Parkinson plus syndrome

Overview Multiple system atrophy (MSA) is a rare, degenerative neurological disorder affecting your body's involuntary (autonomic) functions, including blood pressure, and motor control. MSA was formerly called Shy-Drager syndrome, olivopontocerebellar atrophy or striatonigral degeneration. MSA shares many symptoms with Parkinson's disease, such as slow movement, rigid muscles and poor balance. Symptoms Multiple system atrophy (MSA) affects many parts of your body. Symptoms usually start in adulthood, usually in the 50s or 60s. There are two types of MSA: parkinsonian and cerebellar. The type depends on the symptoms you have when you're diagnosed. Parkinsonian type This is the most common type of MSA. The signs and symptoms are similar to those of Parkinson's disease, such as: • Stiff muscles • Difficulty bending your arms and legs • Slow movement (bradykinesia) • Tremors can occur at rest or when moving your arms or legs • Soft voice • Problems with posture and balance Cerebellar type The main signs and symptoms are problems with muscle coordination (ataxia), but others may include: • Impaired movement and coordination, such as unsteady gait and loss of balance • Slurred, slow or low-volume speech (dysarthria) • Visual disturbances, such as blurred or double vision and difficulty focusing your eyes • Difficulty swallowing (dysphagia) or chewing • Changes in speech, such as slurred speech General signs and symptoms In addition, the primary sign of multiple system atrophy i...

Parkinson’s plus syndrome is the name for a group of neurological conditions that are very similar to Conditions that are considered Parkinson’s plus syndromes include: • Progressive supranuclear palsy (PSP). PSP causes trouble with balance and stability that can mimic Parkinson’s disease. Unlike Parkinson’s disease, people with PSP don’t experience tremors. They do have difficulty with eye movement and are likely to experience more trouble with speech, swallowing, and mood than people with Parkinson’s disease. • Multiple system atrophy (MSA). MSA is a progressive condition that affects your nervous system. It causes stiffness and loss of balance similarly to Parkinson’s disease. Over time, the effects of the disease on your nervous system can lead to difficulty with essential body functions such as digestion, breathing, and your heartbeat. • Corticobasal ganglionic degeneration (CBGD). CBGD is a condition that causes parts of your brain to become smaller. This causes many symptoms that overlap with Parkinson’s disease, such as tremors and balance problems. Over time, it can lead to difficulty with both speaking and writing. • Lewy body dementia (LBD). The symptoms of Parkinson’s plus can vary and depend on the condition you have. Many people will have symptoms that are also found in Parkinson’s disease, such as: • • • stiffness or • difficulty walking and standing • difficulty controlling your movements • • The conditions that make up Parkinson’s plus are not actually Par...

Understanding the differences between Parkinsonism and Parkinson Plus syndromes “Parkinsonism” means “looks like Parkinson’s disease.” To neurologists this means that the person has a somewhat flexed posture, moves slowly, is stiff and usually walks slowly, with small steps and reduced or no arm swing. We call the syndromes “atypical” because they usually differ from Parkinson’s Disease in a few ways: • there is usually no tremor • the two sides are usually affected about equally • the response to L-Dopa and the other medications used in Parkinson’s Disease is not very good • deep brain stimulation surgery is of no value Very often when the condition is mild, at the earliest stages, we can’t tell whether it is Parkinson’s Disease or atypical Parkinson’s Disease (APD) and we treat it as if it is Parkinson’s Disease because we don’t have treatments for the atypical Parkinson disorders. Sometimes they respond to the usual Parkinson’s Disease medications, but usually they don’t. And when they do, the response is not as good as it is with PD. “Parkinson plus” syndromes refer to syndromes which look like atypical PD, but also include additional abnormalities that are not seen in PD. These include: abnormalities of eye movements, gait “ataxia” (wide based walking that looks like the walk of someone who is drunk or walking on a boat), dystonia (abnormal postures), severe problems with low blood pressure on standing, or changes on the neurological exam that are only detected by the...

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FACTS • The terms “parkinsonism” or “parkinsonian” are not diagnoses, but rather meaning slow, stiff, or tremor-like movements, affected speech, and change in gait or walking pattern. • There are many causes of parkinsonism, including Parkinson’s disease (PD) and certain gastrointestinal and psychiatric medications. • Parkinson-plus syndromes are distinct neurodegenerative diseases that resemble PD but have some additional challenging features and different changes in the brain. • These disorders typically do not respond to levodopa, the mainstay of PD treatment. • Parkinson-plus syndromes tend to have a poor prognosis. TYPES Progressive supranuclear palsy (PSP) • Symmetric slowness and stiffness with very early loss of balance and subsequent falls • Impaired eye movements that cause double vision • Tremors usually not present • Often stiff, rigid neck • Spontaneous, unprovoked laughing and crying • Possible shrinkage in the midbrain Multiple System Atrophy (MSA) • Frequent and severe drops in blood pressure, which cause fainting spells • Incontinence • MSA-P (parkinsonian variant) – A slow and stiff subset • MSA-C (cerebellar variant) – A subset with poor coordination and slurred speech • Possible shrinkage in the cerebellum Parkinson’s Disease or Lewy body Dementia (PDD or LBD) • Appears as a cross between Alzheimer’s and Parkinson’s • Cognitive problems include: • Memory loss • Visual hallucinations • Delusions • Frequent changes in level of alertness • Physical signs o...

Parkinson’s plus syndromes, also called “atypical Parkinson’s,” are illnesses that attack your Your Parkinson’s disease is by far the most common of these, but about 15% of people who have a problem making dopamine will have one of the Parkinson’s plus syndromes. Types Parkinson’s plus syndromes are more serious and harder to treat than “classic” Parkinson’s disease. The four main types are: This is the most common Parkinson’s plus syndrome. It causes some of the same issues with movement and your muscles as Parkinson’s disease, like stiffness and problems with walking or balance, but it doesn’t usually make your limbs shake. It also can make it harder to move your This is the second most common form of This affects what’s known as your autonomic nervous system, which controls things like your This is the rarest of the four main types. It kills Its symptoms are like the ones caused by Parkinson’s disease, including the loss of muscle control, sometimes starting on only one side of your body. But it also can hurt your ability to think, see, and speak clearly. As the disease gets worse, it gets harder to walk and swallow. Diagnosis Parkinson’s plus syndromes can look a lot like other conditions that affect your nervous system, so it can sometimes take a while to find out for sure what’s going on. If your doctor thinks you might have Parkinson’s or a Parkinson’s plus syndrome, they’ll recommend that you see a If those don’t show a reason for your symptoms, they may ask you to...

Unfortunately, there is no cure or effective treatment for PSP, though some patients will be treated with Parkinson's medications to help with balance issues. Patients may also use things like specialized glasses, walkers, and regular physical therapy to help improve their quality of life. Cortical-Basal Ganglionic Degeneration Cortical-basal ganglionic degeneration (CBGD) is a rare neurological disease in which nerve cells in the brain break down and die over time. Similar to Parkinson's disease, the most commonly impacted areas control body movement and thinking. The memory loss in Lewy body dementia is less severe than it is with Alzheimer's. However, delusions and hallucinations are more common in the early stages of LBD. Sleep disturbances are also more likely in LBD. A Word From Verywell Distinguishing between Parkinson's disease and the various Parkinson's plus syndromes can be challenging and make for a difficult diagnosis. Be very clear and descriptive with your healthcare provider about the symptoms you are experiencing to ensure an accurate diagnosis. While there are no cures for these Parkinson's plus syndromes, there are medications and therapies that can help mitigate symptoms. • Olfati N, Shoeibi A, Litvan I. Parkinsonism & Related Disorders. 2019;59:101-110. doi:10.1016/j.parkreldis.2018.10.006 • National Institute of Neurological Disorders and Stroke. • National Organization for Rare Disorders. • Johns Hopkins Medicine. • National Organization for Rare Dis...