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This chapter reviews the usefulness of Meta-iodobenzylguanidine (123I-MIBG) in neurology-specific sleep disorders with a particular focus on rapid eye movement (REM) sleep behavior disorder (RBD). Several studies demonstrated the diagnostic reliability of reduced cardiac 123I-MIBG uptake in Parkinson's disease (PD) patients. In general, 123I-MIBG scintigraphy is regarded as an assessment of autonomic function. Autonomic dysfunction is common in α-synucleinopathies, and particularly marked in multiple system atrophy (MSA). Most patients with idiopathic RBD (iRBD) have reduced 123I-MIBG uptake, and an abnormal 123I-MIBG finding supports the diagnosis of RBD. Although an abnormal 123I-MIBG finding cannot predict the development of α-synucleinopathies among iRBD patients, the existence of RBD might be predictive of developing PD with dementia (PDD) in patients with PD. In the near future, 123I-MIBG findings might help predict the development of PDD among PD patients affected with RBD.
The neuroimaging studies have provided new information about brain abnormalities in narcolepsy patients. Differences in brain morphology that are not identifiable by routine visual inspection of individual brain magnetic resonance imaging (MRI) can be investigated using voxel-based morphometry (VBM). The VBM method has some limitations in representing gray matter morphology, and localization in the sulcal regions where the fine details of the anatomy are often obscured by a partial volume effect. On the other hand, the thickness of the cerebral cortex reflects the density and arrangement of cells. Measuring cortical thickness using the cortical surface method has been suggested in studies of gray matter morphometry as a strategy for overcoming the limitation of volumetric analyses. Higher tesla MRI scanners and further development of analysis software of brain MR images are able to better characterize the structural changes in narcoleptic brains.
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