Journal of Movement Disorders

Original Articles

Clinical Significance of Thyroid ¹²³I- Meta-Iodobenzylguanidine Uptake in Parkinson’s Disease: Sang-Won Yoo, Dong-Woo Ryu, Yoonsang Oh, Seunggyun Ha, Joong-Seok Kim; Received February 13, 2026 Accepted May 4, 2026 Published online May 5, 2026; DOI: https://doi.org/10.14802/jmd.26046 [Epub ahead of print]

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Abstract PDF: Objective
The thyroid gland receives sympathetic innervation. ¹²³I-meta-iodobenzylguanidine (¹²³I-MIBG) is a noradrenaline analog taken up by adrenergic nerve terminals. Although thyroid uptake can be detected on ¹²³I-MIBG scintigraphy, its quantitative value is poorly understood. This study examined the clinical relevance of thyroid ¹²³I-MIBG uptake in Parkinson’s disease (PD).
Methods
A total of 233 de novo patients were enrolled in a longitudinal cohort and underwent ¹²³I-MIBG scintigraphy. Early and late heart-to-mediastinum ratios (HMRs) and early thyroid-to-mediastinum ratios (TMRs) were calculated. Baseline TMRs were estimated using a mixed model after verifying the empirical linear decline over time. Observed and model-implied uptake ratios were analyzed in relation to adrenergic blood pressure (BP) control, motor and nonmotor burdens, and quality of life (QoL). Baseline thyroid uptake was further assessed for its influence on longitudinal disease progression.
Results
Patients were assessed for early PD (mean age, 68.7±8.7 years; median disease duration, 1.0 years). The mean follow-up was 57.3±22.1 months. A lower baseline HMR correlated with greater changes in orthostatic BP, greater autonomic symptom burden, and worse motor and nonmotor functions and QoL. Overall, the TMR was not significantly correlated; however, it was associated with a greater occurrence of supine hypertension, orthostatic hypotension, and nondipper or nocturnal hypertension. Thyroid uptake did not influence longitudinal changes in motor, nonmotor, cognitive, or QoL measures, although higher uptake tended to be associated with slower cognitive decline and better QoL.
Conclusion
Thyroid ¹²³I-MIBG uptake did not predict disease progression but may indicate early blood pressure dysregulation and could reflect nonmotor vulnerability in PD patients.

Longitudinal Implications of the BDNF rs6265 Polymorphism for Motor and Nonmotor Features of Parkinson’s Disease in the Korean Population: Sang-Won Yoo, Yun Joong Kim, Dong-Woo Ryu, Yoonsang Oh, Seunggyun Ha, Joong-Seok Kim; J Mov Disord. 2026;19(2):167-177. Published online January 20, 2026; DOI: https://doi.org/10.14802/jmd.25300

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Objective
Brain-derived neurotrophic factor (BDNF) has been suggested to support the endurance and dopamine release of dopaminergic neurons. Its Val66Met polymorphism might modify Parkinson’s disease (PD) evolution, although evidence in Asian populations remains limited. This study aimed to explore how the BDNF rs6265 genotype is associated with the clinical characteristics and longitudinal progression patterns of PD patients in a Korean population.
Methods
A total of 247 patients were enrolled and followed for a mean duration of 50.9±23.9 months. Baseline and/or periodic assessments captured motor severity, nonmotor burden, cognition, orthostatic stress, cardiac denervation, and presynaptic dopamine transporter availability. The repeated measures were manipulated to infer any genotypic differences in the trajectories of each clinical domain.
Results
The genotype frequencies were 31.2% (77/247) for Val/Val carriers and 68.8% (170/247) for Met-allele carriers. Baseline clinical characteristics and presynaptic dopamine transporter availability were comparable between genotypes. Initially, Val homozygotes showed more preserved myocardial innervation and poorer nonfrontal cognitive performance. Longitudinal analyses demonstrated genotype-specific increases in motor and cognitive severity. Compared with Met-allele carriers, the homozygous Val group exhibited accelerated motor progression and a more rapid decline in the frontal domain after 3 years of follow-up.
Conclusion
The differences in myocardial denervation at diagnosis, cognitive profiles, and motor progression might suggest a potential modulatory role of BDNF polymorphisms in PD progression in the Korean population.

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Commentary for “Longitudinal Implications of the BDNF rs6265 Polymorphism for Motor and Nonmotor Features of Parkinson’s Disease in the Korean Population”
Sun Ju Chung
Journal of Movement Disorders.2026; 19(2): 242. CrossRef

Review Article

Cardiac ¹²³I-Meta-Iodobenzylguanidine Imaging as a Biomarker for Body-First Parkinson’s Disease: Linking Peripheral α-Synuclein to Clinical Subtyping: Dong-Woo Ryu, Sang-Won Yoo, Yoonsang Oh, Joong-Seok Kim; J Mov Disord. 2026;19(1):1-10. Published online August 4, 2025; DOI: https://doi.org/10.14802/jmd.25137

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Abstract PDF

Recent neuropathological and imaging studies support the concept of “brain-first vs. body-first” Parkinson’s disease (PD), which is based on the α-synuclein origin site and connectome model. The body-first phenotype is characterized by early involvement of the peripheral autonomic nervous system, particularly the cardiac sympathetic nerves and enteric nerves. ¹²³I-meta-iodobenzylguanidine (¹²³I-MIBG) myocardial scintigraphy is a well-established method for evaluating cardiac sympathetic innervation. This review explores the potential of ¹²³I-MIBG scintigraphy as a biomarker to differentiate the body-first phenotype from the brain-first phenotype. Reduced ¹²³I-MIBG uptake has been observed in idiopathic rapid eye movement (REM) sleep behavior disorder, pure autonomic failure, and incidental Lewy body disease—conditions strongly associated with prodromal or early-stage PD. Postmortem and biopsy evidence indicates α-synuclein accumulation in cardiac nerves and other peripheral sites, which is consistent with bottom-up progression. α-Synuclein seed amplification assays further corroborate the association between the peripheral α-synuclein burden and reduced ¹²³I-MIBG uptake. While ¹²³I-MIBG myocardial scintigraphy is a promising tool, its limitations include cost, limited availability, and potential confounding from underlying cardiac conditions. Nonetheless, early detection of cardiac sympathetic denervation via ¹²³I-MIBG imaging may enhance diagnosis, support subtype classification, and improve the understanding of PD pathogenesis.

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Letter to the editor: B-type natriuretic peptide in Parkinson's disease: a novel biomarker of dysautonomia
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Parkinsonism & Related Disorders.2026; 142: 108123. CrossRef
Human and Mouse Alpha-Synuclein Fibrillation: Impact on h-FTAA Binding and Advancing Strain-Specific Biomarkers in PD Animal Models
Priyanka Swaminathan, Vasileios Theologidis, Hjalte Gram, Debdeep Chatterjee, Per Hammarström, Nathalie Van Den Berge, Mikael Lindgren
International Journal of Molecular Sciences.2026; 27(9): 3807. CrossRef

Letter to the editor

Task-Specific Dystonia in a Professional Billiard Player: Hyukje Lee, Sang-Won Yoo, Joong-Seok Kim; J Mov Disord. 2022;15(1):86-88. Published online September 8, 2021; DOI: https://doi.org/10.14802/jmd.21055

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Erratum

The Impact of Impulsivity on Quality of Life in Early Drug-Naïve Parkinson’s Disease Patients: Dong-Woo Ryu, Joong-Seok Kim, Sang-Won Yoo, Yoon-Sang Oh, Kwang-Soo Lee; J Mov Disord. 2021;14(2):176-176. Published online May 26, 2021; DOI: https://doi.org/10.14802/jmd.19004.e; Corrects: J Mov Disord 2019;12(3):172

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Letters to the editor

Asymmetric Periodic Leg Movements during Sleep after Unilateral Supratentorial Infarction: Two Legs with One Lesion: Sang-Won Yoo, Ko Eun Choi, Joong-Seok Kim; J Mov Disord. 2020;13(3):232-234. Published online June 3, 2020; DOI: https://doi.org/10.14802/jmd.20004

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Unilateral Pseudo-Orthostatic Tremor Provoked by a Remote Limb Movement in Parkinson’s Disease: Sang-Won Yoo, Youngje Heo, Joong-Seok Kim, Kwang-Soo Lee; J Mov Disord. 2020;13(1):69-71. Published online November 8, 2019; DOI: https://doi.org/10.14802/jmd.19056

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Three hertz orthostatic tremor as "red flag sign" candidate for multiple system atrophy
Yuzhou Wang, Churong Liu, Wenhua Zheng, Mengyun Li, Xiaodi Li
Neurological Sciences.2025; 46(3): 1217. CrossRef
Orthostatic Tremor
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Original Article

The Impact of Impulsivity on Quality of Life in Early Drug-Naïve Parkinson’s Disease Patients: Dong-Woo Ryu, Joong-Seok Kim, Sang-Won Yoo, Yoon-Sang Oh, Kwang-Soo Lee; J Mov Disord. 2019;12(3):172-176. Published online August 9, 2019; DOI: https://doi.org/10.14802/jmd.19004; Correction in: J Mov Disord 2021;14(2):176

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Abstract PDF

Objective
Impulse control disorders (ICDs) in Parkinson’s disease (PD) are mostly related to dopamine replacement therapy (DRT); however, drug-naïve PD patients have also frequently experienced impulsivity. This phenomenon makes clinicians hesitate treating patients with DRT. In this study, we assessed the effect of impulsivity on quality of life (QOL) in drug-naïve PD patients.
Methods
Two hundred three newly diagnosed, nonmedicated PD patients were enrolled, and they received structured clinical interviews, physical examinations and validated questionnaires to evaluate motor and nonmotor symptoms and QOL. Impulsivity was evaluated using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease-Rating Scale (QUIP-RS).
Results
Thirty-eight patients (18.7%) had impulsivity with QUIP-RS scores ≥ 1 and 4 patients (2.0%) were diagnosed with combined ICDs. Motor and nonmotor symptoms were significantly correlated with the Parkinson’s Disease Questionnaire-39 summary index. Female sex and QUIP-RS scores were also correlated with QOL in drug-naïve PD patients.
Conclusion
The results of the present study showed that impulsivity negatively influences QOL in early drug-naïve PD patients. In addition, more severe motor and nonmotor symptoms were also associated with lower QOL. Such findings complicate treatment but provide valuable information for managing early PD.

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Reflexive eye movement alterations are related to subclinical impulsive-compulsive behaviors in Parkinson’s disease
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Is GBA1 mutation status a game-changer for impulse control behaviour in Parkinson's disease?
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Frequency of Impulsive-Compulsive Behavior and Associated Psychological Factors in Parkinson’s Disease: Lack of Control or Too Much of It?
Alexandros Kapsomenakis, Dimitrios Kasselimis, Emily Vaniotis, Anastasia Bougea, Christos Koros, Athina Maria Simitsi, Leonidas Stefanis, Constantin Potagas
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Weibing Liu, Tatsuya Yamamoto, Yoshitaka Yamanaka, Masato Asahina, Tomoyuki Uchiyama, Shigeki Hirano, Keisuke Shimizu, Yoshinori Higuchi, Satoshi Kuwabara
Frontiers in Neurology.2021;[Epub] CrossRef
Dopamine genetic risk score predicts impulse control behaviors in Parkinson’s disease
Alison Hall, Samuel R. Weaver, Lindsey J. Compton, Winston D. Byblow, Ned Jenkinson, Hayley J. MacDonald
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A Review of the Concept of Impulsivity
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Letter to the editor

Transient Hypersomnolence Provoked by Metoclopramide in a Patient with Degenerative Parkinsonism: Sang-Won Yoo, Ko Eun Choi, Joong-Seok Kim; J Mov Disord. 2019;12(1):60-62. Published online January 15, 2019; DOI: https://doi.org/10.14802/jmd.18042

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