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Atypical Parkinsonism

Parkinsonism is an umbrella term, which means that the person has symptoms similar to Parkinson’s disease (like tremor, rigidity, slowness of movements and balance problems), although a doctor is not sure whether those symptoms are due to the loss of dopamine. A number of patients with Parkinsonism do not have PD. Only 85% of all Parkinsonism are due to idiopathic Parkinson’s disease. Certain medications, vascular problems, and other neurodegenerative diseases can cause the symptoms similar to Parkinson’s disease. In fact, early in the disease process it may be difficult to know whether a patient has typical Parkinson’s disease or a syndrome that mimics it. The development of additional symptoms and the subsequent course of the disease generally points to the correct diagnosis.

Neurodegenerative diseases causing Parkinsonism are commonly grouped together under the category of Atypical Parkinsonism or Parkinson – plus syndromes. The plus part means, that in addition to expected symptoms of PD, patients have some atypical symptoms as well. Atypical Parkinsonism should be considered particularly in patients with:


Multiple system atrophy (MSA)
Both multiple system atrophy and Parkinson’s cause stiffness and slowness in the early stages. But the additional problems, such as difficulty with swallowing and dizziness that develop in multiple system atrophy, are unusual in early Parkinson’s. The condition used to be known as striatonigral degeneration, Shy Drager syndrome, or olivopontocerebellar atrophy.

Progressive supranuclear palsy (PSP)
Progressive supranuclear palsy is sometimes called Steele-Richardson-Olszewski syndrome. It affects eye movement, balance, mobility, speech and swallowing.

Vascular or arteriosclerotic Parkinsonism
Sometimes, people who have had a stroke, often one so mild that they didn’t notice it, may experience this form of parkinsonism.

Drug-induced Parkinsonism
Some drugs can cause a form of parkinsonism, which is usually reversible.


Response to Parkinson’s drugs:
If your specialist thinks you have Parkinson’s, they will expect you to have a good response to Parkinson’s drugs,such as levodopa (Madopar, Sinemet, or Stalevo). A good response means that your symptoms will improve, as long as a large enough dose is given that lasts for a long enough time. Sometimes, it will only be clear that you’ve responded to medication when the drug is reduced or stopped, and your symptoms become more obvious again. If you don’t have any response toParkinson's medication, it maycast doubt on your diagnosis.

Most people with forms of parkinsonism other than Parkinson’s usually don’t respond, or don’t respond as well, to Parkinson’s drugs. But to confuse matters, some people with forms of parkinsonism other than Parkinson’s will show a good response.

Please remember, if you have both unusual symptoms and no response to Parkinson’s drugs, this doesn’t automatically mean you have another form of parkinsonism. But it may make your specialist want to investigate further.






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