Parkinson’s Plus Syndromes [5 important mimics]

What are the Parkinson’s Plus Syndromes?

It is best to think of the Parkinson’s Plus syndromes as the sisters of Parkinson’s disease.

Although many diseases are similar to Parkinson’s disease, the changes they produce and their symptoms are slightly different. It’s why we think of these diseases as the sisters of Parkinson’s disease.

Another name for them is the “Parkinson’s Plus” syndromes.

Sisters
PSP, MSA, CBD, and other “Parkinson’s Plus” diseases are like the sisters of Parkinson’s disease.

There are three common Parkinson’s Plus syndromes.

Parkinson's Plus Syndromes
1. Progresive Supranuclear Palsy (PSP)
2. Multiple System Atrophy (MSA)
3. Cortico Basal Degeneration (CBD)

Ideally, the specific Parkinson’s Plus Syndrome should be identified correctly before the start of treatment.

But in the early stages of the disease, this may be difficult, and sometimes impossible. You ca read more here [external link: Frontiers in Neurology].

Because it is sometimes impossible to tell PSP, MSA, and CBD apart, doctors sometimes diagnose the patient as having a “Parkinson’s Plus” syndrome without noting the specific disease.

As the years go by, the appearance of characteristic features (such as eye movement problems in PSP) may enable your doctor to make a more precise diagnosis.

Which Symptoms May Indicate a Parkinson’s Plus Syndrome?

If you have any of the following features, you may have a Parkinson’s Plus syndrome. These features are called “red flags”. This means that if you have one of these symptoms, your doctor is supposed to pause and think.

Red flags tell your doctor that you may have one of the Parkinson's Plus syndromes.
Red flag. Your doctor will be extra careful if you have any of the following symptoms.
'Red Flags' suggesting that you may have a Parkinson's Plus Syndrome
1. Lack of response to Levodopa.
2. Frequently falling down, especially backwards.
3. Severe talking or swallowing problems.
4. Problems with eye movement.
5. Impotence.
6. Blurring of vision.
7. Blacking out when rising from a seated position.
8. Problems with thinking or memory loss.
9. Personality changes.
10. Symptoms only in the legs while the arms and hands are completely normal.
11. Rapid progression of the disease

What is the Treatment for a Parkinson’s Plus Syndrome?

The treatment for a Parkinson’s Plus syndrome is the same as the treatment for Parkinson’s disease itself.

Many patients respond to Levodopa. However, what’s challenging is that sometimes Levodopa does not have a dramatic effect. It may also happen that this effect may not last for many years. Therefore, the response to levodopa is somewhat unpredictable.

LevodopaToDopamine
Once it enters the brain, Levdoopa is converted into Dopamine.

That being said, a significant proportion of patients with Parkinson’s Plus syndromes respond positively to a comprehensive treatment effort. This effort should include the treatment of special problems associated with each syndrome. Therefore, it is crucial to figure out which kind of Parkinson’s Plus syndrome early you have so that these specific problems can be treated.

For example:

  1. In PSP, the patient frequently falls backwards because the areas of the brain responsible for balance are not functioning well. In this case, balance training can help.
  2. In MSA, the patient can fall because of a drop in blood pressure when they get up. In this case, they should drink enough water and try to get up slowly to prevent falls. Some medications can also prevent falls.

What is Progressive Supranuclear Palsy (PSP)?

PSP is the most common of the “Parkinson’s Plus” syndromes. Patients with PSP frequently fall backwards.

To know more about PSP, click here: [PSP patient guide]

What is Multiple System Atrophy (MSA)?

MSA is the second most common of the “Parkinson’s Plus” syndromes. Patients with MSA have trouble with a part of their nervous system that controls blood pressure, heart rate, sweating and sexual function.

To know more about MSA, click here: [MSA in detail]

What are Other Types of Parkinson’s Plus Syndromes?

There are many other Parkinson’s Plus Syndromes. Since it’s not possible to describe each of these in detail here, I will mention their names and certain key characteristics.

  1. Corticobasal Degeneration: Characterized by difficulty using automatic movements of an arm or hand.
  2. Dementia with Lewy Bodies: Characterized by hallucinations & disorganized behaviour.
  3. Frontotemporal dementia (“Pick’s disease”): Characterized by personality changes, including impulsivity and dis-inhibition.

Here is a nice review of many Parkinson’s Plus Syndromes. It is very nicely written, but a bit detailed: [McFarland et al 2016, Neurology Continuum].

Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

Call 022-4897-1800

Send Message


NeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar IconNeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar

near LIC, Dr Balabhai Nanavati hospital, near LIC, Swami Vivekananda Road, LIC Colony, Vile Parle

4.7 57 reviews

  • Avatar JAIKUMAR MANI ★★★★★ in the last week
    My experience with Dr Siddharth Kharkar was really awesome. It’s always great to be in the presence of someone who is a renowned expert in his field & … More it brings peace of mind that the advice will obviously be the correct one. In addition, his ability to convey complex workings of the human brain in such simple terms that a layman like me could easily understand was something I really appreciated. I heartily Thank Dr Kharkar for his astute advice & gladly recommend him to anyone who needs a neurologist.
  • Avatar Rohit shetye ★★★★★ 3 weeks ago
    Best Dr. we have ever meet. Dr. Listened to us patiently and gave us the proper solution. No unnecessary test or didn’t frighten us. Thank you so much … More Dr.
  • Avatar Ashish Patil ★★★★★ 4 weeks ago
    Great doctor!! Really appreciate.The doctor diagnosed me correctly and start treatment that will help me a lots to improve my condition. The doctor is … More really good, calm and his nature is down to earth, gives confidence to patient!!! Thank you!!!
  • Avatar Bianca D'silva ★★★★★ in the last week
    We had been looking for a specialist in parkinsons for a while now, for my father and when we found Dr. Siddharth Kharka's details on Google, we were … More partly relieved. Partly because, we were all very anxious not knowing how would our visit turn out. I appreciate Dr. Kharkar and his team. He was very clear in his explanations, his knowledge about parkinsons. He took the time to answer the questions we had, went over the diagnosis and started necessary treatment immediately. The only drawback we experienced was the waiting time. Overall, we left the clinic satisfied, knowing much more than when we walked in. We would highly recommend him to anyone looking for a specialist.
  • Avatar Neelam Satghare ★★★★★ 4 weeks ago
    I have visited the doctor clinic for the first timeBut he gave good advice and helped me overcomeMy doubts and queries. It was a good experience.I am very … More thankful for cooperation.
  • Avatar Nitin Ghotge ★★★★★ a month ago
    Dr.Sidharth Kharkar is one of the best neurologist i came across ....He is really genuine and focused .....We really satisfied after consultancy...
  • Avatar Krishna kumari Radhakrishnan ★★★★★ 2 months ago
    Hi Sharing my experience with Dr KharkarI had consulted with dr regarding my husband’sProblems of tremors. Dr immediately diagnosed on video consultation … More and could help him to control the tremors s of Parkinson’s disease.I found him genuinely polite and free to talk n patiently listening to the patients problem.Now my husband regained his balance n tremors controlled. Many many thanks to Dr Kharkar
  • Avatar a kumar ★★★★★ a month ago
    Dr kharkar is very nice doctor, sir explained each and every thing very nicely, and i am thankful for Dr kharkar for his treatment .
  • Avatar Nidhi Sonawane ★★★★★ 3 months ago
    I had a positive experience with the doctor. He was very sympathetic. His communication skills were good and listened with patience.
  • Avatar Ujwala Sawant ★★★★★ a month ago
    Because of Dr.kharkar sir my husband got new life. Tnx sir.
  • Avatar Mythili Balasubramanian ★★★★★ 4 months ago
    Consultation with the doctor was a very satisfying experience. Was empathetic in his approach, and responded positively to all the queries we had. Thank … More you doctor!
  • Avatar Govind Patel ★★★★★ 2 months ago
    Doctor explained very Good nice person give length time to check body
  • Avatar Sharmila Kumawat ★★★★★ 6 months ago
    Dr Siddharth is one of the best Dr I have ever met. He is kind, polite, helpful and very selfless person. I have migraine and I am his patient since more … More than 2 years. The staff is always helpful and Dr Siddharth is just beyond words for me. Thank you for ur selfless service and kindness u give to all ur patients.

Leave a Comment

India Today Magazine - 2021Noted as one of the Best Neurologists in Mumbai