A SCINTIGRAPHICAL QUALITATIVE-ANALYSIS OF PERIPHERAL VASCULAR SYMPATHETIC FUNCTION WITH META-[I-123]IODOBENZYLGUANIDINE IN NEUROLOGICAL PATIENTS WITH AUTONOMIC FAILURE

In order to assess qualitatively the sympathetic functions of the peri pheral vessels, we performed a scintigraphical study of the entire bod y with meta-[I-123]iodobenzylguanidine (MIBG) in 13 patients with auto nomic failure and 11 healthy subjects as control. The patients compris ed seven with multiple system atrophy (MSA), two with pure autonomic f ailure (PAF), three with Parkinson's disease with autonomic failure (P D with AF) and one with familial amyloid polyneuropathy (FAP). No clin ical evidence of vascular disease was noted in any of the patients and the control subjects. We investigated their autonomic functions using the head up tilt test as well as norepinephrine and isoproterenol inf usion tests. We found that: (i) All of the control subjects showed sat isfactory MIBG uptake; (ii) all of the patients with PAF and FAP, most of whom had postganglionic sympathetic lesions, showed supersensitivi ty and low MIBG uptake; (iii) almost all the patients with MSA, who we re considered to have mainly preganglionic sympathetic lesions, showed supersensitivity and diminished MIBG uptake, although the patients wi th olivopontocerebellar atrophy showed supersensitivity but not dimini shed MIBG uptake. In conclusion, these results suggest that peripheral vascular scintigraphy using MIBG is useful in detecting peripheral ad renergic dysfunction.