Atypical Parkinsonisms

The Northwestern Medicine Parkinson’s Disease & Movement Disorders Clinic, a Cure PSP Center of Care, offers comprehensive care and management of all forms of parkinsonism, including atypical syndromes such as PSP, MSA and CBD.

Parkinsonism is a clinical syndrome defined by the presence of the following symptoms:

Slowness of movement (bradykinesia)
Rigidity or stiffness of the limbs
Postural Instability (stooped, slumped posture) or loss of balance
Resting tremor (especially a pattern called pill rolling)

The presence of two of these four primary features of the syndrome is required to make the diagnosis of Parkinsonism.

Progressive Supranuclear Palsy (PSP)

PSP is a rare neurodegenerative disease that is characterized by the presence of parkinsonian symptoms in combination with limited ocular movements, specifically the inability to look down voluntarily. PSP unlike PD begins on both sides at the same time. PSP patients rarely have tremor. The major disability is difficulty with balance. However, patients can have speech and swallowing dysfunction and memory problems as well.

PSP can be misdiagnosed as PD, especially early in the disease. The cause of PSP remains unknown. Generally symptoms progress more rapidly than in PD, and patients do not respond to PD medications. The main interventions are supportive care and family education.

Multiple System Atrophy (MSA)

MSA describes a group of neurodegenerative conditions that are characterized by the presence of parkinsonism in conjunction with symptoms of other bodily functions. Hence the term “multiple system” atrophy. MSA presents with autonomic or motor deficits. Resting tremor, when a person’s hands, arms or leg may shake even at rest, may occur in MSA, but is not a predominant feature. MSA symptoms vary in onset and severity from one person to another. MSA takes several different forms.

Forms of MSA

MSA-P: MSA-P causes parkinsonian symptoms such as slowed movements and rigidity that generally do not respond to levodopa therapy. Patients also have pronounced autonomic instability manifested in symptoms such as urinary dysfunction and blood pressure instability.
MSA-C: Patients with MSA-C have difficulties with balance, coordination and speech. They may also have parkinsonian symptoms and autonomic disturbances.

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