Parkinson's Disease

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Parkinson's Plus Syndromes

Some conditions have clinical features that are similar to Parkinson's disease and may be confused with Parkinson's, especially early in the course of the disease. These conditions are called Parkinson's plus syndromes.

Postencephalitic Parkinsonism
As anyone will recall who has read the book, Awakenings, by neurologist Dr. Oliver Sacks, or seen the movie made from it, a severe viral disease called encephalitis lethargica struck down almost 5 million people worldwide in the years just after World War I.

It disappeared during the 1920s, but not before it killed one-third of its victims and cast others into a seemingly catatonic state. This "sleeping sickness," as it was called in the United States, was postencephalitic parkinsonism, a disabling neurological disorder which often developed years after the acute phase of encephalitis lethargica had passed. Other viral infections, including western equine encephalomyelitis, eastern equine encephalomyelitis and Japanese B encephalitis, have been known to cause parkinsonian symptoms as well, though rarely.

Striatonigral Degeneration
This condition is characterized by mild problems in the substantia nigra, but severe damage to other parts of the brain that usually are less affected by primary Parkinson's disease. Patients with striatonigral degeneration usually have greater muscular rigidity, and their disease progresses rapidly.

Arteriosclerotic Parkinsonism or Pseudoparkinsonism
A condition in which multiple small strokes cause damage to blood vessels in the brain, arteriosclerotic parkinsonism rarely causes tremors, but most people afflicted with it suffer dementia. The usual drugs used to treat parkinsonian symptoms are largely ineffective with pseudoparkinsonism.

Toxin-Induced Parkinsonism
Some toxins are known to cause parkinsonism. These include manganese dust, carbon disulfide, carbon monoxide and a chemical known as MPTP (1-methyl-4-phenyl-1,2,5,6-tetrahydropyridine).

Progressive Supranuclear Palsy (PSP)
Patients who have progressive supranuclear palsy have rigidity and bradykinesia, which may appear similar to that of Parkinson's disease early after the symptoms develop. However, rigidity associated with PSP usually affects the trunk more than the limbs. Patients with progressive supranuclear palsy have a marked tendency to fall and usually do not experience tremor.

As the condition progresses, patients often develop a characteristic slowing of eye movements, loss of the ability to roll the eyes up or down, and a "suprised" facial expression.

Parkinsonian symptoms also are known to appear in conjunction with other neurological disorders. Among these diseases are progressive supranuclear palsy, Huntington's disease, Alzheimer's disease, Creutzfeldt-Jakob disease and post-traumatic encephalopathy.

Parkinson's Disease, Parkinson’s Plus Syndromes reprinted with permission from neurologychannel.com
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