A New Assessment Tool for Parkinson Disease

n the last decade, transcranial sonography became the traditional diagnostic approach to Parkinson disease in all studies performed to date, as described since 1999.1–7 The first article published by Becker et al8 in 1995 described only semiquantitative assessment of the substantia nigra. After image freezing, the midbrain is zoomed 2or 3-fold, and the hyperechoic area is measured at its largest extension. Finding a value greater than 0.25 cm2 can validate the diagnosis. Therefore, this value reflects a structural change in the substantia nigra, leading to functional impairment of the nigrostriatal dopaminergic system. A recent study reported high interobserver reliability of traditional transcranial sonography.9 Enzo Sanzaro, MD, Francesco Iemolo, MD, Giovanni Duro, MD, Giovanni Malferrari, MD