Relevance of Fluorodopa PET Scan in Dopamine Responsive Dystonia and Juvenile Parkinsonism: A Systematic Review

Round 1

Reviewer 1 Report

This systematic review article is comprehensive, logically organized, and contains valuable information on the relevance of fluorodopa positron emission tomography scan in dopamine-responsive dystonia and juvenile parkinsonism. The authors demonstrated that there is a clear pattern of decreased uptake in the putamen and caudate nucleus when using fluorodopa positron emission tomography scan in cases of juvenile parkinsonism, compared with dopamine-responsive dystonia where the uptake of this marker is slightly decreased but comparable to normal subjects. Therefore, the manuscript should be accepted in the Special Issue: Brain Health Initiative: Advocacy in Global Neurology in the journal, Neurology International.

Author Response

Dear reviewer, thank you for your feedback.

Have a great day!

Juan

Reviewer 2 Report

The authors of “Relevance of Fluorodopa PET scan in Dopamine Responsive Dystonia and Juvenile Parkinsonism. A Systematic Review.” perform a good and timely approach to review alternative diagnostic methods for certain genetic dystonia and Parkinson's disease. The focus was placed on the possibilities of diagnostic PET imaging. The abstract points on that issue truly clear and the good and clear structure stands out. 

The introduction shows the subtypes of Dopamine Responsive Dystonia with the help of a figure. Some aspects of the figure 1 are difficult to read because the letters are too small and the figures should point to scientific question and not being a reproduction of some metabolic pathways. The descriptions of the illustrations below the illustrations are well done. 

Because the PARK, PINK, and LRRK subtypes are quite rare, it would be very helpful to elaborate on the defects they contain. For the reader, the meaning of each letter would certainly be helpful.

Overall the review takes a clinically important approach, which compares genetic with diagnostic imaging techniques, the I recommend a revision. 

Author Response

Dear reviewer:

-A table was added to improve the comprehension of: 'PARK, PINK, and LRRK subtypes are quite rare, it would be very helpful to elaborate on the defects they contain'

-The use of the figure 1 with the metabolic pathway is to show where is the disruption of the pathway leading to each subtype of the Dopamine Responsive Dystonia, Nevertheless, it was added a sentence to remark its importance.

Thank you for the feedback and helpful corrections.

Have a great day!

Juan Moncayo, M.D., et al.

Reviewer 3 Report

The authors reported a systemic review on Fluorodopa PET scan in Dopamine Responsive Dystonia and Juvenile Parkinsonism. I have some comments to the authors.

 

-       The authors should stress in the introduction the reason why they focused their attention on the Fluorodopa PET scan, which is not really very common in the clinical practice. 

-       In the methods the authors should better state the exclusion criteria, in particular the authors should specify that adult-onset dystonia; atypical parkinsonism; and functional neurological disorders have been ruled out. Here some articles to be included in the manuscript:

Defazio G, et al. Diagnostic criteria for blepharospasm: A multicenter international study. Parkinsonism Relat Disord. 2021 Oct;91:109-114. doi: 10.1016/j.parkreldis.2021.09.004. Epub 2021 Sep 8. 

Fabbrini G, et al. Neuroimaging in idiopathic adult-onset focal dystonia. Neurol Sci. 2021 Jul;42(7):2947-2950. doi: 10.1007/s10072-020-05025-w. Epub 2021 Jan 3. PMID: 33389253.

Lidstone SC, et al. Functional movement disorder gender, age and phenotype study: a systematic review and individual patient meta-analysis of 4905 cases. J Neurol Neurosurg Psychiatry. 2022 Jun;93(6):609-616. doi: 10.1136/jnnp-2021-328462

McFarland NR. Diagnostic Approach to Atypical Parkinsonian Syndromes. Continuum (Minneap Minn). 2016

 

-       Results and discussion must be separate paragraph, this is a mandatory point. The results should better describe the findings from the study that the authors have selected. The Tables should be clearer as well. The discussion should comment the results and summarize the strength and weakness of the paper. A paragraph with the limitation of the study should be located at the end of the discussion. I really recommend improving this part. 

Author Response

Dear reviewer:

-A paragraph was added to address this concern: 'The authors should stress in the introduction the reason why they focused their attention on the Fluorodopa PET scan'

-As suggested the exclusion and inclusion criteria were updated for a better understanding to the reader.

-Yes, we agree that Results and Discussion should be separate and also we added a paragraph with the strengths, weakness and limitations of this study.

Thank you for the helpful reviews and comments, they improved the relevance of this study focused on global health disparities. 

Regards,

Juan Moncayo, M.D., et al.

Round 2

Reviewer 3 Report

The authors have improved the manuscript, however, I have some comments to the authors.

 

-       In the methods the authors have correctly expanded the exclusion criteria. Hoverer, in order to help the readers to better understand this methodological choice, it would be better if the authors include these references to the text, at the end of “Exclusion criteria included animal studies, atypical parkinsonism, adult-onset dystonia, and functional neurological disorders, as well as articles that did not fulfil the aim of our 163 study”: 

Defazio G, et al. Diagnostic criteria for blepharospasm: A multicenter international study. Parkinsonism Relat Disord. 2021 Oct;91:109-114. doi: 10.1016/j.parkreldis.2021.09.004. Epub 2021 Sep 8. 

Fabbrini G, et al. Neuroimaging in idiopathic adult-onset focal dystonia. Neurol Sci. 2021 Jul;42(7):2947-2950. doi: 10.1007/s10072-020-05025-w. Epub 2021 Jan 3. PMID: 33389253.

Lidstone SC, et al. Functional movement disorder gender, age and phenotype study: a systematic review and individual patient meta-analysis of 4905 cases. J Neurol Neurosurg Psychiatry. 2022 Jun;93(6):609-616. doi: 10.1136/jnnp-2021-328462

McFarland NR. Diagnostic Approach to Atypical Parkinsonian Syndromes. Continuum (Minneap Minn). 2016

 

-       Please strengthen the results describing the studies that you found. You have correctly included the PRISMA flow-chart, so I recommend following the PRIMSA Checklist for systemic review in order to build your results. This can guide the authors in the right direction.

Author Response

Dear reviewer,

I hope this revision finds you well. 

As suggested we included in the references the articles suggested, also restructured the results and discussion adding pertinent points as per PRISMA protocol to further more contribute to the reader.

Please let me know if any other correction is necessary.

Have a great day!

Sincerely,

Juan Moncayo, M.D.

Round 3

Reviewer 3 Report

The authors have addressed all the points. I have no further comments.