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Generic Name: ioflupane I-123 (EYE oh FLOO payne)
Brand Names:DaTscan
Brand Names:DaTscan
Magnetic Resonance (MR) spectroscopy is a noninvasive diagnostic test for measuring biochemical changes in the brain, especially the presence of tumors. While magnetic resonance imaging (MRI) identifies the anatomical location of a tumor, MR spectroscopy compares the chemical composition of normal brain tissue with abnormal tumor tissue. Neuroimaging or brain imaging is the use of various techniques to either directly or indirectly image the structure, function, or pharmacology of the nervous system.It is a relatively new discipline within medicine, neuroscience, and psychology. Physicians who specialize in the performance and interpretation of neuroimaging in the clinical setting are neuroradiologists.
Medically reviewed by Philip Thornton, DipPharm Last updated on Feb 4, 2020.
- Overview
What is DaTscan?
DaTscan (ioflupane I-123) belongs to a group of drugs called diagnostic radiopharmaceuticals. Ioflupane I-123 is a radioactive agent that allows images of the brain to be detected by a gamma camera.
DaTscan is used to detect brain signs of Parkinson's disease in people with symptoms such as tremors, loss of balance or coordination, shuffling walk, or other movement problems.
DaTscan may also be used for purposes not listed in this medication guide.
Important Information
Before using DaTscan tell your doctor about all your medical conditions or allergies, all medicines you use, and if you are pregnant or breastfeeding.
Before taking this medicine
You should not receive DaTscan if you are allergic to ioflupane I-123. Tell your doctor if you have ever had any type of reaction to another contrast agent, or to iodine.
To make sure DaTscan is safe for you, tell your doctor if you have ever had:
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- kidney disease;
- liver disease; or
- if you have ever had an allergic reaction to potassium iodide or Lugol's Solution.
Older adults may need kidney function tests before receiving DaTscan. Your kidney function may also need to be watched closely after you have received this medicine.
It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant.
You should not breastfeed within 6 days after using ioflupane I-123. If you use a breast pump during this time, throw out any milk you collect. Do not feed it to your baby.
How is DaTscan given?
DaTscan is given as an infusion into a vein. A healthcare provider will give you this injection about 3 to 6 hours before your radiologic test.
At least 1 hour before you are treated with DaTscan, you will be given a liquid drink that contains medicine to protect your thyroid from harmful radioactive effects of ioflupane I-123.
Drink plenty of liquid before you receive DaTscan, and for at least 48 hours afterward. Follow your doctor's instructions about the types and amount of liquids you should drink before and after your test. Ioflupane I-123 is radioactive and it can cause dangerous effects on your bladder if it is not properly eliminated from your body through urination.
![Brain Brain](http://news.bbcimg.co.uk/media/images/78440000/jpg/_78440848_0502c146-2493-4986-b60a-94d82ffac3a4.jpg)
Expect to urinate often during the first 48 hours after your test. You will know you are getting enough extra fluid if you are urinating more than usual during this time. Urinating often will help rid your body of the radioactive iodine.
DaTscan dosing information
Usual Adult Dose for Computed Tomography:
111 to 185 MBq (3 to 5 mCi) intravenously after administration of thyroid blocking agent
Thyroid Blocking Agent:
-Administer Potassium Iodide Oral Solution or Lugol's Solution (equivalent to 100 mg iodide) or potassium perchlorate (400 mg) to block uptake of iodine 123 by the patient's thyroid at least 1 hour before using this drug.
Comments:
-Begin single photon emission computed tomography (SPECT) imaging 3 to 6 hours following administration of this drug.
-Dosing is based upon the radioactivity determined using a suitably calibrated instrument immediately prior to administration.
Uses:
-Visualization of striatal dopamine transporter using SPECT brain imaging to assist in the evaluation of adult patients with suspected Parkinsonian syndromes (PS).
-To help differentiate essential tremor from tremor due to PS (idiopathic Parkinson's disease, multiple system atrophy and progressive supranuclear palsy).
-As an adjunct to other diagnostic evaluations.
Thyroid Blocking Agent:
-Administer Potassium Iodide Oral Solution or Lugol's Solution (equivalent to 100 mg iodide) or potassium perchlorate (400 mg) to block uptake of iodine 123 by the patient's thyroid at least 1 hour before using this drug.
Comments:
-Begin single photon emission computed tomography (SPECT) imaging 3 to 6 hours following administration of this drug.
-Dosing is based upon the radioactivity determined using a suitably calibrated instrument immediately prior to administration.
Uses:
-Visualization of striatal dopamine transporter using SPECT brain imaging to assist in the evaluation of adult patients with suspected Parkinsonian syndromes (PS).
-To help differentiate essential tremor from tremor due to PS (idiopathic Parkinson's disease, multiple system atrophy and progressive supranuclear palsy).
-As an adjunct to other diagnostic evaluations.
See also:
DaTscan dosage information (in more detail)
What happens if I miss a dose?
Since DaTscan is used only given once before your radiologic test, it does not have a daily dosing schedule.
Call your doctor if you will not be able to complete your radiologic test within 3 to 6 hours after you receive your injection.
What happens if I overdose?
Since this medicine is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.
What should I avoid after receiving DaTscan?
Do not allow yourself to become dehydrated during the first few days after receiving DaTscan. Follow your doctor's instructions about the type and amount of liquids you should drink.
DaTscan side effects
Get emergency medical help if you have any of these signs of an allergic reaction to DaTscan: hives, itching, skin redness; difficult breathing; swelling of your face, lips, tongue, or throat.
Common DaTscan side effects may include:
- pain, swelling, burning, or irritation around the IV needle;
- headache;
- dizziness, spinning sensation;
- dry mouth; or
- nausea.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect DaTscan?
Tell your doctor about all your other medicines, especially:
- buspirone;
- a diet pill or stimulant medicine;
- ADHD medications--amoxapine, amphetamine, methamphetamine, methylphenidate, Adderall, Ritalin, and others; Mage and minions apk.
- an antidepressant--bupropion, citalopram, paroxetine, sertraline; or
- medicine to treat Parkinson's disease--benztropine, selegiline.
This list is not complete. Other drugs may interact with ioflupane I-123, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
See also:
DaTscan drug interactions (in more detail)
Further information
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use DaTscan only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Copyright 1996-2020 Cerner Multum, Inc. Version: 3.01.
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The human brain is made up of two types of tissue: gray matter, which is composed of nerve cells, and white matter, which is composed of bundles of nerve fibers that connect nerve cells in different areas of the brain and carry nerve impulses between them.
“The traditional way of thinking is that MS is primarily a white matter disease,” says Lael Stone, MD, formerly a neurologist specializing in multiple sclerosis (MS) at the Cleveland Clinic in Ohio.
But “most [experts] in MS at this point would say that there is clearly involvement of both white and gray matter,” says Dr. Stone. Still, “you could put 10 MS specialists in a room, and they would have a hard time agreeing on which is more important and which comes first.”
White Matter Consists Mainly of Nerve Fibers
![Scan Scan](http://www.extremetech.com/wp-content/uploads/2014/05/dot-optical-brain-scan-640x471.jpg)
White matter appears white because the protective wrapping around nerve fibers, or axons, is a pale, fatty tissue called myelin.
“Axons are like the electric wires of the brain,' says Rhonda Voskuhl, MD, professor of neurology at the UCLA Brain Research Institute and director of the UCLA Multiple Sclerosis Program in Los Angeles.
In MS, the immune system attacks the myelin in the brain, spinal cord, and optic nerves. The attack causes inflammation that eventually leads to sclerosis, which is the medical term for scarring. (That’s how MS got its name.)
'When MS attacks these parts of the brain, it's like stripping the rubber off the wires. That slows down conduction speed and causes the types of MS symptoms that come and go,” says Dr. Voskuhl. “An attack may last for weeks or months, but then the inflammation cools off, and the area recovers completely or partially.”
Gray Matter Is Made of Nerve Cell Bodies, or Neurons
Gray matter, made up of the cells of the central nervous system called neurons, is thickly located in the outer areas of the brain, called the cortex. If you look at the outside of the brain, it looks gray.
“The white matter carries messages from point A to point B,' Stone says. 'The gray matter is point A and point B.'
As MS progresses, changes occur in the gray matter that are different from those occurring in the white matter.
“If you cut off the connections between nerve cells, they eventually die,' Voskuhl explains. 'This causes a shrinking of brain tissue, called gray matter atrophy. MS causes inflammation in white matter and atrophy in gray matter. You can measure atrophy by actual loss of brain volume.'
But demyelination and lesions can also happen in gray matter, even if this isn’t visible using conventional magnetic resonance imaging (MRI) scans, according to Léorah Freeman, MD, PhD, a neurologist and assistant professor at Dell Medical School at the University of Texas at Austin.
In fact, Dr. Freeman says, “We know from postmortem studies that in the most severe cases, up to 70 percent of the gray matter can be demyelinated” in people with MS.
Newer Types of MRI and PET Scans Reveal Disease Progression in the MS Brain
Researchers and doctors who treat MS commonly use MRI scans to study the brain. MRI is imaging created with computers and radio wave energy. New types of MRI provide more detail, making it easier to see gray matter.
Magnetic resonance spectroscopy shows areas of the brain where proteins found only inside neurons are located.
Functional MRI (fMRI) makes images of the brain while a person is doing a specific task, like reading. When fewer areas light up during this test, it may be a sign of gray matter atrophy.
Gray matter damage has been shown to play an important role in MS disease progression, according to a study study published in July 2013 in the journal Annals of Neurology that followed more than 400 people with relapsing-remitting MS.
Using a model that included a patient’s age, gray matter lesions, and gray matter atrophy, researchers were able to correctly predict MS progression in about 94 percent of participants who maintained relapsing-remitting MS status, and 88 percent of those who transitioned to the secondary-progressive stage.
Knowledge of how gray matter damage affects MS has lagged behind what’s known about white matter, due to the limitations of conventional imaging techniques.
“It’s easy to see white matter inflammation, because it lights up like a Christmas tree on MRI,” Stone says. “Gray matter atrophy is harder to see. Eventually, it shows up as an increase in the fluid-filled parts of the brain as the brain shrinks. But that can be confusing, because the truth is that everybody’s brain shrinks over time — with or without MS.”
Freeman notes that newer imaging techniques, like positron emission tomography (PET), can help identify gray matter changes that may not be visible on a conventional MRI.
In a small pilot study published in October 2015 in the journal Annals of Neurology, a research team led by Freeman found that PET scans could effectively map and reveal measurements of neuronal damage in the gray matter of people with various stages of MS.
Symptoms of Gray and White Matter Disease
“In general, white matter disease causes acute MS symptoms, like numbness and weakness,' Stone says. 'Gray matter disease causes progressive symptoms, like fatigue and memory loss. These higher brain functions are called cognitive functions. Most MS disability actually comes from cognitive dysfunction.'
Voskuhl provides another angle: “I think it makes sense to think of some white matter damage like inflammation as temporary, and some gray matter damage like neuron loss as permanent,” she says. “It’s important to know that cognitive changes in MS are not like in Alzheimer’s disease. They don’t affect a person’s intelligence, long-term memory, or their ability to read or carry on a conversation.”
It’s the cumulative damage to both gray and white matter that adds up to MS symptoms, Stone adds. The problem is that even with increasingly detailed imaging techniques, visible changes in the brain don’t correlate exactly with symptoms like fatigue or cognitive impairment.
“Part of the whole discussion is that we are missing something in MS, and we are constantly trying to figure out what it is we are missing,” says Stone.
Freeman is optimistic that advances in imaging will make it easier to pinpoint how communication between different areas of the brain contributes to a wide range of MS symptoms. “We’re trying to make more correlations between specific symptoms and specific locations of lesions or damage,” she notes.
Better Imaging May Lead to Better Drugs for MS
Gaining a better understanding of how MS operates in the brain is critical to developing the next generation of MS drugs, according to Voskuhl.
“We have drugs that can suppress the immune system, reduce MS attacks, and decrease white matter damage. But what we need now are drugs that prevent or reverse long-term disability of all types, including not only cognition but also walking, balance, and vision,' Voskuhl says. 'Research focused on gray matter protection may be the critical next step in this goal.'
Freeman notes that recent advances in imaging, and the better understanding of gray matter damage that they allow, are already affecting how trials of potential new MS drugs are conducted.
“Clinical trials are more consistently looking at the impact of the drug on brain atrophy” in different gray matter structures, Freeman says, “because those are meaningful end points” that the U.S. Food and Drug Administration (FDA) is interested in.
Aside from informing new drug development, advances in imaging may also prove useful to doctors in deciding what course of treatment is best for an individual patient, according to Freeman. Her lab is studying computing techniques to extract more meaningful information from conventional MRIs that are already part of the standard of MS care.
“Right now, the information we’re using from these MRIs to monitor therapy is [whether] patients develop new or active lesions within the white matter,” Freeman explains. “I think we could be using MRI in a different way, to maybe predict treatment response before we even start therapy.”
Artificial Intelligence Could Play a Role in MS Treatment Advances
This vision of MS imaging and treatment could involve using artificial intelligence (AI) technologies to look at the entire brain in MRI scans, and predict individual outcomes and responses to different MS drugs.
In this way, AI could help doctors know “what therapy we should initiate, or when it is time to switch, before patients fail their medication,” says Freeman, as part of a “move from a trial-and-error approach to therapy, and more into a personalized, precision-medicine approach to therapy.”
The best way to get there, the experts agree, is to keep developing and refining imaging techniques that advance our knowledge of the MS brain.
Additional reporting by Quinn Phillips.
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