine D₂ receptor scintigraphy. Methods for the examination of D₂ receptors are positron emission tomography (PET) using ¹¹C- or ¹⁸F-labelled butyrophenones or benzamides or single photon emission tomography (SPECT) using ¹²³l-iodobenzamide (IBZM) respectively. The most important indication in neurology is the differential diagnosis of Parkinsonism: patients with early Parkinson’s disease show an increased D₂ receptor binding (D₂-RB) compared to control subjects. However, patients suffering from Steele-Richardson-Olszewski-Syndrome or Multiple System Atrophy show a decreased D₂-RB and are generally non-responsive to treatment. Postsynaptic blockade of D₂ receptors results in a drug induced Parkinsonian syndrome, which can be diagnosed by D₂ scintigraphy. Further possible indications occur in psychiatry: the assessment of receptor occupancy is useful in schizophrenic patients treated with neuroleptics. Additionally, D₂ receptor scintigraphy might help to clarify the differential diagnosis between neuroleptic malignant syndrome and lethal catatonia. The method might be useful for supervising neurobio- chemical changes in drug dependency and during withdrawal. Assessment of dopamine D₂ receptor binding can simplify the choice of therapy in depressive disorder: patients showing a low D₂ binding are likely to improve following an antidepressive drug treatment whereas sleep deprivation is promising in patients with high D₂ binding.

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