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What Is Parkinson Plus Syndrome

What Is The Treatment For A Parkinsons Plus Syndrome

What is Parkinson Plus Syndrome?

The treatment for a Parkinsons Plus syndrome is the same as the treatment for Parkinsons disease itself.

Many patients respond to Levodopa. However, whats challenging is that sometimes Levodopa does not have a dramatic effect. It may also happen that this effect may not last for many years. Therefore, the response to levodopa is somewhat unpredictable.

That being said, a significant proportion of patients with Parkinsons Plus syndromes respond positively to a comprehensive treatment effort. This effort should include the treatment of special problems associated with each syndrome. Therefore, it is crucial to figure out which kind of Parkinsons Plus syndrome early you have so that these specific problems can be treated.

For example:

  • In PSP, the patient frequently falls backwards because the areas of the brain responsible for balance are not functioning well. In this case, balance training can help.
  • In MSA, the patient can fall because of a drop in blood pressure when they get up. In this case, they should drink enough water and try to get up slowly to prevent falls. Some medications can also prevent falls.
  • Wolff Parkinson White Syndrome Complications

    For many people, WPW syndrome doesnt cause significant problems. But complications can occur, and its not always possible to know your risk of serious heart-related events. If the disorder is untreated, and particularly if you have other heart conditions, you may experience:

    • Fainting spells

    Read Also: Is Parkinson Disease Genetically Inherited

    Understanding The Differences Between Parkinsonism And Parkinson Plus Syndromes

    Parkinsonism means looks like Parkinsons 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 Parkinsons 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 Parkinsons 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 cant tell whether it is Parkinsons Disease or atypical Parkinsons Disease and we treat it as if it is Parkinsons Disease because we dont have treatments for the atypical Parkinson disorders. Sometimes they respond to the usual Parkinsons Disease medications, but usually they dont. 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 , dystonia , severe problems with low blood pressure on standing, or changes on the neurological exam that are only detected by the neurologist in the form of abnormal reflexes.

    Also Check: Is Parkinson Disease Fatal

    How Do I Prevent Falls From Common Hazards

    • Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
    • Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
    • Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
    • Kitchen: Install non-skid rubber mats near the sink and stove. Clean spills immediately.
    • Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
    • Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.

    Corticobasal Degeneration And Corticobasal Syndrome

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    Corticobasal degeneration and corticobasal syndrome are caused by degeneration in the cerebral cortex and the basal ganglia .

    Corticobasal Degeneration is a degenerative brain disease affecting people from the age of 40 onwards. There are neurological similarities to PSP, but the classical clinical picture is often distinct. Patients diagnosed with CBD may also develop features of PSP and vice versa.

    Cognitive problems are common in CBD and are often one of the first symptoms, such as apathy, impulsive behaviour, changes in empathy, and language symptoms. Other signs are progressive numbness and loss of use of one hand. There may also be jerking of the fingers, slowness and awkwardness and the feeling of having an alien limb with complex unintentional movements of one limb causing problems with normal motor tasks. Gradually the arm and/or leg on one side is affected and then the arm and/or leg on the other.

    Read Also: What Is The Life Expectancy Of Someone With Parkinson’s Disease

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    What Are Atypical Parkinsonian Disorders

    Atypical Parkinsonian disorders are progressive diseases that present with some of the signs and symptoms of Parkinsons disease, but that generally do not respond well to drug treatment with levodopa. They are associated with abnormal protein buildup within brain cells.

    The term refers to several conditions, each affecting particular parts of the brain and showing a characteristic course:

    • Dementia with Lewy bodies, characterized by an abnormal accumulation of alpha-synuclein protein in brain cells
    • Progressive supranuclear palsy,; involving tau protein buildup affecting the frontal lobes, brainstem, cerebellum and substantia nigra
    • Multiple system atrophy, another synucleinopathy that affects the autonomic nervous system , substantia nigra and at times the cerebellum
    • Corticobasal syndrome, a rare tauopathy that typically affects one side of the body more than the other and makes it difficult for patients to see and navigate through space

    Also Check: Can Young Adults Get Parkinsons Disease

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    Whats The Outlook For People With Parkinsons Plus

    Although there currently isnt a treatment to halt the progression of Parkinsons plus syndrome, there are treatments that can help you manage your symptoms and improve your quality of life.

    The exact outlook for Parkinsons plus syndrome depends on the person and the specific condition they have. Someone who is otherwise healthy when theyre diagnosed will typically have a longer life expectancy than someone who is already facing other health conditions when theyre diagnosed. Your doctor will monitor your condition over time and can let you know how its progressing.

    Doctors Shine Light On Parkinsons Plus Syndrome An Often Misdiagnosed Brain Disease


    MUSKEGO, WI Doctors are trying to shine a light on a rare brain disorder. Its commonly misdiagnosed, and when identified, it’s often dismissed as a death sentence.

    It’s called Parkinsons plus syndrome, also known as atypical Parkinson’s, and it has no cure. However, neurologists say more must be done to raise awareness.

    During their 48 years of marriage, Linda Raciti says if something was broken, her husband Sal could fix it.

    He’s a perfectionist, so he fixed everything. So, he is my go-to man, said Linda.

    His longest-standing project is a 1940 Ford pick-up truck. Hes been restoring it for decades.

    It was in my mother’s garage before we were married, she recalled.

    But in 2015, Sal began having dizzy spells and started tripping and falling. Multiple neurologists diagnosed him with early-onset Parkinsons. But Linda wasnt so sure.

    Parkinson’s youre more, the shakiness, which he didn’t have any of that; he had the dizziness,” she said.

    It turned out that Sal had progressive supranuclear palsy or PSP. Its also known as Parkinsons plus syndrome.

    The rare brain disorder affects only 7 in 100,000 people. It causes serious problems with walking, balance, eye movements, and eventually, swallowing.

    The median survival for people with PSP is about seven years, and that is much, much, much shorter than someone who has Parkinson’s disease, said Dr. Jori Fleischer, an associate professor of neurological sciences at Rush University Medical Center in Chicago.

    Also Check: What Is The Life Expectancy Of Someone With Parkinson’s Disease

    Conclusion And Future Development

    Since 1986 when two MRI studies on neurodegenerative Parkinson plus syndromes were published , MRI has become a well-established method that can be used for the diagnostic work-up of parkinsonism in clinical routine, providing specific information that point toward the diagnosis of a neurodegenerative condition. The role of MRI has progressed from excluding symptomatic parkinsonism due to other pathologies to distinguishing PD from APD based on specific changes in the basal ganglia and infratentorial structures, as summarized in this review . Fig. 7 gives a pragmatic approach for reading a MRI in a patient presenting with early parkinsonism, while Table 4 summarizes useful MRI findings to help clinicians diagnose patients presenting with degenerative parkinsonism . Only over the past decade, advances in MR methodology allowed the detection of PD-related MR changes and provided a boost for the diagnosis of early PD. The most consistently reported abnormalities in PD include loss of dorsolateral nigral hyperintensity on high-field iron-sensitive sequences and nigral neuromelanin signal changes establishing these qualitative MR markers in routine clinical practice for the diagnosis of early PD .

    Journal of Neural Transmission 124

    Table 4. Summary on Characteristic MRI Patterns for the Differential Diagnosis of Neurodegenerative Parkinsonism

    Depending on the sequence used to measure iron load .
    Typically iron deposition in lower outer part of putamen.

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    Read Also: Can Antipsychotics Cause Parkinsons

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    Diagnosis Of Parkinsons Disease

    A number of disorders can cause symptoms similar to those of Parkinsons disease. People with Parkinsons-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinsons, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinsons. Since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.

    There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinsons disease. Diagnosis is based on a persons medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinsons disease.

    Is There Any Treatment

    Cns Parkinson Davidson 07.

    There is currently no effective treatment for PSP and symptoms usually do not respond to medications.

    • Parkinsons disease medications, such as ropinirole, rarely provide additional benefit. In some individuals, other antiparkinsonian medications, such as levodopa, can treat the slowness, stiffness, and balance problems associated with PSP, but the effect is usually minimal and short-lasting.
    • Botulinum toxin, which can be injected into muscles around the eyes, can treat excessive eye closing.
    • Some antidepressant drugs may offer some benefits beyond treating depression, such as pain relief and decreasing drooling.

    Non-drug treatment for PSP can take many forms.

    • Weighted walking aids can help individuals avoid falling backward.
    • Bifocals or special glasses called prisms are sometimes prescribed for people with PSP to remedy the difficulty of looking down.
    • Exercise;supervised by a healthcare professional can keep joints limber but formal physical therapy has no proven benefit in PSP.

    A gastrostomy may be necessary when there are swallowing disturbances or the definite risk of severe choking.

    Deep brain stimulationwhich uses surgically implanted electrodes and a pacemaker-like medical device to deliver electrical stimulation to specific areas in the brain ;to block signals that cause the motor symptoms of several neurological disordersand other surgical procedures commonly used in individuals with Parkinsons disease have not

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    Whats The Difference Between Dementia With Lewy Bodies And Parkinsons

    In dementia with Lewy bodies, dementia always appears first. There can also be changes in alertness as well as visual hallucinations. However, because of the presence of Lewy bodies throughout the entire brain, characteristics of this disease not only include cognitive characteristics, but also physical, sleep, and behavioral changes. As the disease progresses, the motor symptoms common to Parkinsons such as tremor, slowness, stiffness, and walking and balance problems will appear.

    For more information on dementia with Lewy bodies, visit

    What Are The Parkinsons Plus Syndromes

    It is best to think of the Parkinsons Plus syndromes as the sisters of Parkinsons disease.

    Although many diseases are similar to Parkinsons disease, the changes they produce and their symptoms are slightly different. Its why we think of these diseases as the sisters of Parkinsons disease.

    Another name for them is the Parkinsons Plus syndromes.

    There are three common Parkinsons Plus syndromes.

    Ideally, the specific Parkinsons Plus Syndrome should be identified correctly before the start of treatment.

    But in the early stages of the disease, this may be difficult, and sometimes impossible. You ca read more here .

    Because it is sometimes impossible to tell PSP, MSA, and CBD apart, doctors sometimes diagnose the patient as having a Parkinsons Plus syndrome without noting the specific disease.

    As the years go by, the appearance of characteristic features may enable your doctor to make a more precise diagnosis.

    Read Also: What Is Dbs Surgery For Parkinson’s Disease

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    Associated Complications Of Pd

    What is Progressive Supranuclear Palsy?

    There are quite a few associated complications of Parkinson’s disease, and dementia is one of them. Therefore, if the documentation indicates the patient has dementia secondary to Parkinsons disease, it would be reported as:

    • G20, Parkinsons disease
    • F02.80, Dementia in other diseases classified elsewhere without behavioral disturbance

    To find these codes, we can look under “dementia” and go down the list to “in ,” and “Parkinson’s disease G20 .” This means the code in brackets is a secondary code and must be reported after the code for the underlying condition . Parkinson’s is the underlying cause, and dementia is the manifestation of the Parkinson’s.

    F02.80 applies to:

    • Dementia in other diseases classified elsewhere without behavioral disturbance
    • Dementia in other diseases classified elsewhere NOS
    • Major neurocognitive disorder in other diseases classified elsewhere

    Also Check: Parkinsons Life Expectancy

    Dementia With Lewy Bodies

    DLB is a brain disease that causes progressive changes with movement or thinking. In DLB, abnormal structures called Lewy bodies form in certain areas of the brain. Sometimes the symptoms of DLB resemble those of Parkinson’s disease√Ęsuch as a shuffling gait, tremor, and problems with movement. In other cases, symptoms of DLB may mimic the symptoms of Alzheimer’s disease. Often a combination of both Parkinson’s and Alzheimer’s symptoms appear together. These symptoms may occur in DLB because the structures in the brain affected by DLB are similar to those affected by Parkinson’s disease or Alzheimer’s disease. Some experts think that DLB may be a form of Parkinson’s disease or Alzheimer’s disease.

    The progression of DLB is slow. Although there is no cure for DLB, treatment is available to reduce symptoms of the disease.

    What Is Parkinsons Disease

    Parkinsons disease is a nervous system disease that affects your ability to control movement. The disease usually starts out slowly and worsens over time. If you have Parkinsons disease, you may shake, have muscle stiffness, and have trouble walking and maintaining your balance and coordination. As the disease worsens, you may have trouble talking, sleeping, have mental and memory problems, experience behavioral changes and have other symptoms.

    Recommended Reading: Life Expectancy Of Someone With Parkinson’s

    What Are Stages Of Progression Known In Parkinsons Disease

    The progression of Parkinsons disease is mostly divided into five stages-

    Stage 1- This stage is characterized by the mildest form of Parkinsons. The symptoms are not so severe to interfere with daily tasks and overall lifestyle. Friends and family members may notice some sort of changes in the way the patient walks, his posture and some facial expression. One of the distinct symptom of Parkinsons is the tremors are other problems in movement and exclusive to one side of the body. If doctor is consulted at this stage, the prescribed medication can help ease out the symptoms at this stage of Parkinsons disease.

    Stage 2- This phase is considered to be the moderate form of Parkinsons because the symptoms get distinctively noticed by people. Muscle stiffness is quite common at this stage. It must be remembered that although there may be an increase of tremors and irregular posture, stage 2 Parkinsons disease does not impair the balance of the patient.

    Stage 3- The Parkinsons disease patient may experience a turning point in this stage as along with the symptoms he may not be able to maintain his balance and experience decreased reflexes. Movements become slower and falls become common. Medication along with occupational therapy may be advised.

    Stage 4- It becomes impossible to even stand without assistance at stage 4 Parkinsons disease. Living alone may make daily tasks impossible and dangerous. Thus, the patient will need a caregiver from this stage.


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