Fanciulli Alessandra, Sixel-Döring Friederike, Buhmann Carsten, Krismer Florian, Hermann Wiebke, Winkler Christian, Woitalla Dirk, Jost Wolfgang H, Trenkwalder Claudia, Höglinger Günter
Department of Neurology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
Paracelsus-Elena-Klinik, Kassel, Germany.
J Neurol. 2025 Jan 3;272(1):90. doi: 10.1007/s00415-024-12730-5.
Non-motor symptoms frequently develop throughout the disease course of Parkinson's disease (PD), and pose affected individuals at risk of complications, more rapid disease progression and poorer quality of life. Addressing such symptom burden, the 2023 revised "Parkinson's disease" guideline of the German Society of Neurology aimed at providing evidence-based recommendations for managing PD non-motor symptoms, including autonomic failure, pain and sleep disturbances.
Key PICO (Patient, Intervention, Comparison, Outcome) questions were formulated by the steering committee and refined by the assigned authors. Recommendations were drafted based on relevant studies, systematic reviews, meta-analyses and high-quality guidelines identified by the literature search. They were subsequently reviewed, revised, and voted by the Guideline Group in online consensus conferences. Consensus was achieved in case of > 75% agreement among the group members. The consensus was considered strong, if agreement was > 95%.
The guideline entails: (i) 10 PICOs and 23 recommendations on the diagnosis and treatment of urogenital, cardiovascular and gastrointestinal autonomic failure; (ii) four PICOs and four recommendations on the possible types of pain in PD individuals, their diagnosis and treatment; (iii) 11 PICOs and 11 recommendations on the screening, diagnosis and treatment of sleep disturbances and excessive daytime sleepiness in PD individuals, as well as on their prognostic implications. Thirty-one out of 38 recommendations achieved a strong consensus.
The current German PD guideline provides a practice-oriented and etiology-driven stepwise approach to the diagnosis and treatment of autonomic failure, pain and sleep disturbances in PD individuals.
非运动症状在帕金森病（PD）的病程中经常出现，使患者面临并发症风险、疾病进展加快以及生活质量下降的问题。为解决此类症状负担，德国神经病学学会2023年修订的《帕金森病》指南旨在为管理PD非运动症状提供循证建议，这些症状包括自主神经功能衰竭、疼痛和睡眠障碍。
指导委员会制定了关键的PICO（患者、干预措施、对照、结局）问题，并由指定作者进行完善。根据文献检索确定的相关研究、系统评价、荟萃分析和高质量指南起草建议。随后，指南小组在在线共识会议上对这些建议进行审查、修订和投票。如果小组成员之间的同意率超过75%，则达成共识。如果同意率超过95%，则认为该共识是强有力的。
该指南包括：（i）关于泌尿生殖系统、心血管系统和胃肠道自主神经功能衰竭的诊断和治疗的10个PICO和23条建议；（ii）关于PD患者可能的疼痛类型、诊断和治疗的4个PICO和4条建议；（iii）关于PD患者睡眠障碍和日间过度嗜睡的筛查、诊断和治疗及其预后影响的11个PICO和11条建议。38条建议中有31条达成了强有力的共识。
当前的德国PD指南为PD患者自主神经功能衰竭、疼痛和睡眠障碍的诊断和治疗提供了一种以实践为导向且基于病因的逐步方法。
