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Neurology and Neuroscience

Parkinson's Plus

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About Parkinson's Plus

About 10 percent of patients with parkinsonism, a collection of symptoms that includes tremors, slow movement, impaired speech, and muscle stiffness, have one of three progressive neurodegenerative disorders called atypical Parkinson's or Parkinson's Plus Syndromes. These rare disorders affect the nerves that control walking, balance, mobility, vision, speech, and swallowing. The diseases progress faster in general than Parkinson's disease, and patients often have more difficulty with thought processes than with true Parkinson's disease. The disorders are:

  • Progressive supranuclear palsy (PSP)
  • Multiple system atrophy (MSA) (previously called either striatonigral degeneration, sporadic olivopontocerebellar atrophy, or Shy-Drager syndrome)
  • Corticobasal degneration (CBD)

The symptoms of PSP, MSA, and CDB are very similar to those of Parkinson's disease, and diagnosing them all correctly can be challenging. Neurologists at Columbia's Center for Parkinson's Disease and Other Movement Disorders and Weill Cornell's Parkinson's Disease and Movement Disorders Institute see many patients with both Parkinsons's and atypical Parkinson's (Parkinson's plus), and are expert at distinguishing them and helping patients and their families manage these often complex diseases.

Treatment for Parkinson's Plus

There is currently no cure for these diseases so neurologists' goal is to alleviate the symptoms. Some of the most troubling symptoms and their treatments are:

  • Rigidity and tremor, which may respond in some cases to a medication called levodopa.
  • Dystonia, which may be alleviated by intramuscular injection of botulinum toxin.
  • Orthostatic hypotension (a sudden drop in blood pressure), which can be managed with increased liquid or salt intake, compression stockings, fludrocortisone, midodrine, and other drugs that raise blood pressure.
  • Depression, which may be treated by antidepressants.
  • Constipation, which is helped by increased dietary fiber or laxatives.
  • Male impotence, which may respond to medications, or a surgical procedure (penile implant).
  • Swallowing difficulties: a modified diet or sometimes an artificial feeding tube.

Rehabilitation for Parkinson's Plus

Physical, occupational, speech, and nutrition therapy can all help patients maintain function as long as possible. Adaptive and augmentative equipment can help patients with atypical Parkinson's continue to remain mobile and ensure their safety. Rehabilitation experts at NewYork-Presbyterian will:

  • Evaluate muscle strength and motor skills and develop an individualized program to maintain existing motor function.
  • Recommend devices including neck supports, canes, walkers, and wheelchairs and equipment for the home to ensure patient safety and mobility.
  • Discuss ways to modify activities, conserve energy, and simplify work.
  • Provide voice exercises to help with speech.
  • Recommend ways to avoid complications related to difficulties swallowing.

Research for Parkinson's Plus

Researchers at Columbia's Center for Parkinson's Disease and Other Movement Disorders or Weill Cornell's Parkinson's Disease and Movement Disorders Institute are conducting studies to find the causes of these disorders, and to improve the care and management of patients who have them.

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