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Parkinson-Plus Syndromes - Topic Overview

Parkinson-plus syndromes are a group of neurological conditions that are similar to Parkinson's disease but have unique characteristics. These syndromes can be hard to diagnose because the symptoms mimic other conditions. Following are the four most common types of Parkinson-plus syndromes.

Progressive supranuclear palsy (PSP)

PSP is a rare disorder that, like Parkinson's disease, causes problems with balance and stability when a person is walking or standing. Rigid and stiff muscles, especially those of the neck and spine, make body movement difficult. The symptom that most distinguishes PSP from Parkinson's disease and other neurologic conditions is problems with eye movement that occurs in addition to the body movement problems.

Problems with speech and swallowing are more common and become worse in PSP than they do in Parkinson's disease. Depression and emotional difficulties are also more prominent. Unlike Parkinson's disease, PSP rarely causes tremors. PSP progresses more quickly than Parkinson's and often leads to disability within 5 to 10 years.

While there is currently no cure for PSP, some symptoms may be controlled with medicines. Symptoms of depression that are related to PSP may improve with antidepressant medications, and some movement problems may respond to antiparkinson medicines such as levodopa.

Multiple system atrophy (MSA)

MSA is a series of three related disorders that slowly but progressively affect the nervous system. One disorder (called olivopontocerebellar atrophy, or OPCA) causes problems with balance, coordination, and speech. A second disorder (called striatonigral degeneration) causes slow body movement and stiff muscles similar to Parkinson's disease. The third disorder (called Shy-Drager disease) interferes with automatic body functions that are controlled by the autonomic nervous system, such as breathing, heart rate, digestion, and blood pressure.

Parkinson-like symptoms of MSA include stiff and rigid muscles and limbs, loss of balance and coordination when walking, difficulty swallowing and speaking, blurred vision, constipation and urination problems, and erectile dysfunction. Both MSA and Parkinson's disease can cause dizziness when standing up (orthostatic hypotension) due to a drop in blood pressure, which, in MSA, may be severe enough to cause brief blackouts. There is no effective way to stop the nerve degeneration that occurs with MSA, but medicines can help relieve symptoms.

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