Jump to content


E-Newsletter Signup Like us on Facebook Sign Up For Our e-Newsletter
Photo

analyzing spect results


  • Please log in to reply
9 replies to this topic

#1 goldenboy

goldenboy

    Member

  • Members
  • PipPip
  • 14 posts

Posted 27 December 2011 - 06:51 PM

Hi

I've read here that analyzing spect results can be difficult. I am not sure why it is so since all the spect i've seen on the internet is very clear. One side has less uptake than the other regarding the shape.

Could it be difficult since the "uptake-shape" could more or less be the same, but the intensity in uptake could be different.

I did a spect two years ago and it came back normal. The neurologist would like to do antoher one, and i have a new appointment with him in a few days. For that reason i was looking through some papers and at my spect results. I did not notice it before, since the shapes was almost the same, but the uptake on my contralateral side of symptoms was much "weaker" than on the ipsilateral side. The ipsilateral show a very intense uptake, almost a bright white light, but on the other side much darker yellow light. There is a marked difference on all 16 pictures.

I was going to say no thanks to a new scan, since studies shows that swedds remains swedds and there is no point that more radioactive stuff than needed. But would above suggest that i did that a new one?

regards
gb.

#2 Dr. Okun

Dr. Okun

    Advanced Member

  • Ask the Doctor Moderators
  • PipPipPip
  • 4,553 posts
  • LocationUniversity of Florida

Posted 28 December 2011 - 10:02 AM

GB,

You are correct in that the analysis of SPECT scans can be tricky and requires some expertise.

The most important thing is to follow the clinical picture and changes in clinical course. The diagnosis of PD is still best made on clinical grounds.

If your doc and expert radiologist are not sure about the PET results and your symptoms continue to progress then a repeat SPECT scan could be useful; however the most useful thing is to treat the symptoms regardless of the scan.

Hope that helps.
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips

#3 goldenboy

goldenboy

    Member

  • Members
  • PipPip
  • 14 posts

Posted 29 December 2011 - 06:15 PM

Hi

I've had an appointment with a a new neurologist today since the one i have been using have retired. He said i did not look like a typical parkinson patient, probably due my lack of tremor, but he did a full exam.
After he told me i probably had early parkinsons. (I belive it was signs like: marked cogwheel rigidity on my right side, akenisia, reduced arm swing).
He also studied my DatScan from two years ago and told me they looked normal but could also see a diffrense from left/right. Could mean nothing. He did not ask me to do anther scan.

I got some medicine to take. The medicine name are "eldepryl" and the working stuff is: selegiline. I was asked to take 10mg each morning.

a) Would the above medicine do any harm if i do not have parkinson.
B) I am using low dose with betablocker to help reduce heart arrythima. (Got some after a sucessful ablation some years ago). The arrythima is not dangerous. (VES and SVES sometimes coupled). I belive selegiline must be taken with caution if you have any heart issues. What is your recommendations to do when starting taking this medicine. Should i do it at a doctors office? My blood pressure is ok: 135/78
c) If the medicine show little or no effect could i then say i do not have parkinson? would this medicine reduce rigidity the first day if it is present due parkinson?

Regards
gb

#4 Dr. Okun

Dr. Okun

    Advanced Member

  • Ask the Doctor Moderators
  • PipPipPip
  • 4,553 posts
  • LocationUniversity of Florida

Posted 30 December 2011 - 08:08 AM

GB,

Selegiline 5mg in the morning and 5mg at noon is a typical schedule and it is usually well tolerated. It has a very mild symptomatic effect in PD and you may or may not notice a difference. Check with your cardiologist for safety regarding cardiac rhythms and selegiline.

Usually you need to have a UPDRS clinical exam off medicines for 12 hours and then start some sinemet and work up to a reasonable dose or at least 2-2.5 tabd per dose and get retested. The difference in UPDRS will be a better predictor of PD-- but remember parkinsonism can also have some response.

Hang in there and remember 20% of PD patients have no tremor.
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips

#5 goldenboy

goldenboy

    Member

  • Members
  • PipPip
  • 14 posts

Posted 02 January 2012 - 02:51 PM

Hi

Thank you for your answers.

(I forgot to mention that i am 36 years old, and the doctors have followed me for almost 4 years. very slow progression).

I have one more question.
I have been reading that there is something called rasagiline that could also be used as monotherpy at early stage. From what i have been reading rasagiline has less sideeffects. They also belive rasagiline could have the same effect like selegiline had in the DATATOP study.

My question is this:
If you could choose between selegiline and rasagiline (Price not to be evaluated) , wich one would you recommend?

Regards
gb

#6 Dr. Okun

Dr. Okun

    Advanced Member

  • Ask the Doctor Moderators
  • PipPipPip
  • 4,553 posts
  • LocationUniversity of Florida

Posted 03 January 2012 - 05:26 PM

Symptomatically they are probably the same.

Cost favors selegiline.

The once a day versus twice a day favors rasagiline.

The amphetamine metabolite in selegiline could be a plus or minus. Amphetamine could affect sleep in a negative way, but could also help attention.

They are both well tolerated and have never been compared head to head in a large study.

I am comfortable with both, and some people favor rasagiline for the study design in their recent report.
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips

#7 goldenboy

goldenboy

    Member

  • Members
  • PipPip
  • 14 posts

Posted 06 January 2012 - 01:48 PM

Thank for your help.

I find my self to be in a difficult situation.

I have produced a html-page i hope you could take a look at. I show my spect scan with different color toning.
If you could take a quick look and give me a short message back if these looks all normal to you. Click on imagw to view normal size.
I understand that you can not diagnose just by seeing this pictures of course.

These pictures show normal shapes, but less dopamine on left side vs. right side in all slices
I have been diagnosed with parkinsons as mentioned earlier.

Here is the link. (Could you please not publish this link on public forum?).


Have a nice day.

Regards
gb

Edited by goldenboy, 07 January 2012 - 11:10 AM.


#8 Dr. Okun

Dr. Okun

    Advanced Member

  • Ask the Doctor Moderators
  • PipPipPip
  • 4,553 posts
  • LocationUniversity of Florida

Posted 07 January 2012 - 10:36 AM

It is hard to be sure by looking and someone with experience needs to look at your scan versus the many scans done at your hospital and also look at the numbers associated with the scan. Having said that it doesn't look bad from the images you have shown and could very well be in the normal range. There are a group of patients with PD and dystonia symptoms and normal SPECT scans called SWEDDS. If you are unsure wait a year or two and repeat-- and see if it changes or worsens. Over time PD scans worsen.
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips

#9 goldenboy

goldenboy

    Member

  • Members
  • PipPip
  • 14 posts

Posted 14 February 2012 - 06:34 PM

Hi. again ..

I just ordered my result from my first scan at 2008. This was normal. Nucleus left/right the same. Putamen left/right aprox 7% diffrence (less on left side).
In 2010 i had a new scan, and this is the scan you looked at. This shows both nucleus and putamen left side reduced by 25-28%.

I was told in 2010 that this difference could be normal for me, but why did my scan in 2008 show up almost identical uptake on each side and not now?

I can do another scan. Would that be wise to do and see if there has been more changes?
(I have two neurologist saying i have PD and one saying i don't. Have not started selegiline yet as i do not know what to belive).

(Btw: I am thinking that this could just be the machine since it should be at least 60% reduction before symptom start)

regards
gb

#10 Dr. Okun

Dr. Okun

    Advanced Member

  • Ask the Doctor Moderators
  • PipPipPip
  • 4,553 posts
  • LocationUniversity of Florida

Posted 15 February 2012 - 07:18 AM

GB,

This is interesting. Unfortunately you have now exposed the gray-zone of SPECT interpretation. It is best to choose a great doctor with a lot of experience and to go by examination findings and response to medications and therapies. It is very hard to interpret these differences. The other thing you can do is see Ken Mark in New Haven as he is an expert on SPECT.
Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips




0 user(s) are reading this topic

0 members, 0 guests, 0 anonymous users