• Carolina Brain Center, PC, Chiropractors D.C., Raleigh, NC

Atypical Parkinson’s Disease

Atypical Parkinson’s disease processes are typically not very responsive to dopaminergic medication therapy. Therefore, physical treatments offered by Carolina Brain Center are especially important in helping you achieve and maintain a better quality of life. For more information about the treatment of Parkinson’s disease at our office click here.

Progressive Supranuclear Palsy. PSP is one of the more common forms of atypical PD. PSP has a typically earlier onset (50 years of age) and progresses more rapidly than PD. Signs of PSP include imbalance resulting in falls, trunk rigidity, changes in the voice and in the ability to swallow, which results in choking, and diminished ability to move the eyes vertically (up and down). Dementia is an eventual outcome of this disease process. Some patients may have shrinking of a pontine area of the brainstem, which can be seen on an MRI of the brain. Dopaminergic medication treatment is often tried with little benefit.

Corticobasal Degeneration . CBD is the least common of the atypical causes of Parkinsonism. The initial symptoms of CBD include asymmetric bradykinesia, rigidity, limb dystonia and myoclonus (rapid jerking of a limb), postural instability, and disturbances of language. There is often marked and disabling apraxia of the affected limb, where it becomes difficult or impossible to perform coordinated movements of the affected limb even though there is no weakness or sensory loss. Sometimes this can be so severe that the movements of the affected limb cannot be controlled and is called ‘alien limb’ phenomenon. Dopaminergic medication treatment is often tried with no benefit.

Multiple System Atrophy. MSA is a larger term for several disorders in which one or more system in the body deteriorates. Included in the category of MSA are Shy-Drager syndrome (this term is rarely used anymore), Striatonigral degeneration (SND) and OlivoPontoCerebellar Atrophy (OPCA). There are two major subtypes, MSA- P (similar to SND), in which Parkinsonian signs predominate, and MSA-C, a cerebellar dysfunction type that resembles OPCP. Symptoms include bradykinesia, poor balance, abnormal autonomic function, rigidity, difficulty with coordination, or a combination of these features. Initially, it may be difficult to distinguish MSA from PD. However, if you have a more rapid progression, poor response to common PD medications, and development of other symptoms, this may indicate an MSA diagnosis.

Multiple small strokes can cause Vascular Parkinsonism. Gait disturbances are more common than tremor, and symptoms are worse in the lower extremity. Symptoms are likely to be asymmetric. They are usually abrupt in onset and then become static or slow to progress. Dopaminergic medication treatment is not likely to improve motility.

Dementia with Lewy bodies. DLB is a neurodegenerative disorder that results in progressive intellectual and functional deterioration. Patients with DLB usually have early dementia, prominent visual hallucinations, fluctuations in cognitive status over the day, and Parkinsonism. It is not uncommon for patients to present with cognitive problems, particularly language problems known as aphasia. Other cognitive changes in patients with DLB include deficits in attention and executive function and the ability to produce, recognize, draw, or match figures. Dopaminergic medication treatment does not help.

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