The Assessment of Subregions in the Frontal Lobe May Be Feasible in the Differential Diagnosis of Progressive Supranuclear Palsy-Parkinsonism Predominant (PSP-P) and Multiple System Atrophy (MSA)

Piotr Alster; Natalia Madetko-Alster; Bartosz Migda; Michał Nieciecki; Dariusz Koziorowski; Leszek Królicki

doi:10.3390/diagnostics12102421

The Assessment of Subregions in the Frontal Lobe May Be Feasible in the Differential Diagnosis of Progressive Supranuclear Palsy-Parkinsonism Predominant (PSP-P) and Multiple System Atrophy (MSA)

Diagnostics (Basel). 2022 Oct 7;12(10):2421. doi: 10.3390/diagnostics12102421.

Authors

Piotr Alster¹, Natalia Madetko-Alster¹, Bartosz Migda², Michał Nieciecki³, Dariusz Koziorowski¹, Leszek Królicki⁴

Affiliations

¹ Department of Neurology, Medical University of Warsaw, 03-242 Warsaw, Poland.
² Diagnostic Ultrasound Lab, Department of Pediatric Radiology, Medical Faculty, Medical University of Warsaw, 03-242 Warsaw, Poland.
³ Department of Nuclear Medicine, Children's Memorial Health Institute, 04-736 Warsaw, Poland.
⁴ Department of Nuclear Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland.

Abstract

Progressive Supranuclear Palsy-Parkinsonism Predominant (PSP-P) is associated with moderate responsiveness to levodopa treatment and a possible lack of typical PSP milestones. The clinical manifestation of PSP-P poses difficulties in neurological examination. In the early stages it is often misdiagnosed as Parkinson's Disease, and in the more advanced stages PSP-P shows more symptoms in common with Multiple System Atrophy-Parkinsonian type (MSA-P). The small number of tools enabling differential diagnosis of PSP-P and MSA leads to the necessity of searching for parameters facilitating in vivo diagnosis. In this study, 14 patients with PSP-P and 21 patients with MSA-P were evaluated using Single Photon Emission Computed Tomography. Considering the fact that PSP is linked with frontal deficits, regions of the frontal lobe were assessed in the context of hypoperfusion and their possible usefulness in the differential diagnosis with MSA-P. The outcome of the work revealed that the right middle frontal gyrus was the region most significantly affected in PSP-P.

Keywords: PSP; SPECT; frontal perfusion; progressive supranuclear palsy.

Grants and funding

Funding for this work was provided by internal funds from the Department of Neurology and the Department of Nuclear Medicine. No additional funds were used in the study.