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Hilfreiche Zusatzuntersuchungen beim idiopathischen Parkinson-Syndrom

Helpful instrumental examinations in idiopathic Parkinson’s disease

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Zusammenfassung

Hintergrund

Die klinische Diagnose eines idiopathischen Parkinson-Syndroms (IPS) kann schwierig sein. In solchen Fällen empfiehlt es sich, zusätzliche apparative Methoden einzusetzen.

Fragestellung

Dieser Artikel gibt einen Überblick über aktuelle und vielversprechende zukünftige Untersuchungsmethoden beim beginnenden IPS.

Ergebnisse

Die 1,5-Tesla-Magnetresonanztomographie (MRT) bzw. die Computertomographie sind v. a. zur Abgrenzung symptomatischer Parkinson-Syndrome etabliert. Neue MRT-Technologien (Diffusions-Tensor-Imaging-MRT, eisensensitive und neuromelaninsensitive Sequenzen im Hochfeld-MRT) können künftig vor allem für die Frühdiagnose Bedeutung erlangen. Für die Früh- und Differenzialdiagnostik ist die transkranielle B‑Bild-Sonographie der Substantia nigra und Basalganglien etabliert, insbesondere in der Kombination mit diagnostischen Markern, dies erfordert aber einen ausreichend geschulten Untersucher bzw. den Einsatz validierter digitaler Bildanalyseinstrumente. Von den nuklearmedizinischen Verfahren differenziert der DATScan das IPS gut vom essenziellen Tremor, medikamentösen Parkinsonoid und von psychogener Bewegungsstörung, nicht aber von den atypischen PS. Hingegen können die Fluorodesoxyglucose-Positronenemissionstomographie und die myokardiale MIBG-Szintigraphie die Abgrenzung zu atypischen PS unterstützen. Die Riechtestung ist für die routinemäßige Anwendung zu empfehlen, insbesondere in Kombination mit weiteren diagnostischen Markern. Dies trifft bislang nicht zu für genetische, laborchemische oder histologische Untersuchungen. Vielversprechend für die klinische Anwendung sind Verfahren zur sensorbasierten Detektion von Bewegungsstörungen.

Schlussfolgerung

Apparative Diagnoseverfahren können zur klareren Abgrenzung gegenüber Differenzialdiagnosen des IPS hilfreich sein.

Abstract

Background

The clinical diagnosis of idiopathic Parkinson’s disease (iPD) can be challenging. In these cases, additional diagnostic methods are available that can help to improve diagnostic accuracy.

Objectives, material and methods

This article provides an overview of currently available and promising novel ancillary methods for the early and differential diagnosis of iPD.

Results

Imaging tools, such as 1.5 Tesla magnetic resonance imaging (MRI) and computed tomography (CT) are mainly used for the differentiation between iPD and symptomatic parkinsonian syndromes (PS). High-resolution diffusion tensor imaging and iron and neuromelanin-sensitive high-field MRI sequences can become important in the future, particularly for earlier diagnosis. Transcranial B‑mode sonography of the substantia nigra and basal ganglia is established for early and differential diagnostics, especially in the combination of diagnostic markers but necessitates an adequately trained investigator and the use of validated digital image analysis instruments. DATScan can discriminate iPD from essential tremor, medication-induced parkinsonism and psychogenic movement disorder but not iPD from atypical PS. For the latter differential diagnosis, fluorodeoxyglucose positron emission tomography and myocardial metaiodobenzylguanidine scintigraphy can be helpful. Olfactory testing should preferably be used in combination with other diagnostic tests. Genetic, biochemical and histopathological tests are currently not recommended for routine use. Novel sensor-based techniques have a high potential to support clinical diagnosis of iPD but have not yet reached a developmental stage that is sufficient for clinical use. Novel sensor-based techniques have high potential to support clinical diagnosis of iPD, but have not yet reached a development stage that is sufficient for clinical use.

Conclusion

Ancillary diagnostic methods can support the early and differential diagnosis of iPD.

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Authors and Affiliations

  1. Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Rostock, Deutschland

    U. Walter

  2. Universitätsklinik für Neurologie, Medizinische Universität Wien, Wien, Österreich

    H. Zach

  3. Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, Niederlande

    H. Zach

  4. Hertie Institut für klinische Hirnforschung, Universität Tübingen und Deutsches Zentrum für Neurodegenerative Erkrankungen, Tübingen, Deutschland

    I. Liepelt-Scarfone

  5. Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland

    W. Maetzler

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Walter, U., Zach, H., Liepelt-Scarfone, I. et al. Hilfreiche Zusatzuntersuchungen beim idiopathischen Parkinson-Syndrom. Nervenarzt 88, 365–372 (2017). https://doi.org/10.1007/s00115-017-0289-z

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