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Here, we report the importance of longitudinal evaluation of a patient with organophosphate\u2010induced toxic parkinsonism using dopamine transporter single\u2010photon emission computed tomography (DAT\u2010SPECT). This case may provide crucial insights into the pathophysiology of the syndrome and inform therapeutic decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>\n                      We report a case of organophosphate\u2010induced toxic parkinsonism with persistent parkinsonian symptoms evaluated longitudinally using DAT\u2010SPECT. A 68\u2010year\u2010old woman with a history of bipolar disorder was found collapsed at home on Day 0 with impaired consciousness, miosis, hypersalivation, and bradycardia. Organophosphate poisoning was diagnosed based on markedly reduced cholinesterase levels and the presence of an organophosphate pesticide in a shed at her home. Parkinsonian symptoms gradually emerged from Day 18, including hypophonia and a gait disturbance. On Day 60, DAT\u2010SPECT showed reduced radiotracer uptake in the bilateral striatum, more pronounced on the right. After toxic parkinsonism was diagnosed,\n                      <jats:sc>l<\/jats:sc>\n                      \u2010dopa was titrated up to 600\u2009mg\/day without clinical benefit and discontinued due to adverse effects. Treatment with amantadine and trihexyphenidyl was then initiated, resulting in partial symptomatic improvement, although symptoms persisted. Despite clinical improvement, follow\u2010up DAT\u2010SPECT on Day 131 showed a further reduction in striatal tracer uptake, whereas quantitative improvement was observed on Day 200.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Parkinsonism is an uncommon sequela of organophosphate poisoning and may be accompanied by abnormal DAT\u2010SPECT findings. Moreover, amantadine and trihexyphenidyl may represent effective therapeutic options for this condition.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pcn5.70333","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:38:47Z","timestamp":1777527527000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The importance of longitudinal evaluation using DAT\u2010SPECT in organophosphate\u2010induced toxic parkinsonism"],"prefix":"10.1002","volume":"5","author":[{"given":"Shuhei","family":"Nakao","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Division of Clinical Neuroscience, Faculty of Medicine University of Miyazaki Miyazaki Japan"},{"name":"Miyazaki Prefectural Miyazaki Hospital Miyazaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoichiro","family":"Kogoh","sequence":"additional","affiliation":[{"name":"Department of 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