Parkinsonism, atypical parkinsonism and parkinsonism plus

GENERAL ASPECTS

Parkinsonism or parkinsonian syndrome consists of a conjunction of several symptoms: slowness, rigidity, resting tremor and gait and balance disturbances. The diagnosis of these symptoms is clinical since they can be detected in the neurological examination. Once the diagnosis of parkinsonism has been established, the cause of parkinsonism should be sought. It can be of secondary origin such as the intake of certain drugs, hormonal alterations, the presence of a tumor, hydrocephalus (excess fluid in the brain) or cerebral ischemia injury. If no disease is found that produces parkinsonism in a secondary way, we speak of a parkinsonism of primary origin.

The primary disease that most frequently produces these symptoms is Parkinson’s disease, but there are other less frequent neurodegenerative diseases, so they are called atypical, which can also produce parkinsonism.

Atypical parkinsonisms are characterized by having some additional features different from Parkinson’s disease and have a limited response to levodopa treatment.

TYPES OF ATYPICAL PARKINSONISMS

• Atrophy Multiple System (AMS): Patients may present with parkinsonian symptoms accompanied by urinary incontinence, erectile dysfunction, orthostatic hypotension, or difficulties in coordination and balance.
• Progressive Supranuclear Palsy (PSP): This disorder is distinguished by severe balance problems and backward falls, trunk rigidity, and eye movement difficulties.
• Corticobasal degeneration (CBD): Characterized by a combination of parkinsonian symptoms and cortical signs such as apraxia, asymmetric dystonia, myoclonias and a difficulty in performing complex voluntary movements.
• Dementia with Lewy Bodies (DLB): Unlike other atypical parkinsonisms, this disorder presents with prominent cognitive symptoms from the onset, including fluctuations in attention and cognition, visual hallucinations and parkinsonian symptoms.

DIAGNOSIS

Diagnosis involves evaluation of the clinical history, neurological testing and, in some cases, imaging tests. Identification of the specific subtype is crucial for proper management.

TREATMENT

Treatment of atypical parkinsonisms is mainly symptomatic and supportive. Therapeutic approaches may include:

• Medication: Although response to levodopa is limited, some patients may benefit from its use. Other drugs may be used to control specific symptoms, such as antidepressants for depression and medications to manage autonomic dysfunction.
• Non-pharmacological therapies: Physical and occupational therapy are crucial to maintaining the patient’s mobility and independence. Speech therapy may also be helpful for those with speech and swallowing difficulties.

In summary, atypical parkinsonisms are complex disorders that require a specialized diagnostic and therapeutic approach, as well as a multidisciplinary approach to address their multiple manifestations and improve patients’ quality of life.