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Still, the brain structures to be examined for the diagnostic questions and the requirements for being a qualified investigator were not specified in detail. These issues have now been addressed in the 2023 update of the clinical guideline on PD by the German Society of Neurology (DGN).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The recommendations were based on a systematic literature review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three diagnostic questions were defined: (1) What is the accuracy of TCS in the differential diagnosis of PD versus atypical and secondary Parkinsonian syndromes? (2) What is the accuracy of TCS in the differential diagnosis of PD versus essential tremor? (3) What is the accuracy of TCS in the diagnosis of PD in persons with typical early symptoms, compared with the diagnosis established by clinical follow-up? The brain structures to be assessed and the level of recommendation were formulated for these questions. The training requirements for being regarded as qualified TCS investigator were stipulated by the responsible medical societies (German Society of Ultrasound in Medicine, DEGUM; German Society for Clinical Neurophysiology and Functional Imaging, DGKN). Finally, the recommendations for these diagnostic questions reached strong consensus (each\u2009\u2265\u200997%) of the guideline committee. Here, the details of review and recommendations are presented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The updated guideline clarifies the diagnostic uses and limitations of TCS in PD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-024-12502-1","type":"journal-article","created":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T00:01:44Z","timestamp":1720051304000},"page":"7387-7401","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Systematic review-based guideline \u201cParkinson\u2019s disease\u201d of the German Society of Neurology: diagnostic use of transcranial sonography"],"prefix":"10.1007","volume":"271","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6280-785X","authenticated-orcid":false,"given":"Uwe","family":"Walter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai F.","family":"Loewenbr\u00fcck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Dodel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Storch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Trenkwalder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcnter","family":"H\u00f6glinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the German Parkinson Guideline Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,4]]},"reference":[{"key":"12502_CR1","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1212\/wnl.45.1.182","volume":"45","author":"G Becker","year":"1995","unstructured":"Becker G, Seufert J, Bogdahn U, Reichmann H, Reiners K (1995) Degeneration of substantia nigra in chronic Parkinson\u2019s disease visualized by transcranial color-coded real-time sonography. 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He was funded by\u00a0the German Federal Ministry of Education and Research\u00a0(BMBF) outside the present study.\u00a0He serves as Joint Editor-in-Chief of the European Journal of Ultrasound (Thieme, Stuttgart, Germany). K.L. has stated explicitly that there are no conflicts of interest in connection with this article. R.D. received research support from DGN, Faber-Stiftung Marburg, General Electric, LINF, and Roche. He serves as a consultant for Lilly. He received honoraria for scientific presentations from Eisai, Lilly, Roche and others but all honoraria were used for research (except travel costs). He is an investigator on three patents hold by the Philipps-University Marburg, Germany. A.S. has received funding from the Deutsche Forschungsgemeinschaft (German Research Association) and the Helmholtz-Association outside the present study. He has received honoraria for presentations\/advisory boards\/consultations from Esteve, Desitin, Lobsor Pharmaceuticals, STADA, Bial, RG Gesellschaft, Zambon, NovoNordisk and AbbVie outside the present study. He has received royalties from Kohlhammer Verlag and Elsevier Press. He serves as an editorial board member of Stem Cells International. C.T. has received funding from the DLR (German Research Association) by ERA-Net Project BRAVA (EU-Grant) outside the present study. She has received honoraria for presentations\/advisory boards\/consultations from Abbvie, UCB, STADA, Bial, Roche, Boehringer Ingelheim Pharma, Convatec, Ono Pharmaceuticals outside the present study. She has received royalties from Thieme Publisher and licence Fees for Parkinson Sleep Scale. She has received travel stipends from the Movement Disorder Society. She serves as an editorial board member for Sleep Medicine. G.H. received research support from Abbvie, UCB; has ongoing research collaborations with Roche, UCB, Abbvie; serves as a consultant for Abbvie, Alzprotect, Amylyx, Aprinoia, Asceneuron, Bayer, Bial, Biogen, Biohaven, Epidarex, Ferrer, Kyowa Kirin, Lundbeck, Novartis, Retrotope, Roche, Sanofi, Servier, Takeda, Teva, UCB; received honoraria for scientific presentations from Abbvie, Bayer, Bial, Biogen, Bristol Myers Squibb, Kyowa Kirin, Pfizer, Roche, Teva, UCB, Zambon. He holds a patent (H\u00f6glinger GU, H\u00f6llerhage M, R\u00f6sler T. Treatment of Synucleinopathies. United States Patent No.: US 10,918,628 B2, Date of Patent: Feb. 16, 2021; and European Patent No.: EP 17 787 904.6\u20131109 \/ 3 525 788). He received publication royalties from Academic Press, Kohlhammer, and Thieme. He was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany\u2019s Excellence Strategy within the framework of the Munich Cluster for Systems Neurology (EXC 2145 SyNergy \u2013 ID 390857198); the German Federal Ministry of Education and Research (BMBF, CurePML EN2021-039); European Joint Programme on Rare Diseases (Improve-PSP); Deutsche Forschungsgemeinschaft (DFG, HO2402\/18\u20131 MSAomics); and participated in industry-sponsored research projects from Abbvie, Biogen, Biohaven, Novartis, Roche, Sanofi, UCB.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}]}}