There are four main Parkinson-plus syndromes, which present as Parkinsonism (triad of resting tremor, hypertonia, and bradykinesia) with additional clinical features
Progressive supranuclear palsy
Parkinsonism and vertical gaze palsy (dysfunction of the muscles involved in looking upwards)
Tend to present with a more symmetric and tremor-negative parkinsonism
Multiple system atrophy
Rare condition where the neurones of multiple systems in the brain degenerate
Affects the basal ganglia as well as multiple other areas
The degeneration of the basal ganglia lead to a Parkinson’s presentation
The degeneration in other areas lead to autonomic dysfunction (causing postural hypotension, constipation, abnormal sweating and sexual dysfunction) and cerebellar dysfunction (causing ataxia)
Tend to present with a more symmetric and tremor-negative parkinsonism
Cortico-basal degeneration
Parkinsonism and involves spontaneous activity by an affected limb, or akinetic rigidity of that limb - ‘alien hand syndrome’
Patients sometimes present with apraxia - the inability to conceptulise movement i.e. description of not being able to follow instructions, but being able to do them automatically
Lewy body dementia
Parkinsonism and fluctuations in cognitive impairment and visual hallucinations, often before Parkinsonian features occur
Others
Drug-induced parkinsonism
Dopamine-blocking or depleting drugs, particularly neuroleptics (with the exception of clozapine), induce parkinsonism or worsen symptoms in affected patients, and may precipitate symptoms in elderly patients in the presymptomatic phase
Antimuscarinic drugs reduce these symptoms, although tardive dyskinesia may be made worse
Wilson’s disease
Rare and treatable disorder of copper metabolism inherited as an autosomal recessive trait
Neurological manifestations:
An akinetic-rigid syndrome similar to Parkinson's disease
Pseudosclerosis dominated by tremor
Ataxia
A dystonic syndrome, which often leads to severe contractures