{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:45:25Z","timestamp":1792028725547,"version":"4.4.0"},"reference-count":245,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2012,12,22]],"date-time":"2012-12-22T00:00:00Z","timestamp":1356134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2013,1]]},"abstract":"\n Background<\/jats:title>\n \n A Task Force was convened by the\n EFNS<\/jats:styled-content>\n \/\n MDS<\/jats:styled-content>\n \u2010\n ES<\/jats:styled-content>\n Scientist Panel on\n P<\/jats:styled-content>\n arkinson's disease (\n PD<\/jats:styled-content>\n ) and other movement disorders to systemically review relevant publications on the diagnosis of\n PD<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Following the\n EFNS<\/jats:styled-content>\n instruction for the preparation of neurological diagnostic guidelines, recommendation levels have been generated for diagnostic criteria and investigations.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n For the clinical diagnosis, we recommend the use of the\n Q<\/jats:styled-content>\n ueen\n S<\/jats:styled-content>\n quare\n B<\/jats:styled-content>\n rain\n B<\/jats:styled-content>\n ank criteria (Level\n B<\/jats:styled-content>\n ). Genetic testing for specific mutations is recommended on an individual basis (Level\n B<\/jats:styled-content>\n ), taking into account specific features (i.e. family history and age of onset). We recommend olfactory testing to differentiate\n PD<\/jats:styled-content>\n from other parkinsonian disorders including recessive forms (Level\n A<\/jats:styled-content>\n ). Screening for pre\u2010motor\n PD<\/jats:styled-content>\n 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\n PD<\/jats:styled-content>\n and other parkinsonian syndromes. We recommend an assessment of cognition and a screening for\n REM<\/jats:styled-content>\n sleep behaviour disorder, psychotic manifestations and severe depression in the initial evaluation of suspected\n PD<\/jats:styled-content>\n cases (Level\n A<\/jats:styled-content>\n ). Transcranial sonography is recommended for the differentiation of\n PD<\/jats:styled-content>\n from atypical and secondary parkinsonian disorders (Level\n A<\/jats:styled-content>\n ), for the early diagnosis of\n PD<\/jats:styled-content>\n and in the detection of subjects at risk for\n PD<\/jats:styled-content>\n (Level\n A<\/jats:styled-content>\n ), although the technique is so far not universally used and requires some expertise. Because specificity of\n TCS<\/jats:styled-content>\n for the development of\n PD<\/jats:styled-content>\n is limited,\n TCS<\/jats:styled-content>\n should be used in conjunction with other screening tests. Conventional\n magnetic resonance imaging<\/jats:styled-content>\n and diffusion\u2010weighted imaging at 1.5\n T<\/jats:styled-content>\n are recommended as neuroimaging tools that can support a diagnosis of multiple system atrophy (\n MSA<\/jats:styled-content>\n ) or progressive supranuclear palsy versus\n PD<\/jats:styled-content>\n on the basis of regional atrophy and signal change as well as diffusivity patterns (Level\n A<\/jats:styled-content>\n ). DaTscan SPECT is registered in\n E<\/jats:styled-content>\n urope and the\n U<\/jats:styled-content>\n nited\n S<\/jats:styled-content>\n tates for the differential diagnosis between degenerative parkinsonisms and essential tremor (Level\n A<\/jats:styled-content>\n ). More specifically,\n DaTscan<\/jats:styled-content>\n 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 [\n 123<\/jats:sup>\n I]\n MIBG<\/jats:styled-content>\n \/\n SPECT<\/jats:styled-content>\n cardiac uptake may be used to identify patients with\n PD<\/jats:styled-content>\n versus controls and\n MSA<\/jats:styled-content>\n patients (Level\n A<\/jats:styled-content>\n ). All other\n SPECT<\/jats:styled-content>\n 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\n positron emission tomography<\/jats:styled-content>\n imaging in\n PD<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The diagnosis of\n PD<\/jats:styled-content>\n 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\u2010symptomatic phase of the disease.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ene.12022","type":"journal-article","created":{"date-parts":[[2012,12,22]],"date-time":"2012-12-22T04:33:47Z","timestamp":1356150827000},"page":"16-34","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":443,"title":["EFNS<\/scp>\n \/\n MDS<\/scp>\n \u2010\n ES<\/scp>\n recommendations for the diagnosis of\n P<\/scp>\n arkinson's disease"],"prefix":"10.1111","volume":"20","author":[{"given":"A.","family":"Berardelli","sequence":"first","affiliation":[{"name":"Dipartimento di Neurologia e Psichiatria and IRCCS NEUROMED Institute Sapienza, Universit\u00e0 di Roma Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. 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