Atypical Parkinsonism

Parkinson’s disease is a condition caused by the death of cells in the part of the brain that makes dopamine, a chemical that carries information from one nerve to another. Patients with atypical parkinsonism have many of the same symptoms as other Parkinson’s patients, but other problems as well. The cause of their disease is different and the progression is usually faster. These patients also have cells dying in the part of the brain that has receptors, cells that receive the information carried by dopamine.

There are several forms of atypical parkinsonism, which include:

  • Progressive supranuclear palsy (PSP)
  • Multiple system atrophy
  • Corticobasal degeneration (CBD)
  • Dementia with Lewy bodies (DLB)
  • Vascular parkinsonism
  • Normal pressure hydrocephalus

Symptoms

Some symptoms of atypical parkinsonism are similar to those of typical Parkinson’s, including:

  • Shaking (tremors)
  • Slowed movement
  • Stiffness
  • Difficulty walking
  • Difficulty with balance

Atypical parkinsonism also has additional symptoms associated with it which can vary depending on form of the condition, and may include:

  • Not being able to look up or down
  • Unstable blood pressure
  • Sleep disturbances
  • Visual disturbances or hallucinations
  • Prolonged, uncontrolled muscle tightness in the limbs
  • Voice changes
  • Difficulty swallowing
  • Memory problems


Causes and Risk Factors

The causes for most forms of atypical parkinsonism are unknown. Unlike typical Parkinson’s, there is no evidence that indicates that it is genetic, meaning that it does not come from parents passing it to their children. Some research has found some link to the disease and toxins in the environment that can damage the nerves that make dopamine.

Different forms of atypical parkinsonism can affect certain portions of the population differently. PSP is more frequently diagnosed in women and patients over the age of 60 years old. LBD is most often seen in men as well as patients over the age of 50, and those who have a blood relative with the condition.

Diagnosis

There is no test that can detect atypical parkinsonism at an early stage. The condition is usually diagnosed when a patient has symptoms and visits their doctor. The doctor will take a medical history and perform an examination of the nervous system.

An MRI scan may be performed to show signs of atypical parkinsonism or rule out other conditions with similar symptoms. Doctors may also order blood tests to check for abnormal thyroid hormone levels, liver damage or other problems. If dementia is a symptom, another type of imaging, called a PET scan, may be indicated.

If the doctor is having difficulty determining if the patient has Parkinson’s or atypical parkinsonism, she may ask the patient to take a dopamine supplement. This medicine, usually a drug called levodopa, helps increase the body’s dopamine supply. Patients with typical Parkinson’s disease will have improved symptoms because their dopamine receptors still work well. Those with atypical parkinsonism will not have any improvement.

Treatments

Currently there is no cure for atypical parkinsonism, although sometimes symptoms can be partially relieved with medications that affect dopamine. Other medications that may be used for treatment include botulinum toxin (Botox) and antidepressants. Other symptomatic medications may be useful.

Exercise and physical and occupational therapy are helpful at all stages of atypical parkinsonism to help maintain strength, mobility and independence.

As the individual’s medical condition changes, adjustments in treatment are needed to balance quality-of-life issues and side effects of treatment.

Emotional support and education about the illness should begin early and continue throughout the course of the disease. Participating in support groups is a good way for patients to learn more and share emotional support.