Mandatory medical device diagnostics.
- Computed tomography of the skull (cranial CT, cranial CT or cCT) or cranial magnetic resonance imaging (cMRI)-should be performed at least once as part of the diagnostic workup to rule out symptomatic causes in the diagnosis of PD (expert consensus)For clinical neurologic verification of the diagnosis and for therapy monitoring, the patient should be examined after three months and thereafter as clinically needed, but at least once a year. (Expert consensus)
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification or to exclude complications.
- Transcranial Doppler sonography (ultrasound examination through the intact skull for orienting control of cerebral (“concerning the brain”) blood flow; brain ultrasound) – in this process, ultrasound probes are directed from the temple to the “substantia nigra” (black substance) [when the substantia nigra gradually perishes in the course of Parkinson’s disease, the iron content increases even more; this leads to a particularly strong echo (bright shadow on the screen) in the sonography]
- Magnetic resonance imaging of the skull (cranial MRI, cranial MRI or cMRI) – can be used with the inclusion of planimetric methods or diffusion-weighted sequences (DWI/DTI) for the differential diagnosis of neurodegenerative Parkinson’s syndromes (atypical/idiopathic)
- Fluorodeoxyglucose positron emission tomography (FDG-PET; nuclear medicine procedure that allows the creation of cross-sectional images of living organisms by visualizing the distribution patterns of weak radioactive substances) – may be performed in well-justified cases for the best possible differential diagnostic assignment of Parkinson’s disease, especially for the delineation of atypical neurodegenerative Parkinson’s syndromes. The indication for this examination should be reviewed and recommended by a neurologist.
- Presynaptic dopamine transporter SPECT (DAT-SPECT; single photon emission computed tomography (SPECT for short)) should be performed early in the course of the disease to detect a nigrostriatal deficit in clinically unclear Parkinson’s or Tremor syndromeNote: “Cerebral single-photon emission computed tomography (SPECT) (dopamine transporter presynaptic, IBZM postsynaptic) should not be used for differential diagnosis in established Parkinson’s disease to differentiate atypical neurodegenerative disease variants (especially MSA and PSP).”
- DaTSCAN scintigraphy (synonyms: dopamine transporter scintigraphy; brain scintigraphy) is a nuclear medicine examination method for imaging specific neurotransmitter transporters in the brain – for confirming diagnosis in cases of clinical suspicion; a normal result in DaTSCAN can exclude Parkinson’s syndrome by 97%.
- Doppler/duplex sonography (ultrasound examination: combination of a sonographic cross-sectional image (B-scan) and the Doppler sonography method; imaging method in medicine that can dynamically represent fluid flows (especially blood flow)) – in cases of suspected vascular disease
- Encephalogram (EEG; recording of the electrical activity of the brain) – when cognitive disorders are suspected.
- Polysomnography (sleep laboratory; measurement of various bodily functions during sleep, which provide information about sleep quality) – if neurodegeneration is suspected, as in the context of multisystem atrophy.
In addition, there are other special forms of examination such as sphincter EMG (examination of the innervation, ie the control of the sphincter by nerves) or measurement of various reflexes in difficult to diagnose Parkinson’s disease. Further notes
- When symptoms worsen in PD patients, specific sequences of diffusion-weighted MRI images show an increase in free water (extracellular fluid z.B. due to vasogenic edema).
