EFNS/MDS-ES recommendations for the diagnosis of Parkinson's disease
Por:
Berardelli, A, Wenning, GK, Antonini, A, Berg, D, Bloem, BR, Bonifati, V, Brooks, D, Burn, DJ, Colosimo, C, Fanciulli, A, Ferreira, J, Gasser, T, Grandas, F, Kanovsky, P, Kostic, V, Kulisevsky, J, Oertel, W, Poewe, W, Reese, JP, Relja, M, Ruzicka, E, Schrag, A, Seppi, K, Taba, P, Vidailhet, M
Publicada:
1 ene 2013
Resumen:
Background: A Task Force was convened by the EFNS/MDS-ES Scientist Panel on Parkinson's disease (PD) and other movement disorders to systemically review relevant publications on the diagnosis of PD.
Methods: Following the EFNS instruction for the preparation of neurological diagnostic guidelines, recommendation levels have been generated for diagnostic criteria and investigations.
Results: For the clinical diagnosis, we recommend the use of the Queen Square Brain Bank criteria (Level B). Genetic testing for specific mutations is recommended on an individual basis (Level B), taking into account specific features (i.e. family history and age of onset). We recommend olfactory testing to differentiate PD from other parkinsonian disorders including recessive forms (Level A). Screening for premotor PD with olfactory testing requires additional tests due to limited specificity. Drug challenge tests are not recommended for the diagnosis in de novo parkinsonian patients. There is an insufficient evidence to support their role in the differential diagnosis between PD and other parkinsonian syndromes. We recommend an assessment of cognition and a screening for REM sleep behaviour disorder, psychotic manifestations and severe depression in the initial evaluation of suspected PD cases (Level A). Transcranial sonography is recommended for the differentiation of PD from atypical and secondary parkinsonian disorders (Level A), for the early diagnosis of PD and in the detection of subjects at risk for PD (Level A), although the technique is so far not universally used and requires some expertise. Because specificity of TCS for the development of PD is limited, TCS should be used in conjunction with other screening tests. Conventional magnetic resonance imaging and diffusion-weighted imaging at 1.5 T are recommended as neuroimaging tools that can support a diagnosis of multiple system atrophy (MSA) or progressive supranuclear palsy versus PD on the basis of regional atrophy and signal change as well as diffusivity patterns (Level A). DaTscan SPECT is registered in Europe and the United States for the differential diagnosis between degenerative parkinsonisms and essential tremor (Level A). More specifically, DaTscan is indicated in the presence of significant diagnostic uncertainty such as parkinsonism associated with neuroleptic exposure and atypical tremor manifestations such as isolated unilateral postural tremor. Studies of [I-123]MIBG/SPECT cardiac uptake may be used to identify patients with PD versus controls and MSA patients (Level A). All other SPECT imaging studies do not fulfil registration standards and cannot be recommended for routine clinical use. At the moment, no conclusion can be drawn as to diagnostic efficacy of autonomic function tests, neurophysiological tests and positron emission tomography imaging in PD.
Conclusions: The diagnosis of PD is still largely based on the correct identification of its clinical features. Selected investigations (genetic, olfactory, and neuroimaging studies) have an ancillary role in confirming the diagnosis, and some of them could be possibly used in the near future to identify subjects in a pre-symptomatic phase of the disease.
Filiaciones:
Berardelli, A:
Univ Roma La Sapienza, Dipartimento Neurol & Psichiatria, I-00185 Rome, Italy
Univ Roma La Sapienza, IRCCS NEUROMED Inst, I-00185 Rome, Italy
Wenning, GK:
Med Univ Innsbruck, Dept Neurol, A-6020 Innsbruck, Austria
Antonini, A:
Parkinsons Dis & Movement Disorders Unit IRCCS, Milan, Italy
Berg, D:
Univ Tubingen, Dept Neurodegenerat Dis, Hertie Inst Clin Brain Res, German Ctr Neurodegenerat Dis, Tubingen, Germany
DZNE, Tubingen, Germany
Bloem, BR:
Radboud Univ Nijmegen, Med Ctr, Dept Neurol, Donders Inst Brain Cognit & Behav, NL-6525 ED Nijmegen, Netherlands
Bonifati, V:
Erasmus MC, Dept Clin Genet, Rotterdam, Netherlands
Brooks, D:
Univ London Imperial Coll Sci Technol & Med, Hammersmith Hosp, Dept Clin Neurosci, London, England
Burn, DJ:
Newcastle Univ, Inst Ageing & Hlth, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England
Colosimo, C:
Univ Roma La Sapienza, Dipartimento Neurol & Psichiatria, I-00185 Rome, Italy
Fanciulli, A:
Med Univ Innsbruck, Dept Neurol, A-6020 Innsbruck, Austria
Ferreira, J:
Fac Med Lisbon, Ctr Estudos Egas Moniz, Lisbon, Portugal
Gasser, T:
Univ Tubingen, Dept Neurodegenerat Dis, Hertie Inst Clin Brain Res, German Ctr Neurodegenerat Dis, Tubingen, Germany
Grandas, F:
Hosp Univ Gregorio Maranon, Movement Disorders Res Unit, Madrid, Spain
Kanovsky, P:
Palacky Univ, Dept Neurol, CR-77147 Olomouc, Czech Republic
Kostic, V:
Univ Belgrade, Sch Med, Inst Neurol CCS, Belgrade, Serbia
Kulisevsky, J:
Univ Autonoma Barcelona, St Pau Hosp, Dept Neurol, Movement Disorders Unit, E-08193 Barcelona, Spain
CIBERNED, Barcelona, Spain
Oertel, W:
Univ Marburg, Dept Neurol, Ctr Nervous Dis, Marburg, Germany
Poewe, W:
Med Univ Innsbruck, Dept Neurol, A-6020 Innsbruck, Austria
Relja, M:
Univ Zagreb, Sch Med, Movement Disorders Ctr, Dept Neurol, Zagreb 41001, Croatia
Univ Zagreb, Univ Hosp Ctr, Zagreb 41000, Croatia
Ruzicka, E:
Charles Univ Prague, Fac Med 1, Prague, Czech Republic
Charles Univ Prague, Gen Univ Hosp Prague, Prague, Czech Republic
Schrag, A:
UCL, Inst Neurol, London, England
Seppi, K:
Med Univ Innsbruck, Dept Neurol, A-6020 Innsbruck, Austria
Taba, P:
Univ Tartu, Dept Neurol & Neurosurg, EE-50090 Tartu, Estonia
Vidailhet, M:
Hop La Pitie Salpetriere, Paris, France
Hop La Pitie Salpetriere, CRICM UPMC, INSERM UMR S975, CNRS UMR7225, Paris, France
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