What features differentiate an atypical parkinsonism (Parkinson-plus syndromes) from Parkinson disease (PD)?

Updated: Jan 24, 2019
  • Author: Robert A Hauser, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Early clinical features that suggest an atypical parkinsonism rather than Parkinson disease include the following [22] :

  • Falls at presentation or early in the disease

  • Poor response to levodopa

  • Symmetry at disease onset

  • Rapid disease progression

  • No tremor

  • Dysautonomia (eg, urinary incontinence, fecal incontinence, catheterization for urinary retention, persistent erectile failure, prominent symptomatic orthostatic hypotension)

The atypical parkinsonisms are usually associated with little or no tremor, relatively early speech and balance difficulty, and little or no response to dopaminergic medications. Multiple system atrophy (MSA) is relatively symmetric and characterized by parkinsonism, often with some combination of autonomic, corticospinal, and cerebellar dysfunction. Progressive supranuclear palsy (PSP) is relatively symmetric and characterized by parkinsonism with early falls (often in the first year) and a supranuclear gaze palsy in which the patient has difficulty with voluntary down-gaze. Corticobasal ganglionic degeneration (CBD) is typically very asymmetric and characterized by both cortical (difficulty identifying objects, apraxias) and basal ganglionic (usually marked rigidity in an arm) features.


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