Diagnosis and treatment of autonomic failure, pain and sleep disturbances in Parkinson’s disease: guideline “Parkinson’s disease” of the German Society of Neurology
Authors: Fanciulli Alessandra , Sixel-Döring Friederike , Buhmann Carsten , Krismer Florian , Hermann Wiebke , Winkler Christian , Woitalla Dirk , Jost Wolfgang H. ,   German Parkinson’s Guideline Group, Bähr Mathias , Becktepe Jos , Berg Daniela , Brockmann Kathrin , Ceballos-Baumann Andrés , Claßen Joseph , Deuschl Cornelius , Deuschl Günther , Dodel Richard , Ebersbach Georg , Beelitz-Heilstätten  , Eggers Carsten , van Eimeren Thilo , Fimm Bruno , Folkerts Ann-Kristin , Gausepohl Madeleine , Segeberg Bad , Hasan Alkomiet , Hilker-Roggendorf Rüdiger , Höllerhage Matthias , Hopfner Franziska , Jost Wolfgang , Kalbe Elke , Kassubek Jan , Klebe Stephan , Klein Christine , Klietz Martin , Köglsperger Thomas , Kühn Andrea , Krack Paul , Krismer Florian , Kuhlenbäumer Gregor , Levin Johannes , Liepelt-Scarfone Inga , Lingor Paul , Loewenbrück Kai , Löhle Matthias , Lorenzl Stefan , Maaß Sylvia , Maetzler Walter , Menzel Regina , Meyer Philipp T. , Mollenhauer Brit , Neumann Manuela , Odin Per , Outeiro Tiago , Pötter-Nerger Monika , Reese René , Reetz Kathrin , Rieß Olaf , Ruf Viktoria , Schneider Anja , Schrader Christoph , Schnitzler Alfons , Seppi Klaus , Storch Alexander , Tönges Lars , van Eimeren Thilo , Walter Uwe , Wächter Tobias , Warnecke Tobias , Wegner Florian , Witt Karsten , Woitalla Dirk , Zeuner Kirsten , Trenkwalder Claudia , Höglinger Günter 
Published: January 2025

Abstract

Background and objective
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.

Methods
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%.

Results
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.

Conclusion
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.