Atypical Parkinsonism

Atypical Parkinsonism is an umbrella term for a group of neurodegenerative disorders associated with disabling parkinsonian motor symptoms, but with additional neurological features or etiologies not typical of Parkinson’s disease (PD). It is commonly diagnosed as Multiple System Atrophy (MSA), Progressive Supranuclear Palsy (PSP), and Corticobasal Degeneration (CBD). There is no definitive diagnostic tool or test for atypical parkinsonism, and diagnosis relies largely on thorough neurological examination and history. MSA is largely characterized by autonomic dysfunction, including fluctuations in blood pressure, abdominal symptoms and erectile problems, as well as balance and gait abnormalities and speech problems. Patients may also experience tremor, rigidity, and bradykinesia, as well as cognitive, relay and executive function impairment. PSP is primarily defined by an early onset, vertical gaze palsy, gait abnormalities due to dystonia and impaired speech, including difficulty with phrasing and verbal articulation. Additionally, rigidity, bradykinesia and tremor may also be present. Patients may also manifest with dysphagia, dementia, personality changes, and increased sensitivity to antiparkinsonian medications. Lastly, CBD presents with frontal/executive function and refractory language disorder, dystonia, rigidity, bradykinesia, and tremor. Cognitive deficits, behavioral changes, optic ataxia and alien limb phenomena may also occur. The treatment of atypical parkinsonism is largely symptomatic, and patients are typically treated with medications and physical therapy. The primary goal of therapy is to reduce pain, control rigidity, and improve balance and gait. Most patients are prescribed anticholinergic, antihistamine medications, such as benztropine, to reduce tremor. Antidepressants are also sometimes prescribed, while Dopamine agonists are only used when the patient has a positive response.