Parkinsonism Plus syndromes

Even though most of the hypokinetic disorders are typically Parkinson’s disease, there are small percentage of degenerative diseases which do have features of Parkinson’s disease (namely, tremors, stiffness, slowness, balance issue), but are different in their clinical features, outcome and pathological changes and hence these are called as Parkinsonism plus syndromes. Some of these include Multiple system atrophy (commonly known as MSA), progressive supranuclear palsy, corticobasal syndrome and others.

Parkinson-plus syndromes, also known as disorders of multiple system degeneration, are a group of neurodegenerative diseases featuring the classical features of Parkinson’s disease (tremor, rigidity, akinesia/bradykinesia, postural instability) with additional features that distinguish them from simple idiopathic Parkinson’s disease. Some consider Alzheimer’s disease to be in this group. Parkinson-plus syndromes are either inherited genetically or occur sporadically.

Parkinson Plus syndromes are often difficult to differentiate from Parkinson’s disease and each other. They include multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBGD). Dementia with Lewy bodies (DLB), may or may not be part of the PD spectrum, but it is increasingly recognized as the second most common type of neurodegenerative dementia after Alzheimer’s disease. These disorders are currently lumped into two groups, the synucleinopathies and the tauopathies.

Additional Parkinson-plus syndromes include Pick’s disease and olivopontocerebellar atrophy (OPCA).[5] The latter is characterized by ataxia and dysarthria, and may occur either as an inherited disorder or as a variant of multiple system atrophy. MSA is also characterized by autonomic failure, formerly known as Shy-Drager syndrome. Accurate diagnosis of these Parkinson-plus syndromes is improved when precise diagnostic criteria are used.[3] Since diagnosis of individual Parkinson-plus syndromes is difficult, the prognosis is often poor. Proper diagnosis of these neurodegenerative disorders is important as individual treatments will vary depending on the condition.

Secondary Parkinsonism Syndromes

Secondary Parkinsonism syndromes are a group of diseases which are clinically similar to Parkinson’s disease like symptoms but are caused by various other causes like stroke, brain infection, brain trauma, drug effects, and metabolic causes.