Parkinson's Disease (cont.)
What Other Diseases Resemble Parkinson's?
A number of disorders can cause symptoms similar to those of Parkinson's
disease. People with
symptoms that resemble Parkinson's disease but that result from other causes are sometimes said
to have parkinsonism. Some of these disorders are listed below.
- Postencephalitic parkinsonism. Just after the first
World War, a viral disease, encephalitis lethargica, attacked almost 5 million people throughout
the world, and then suddenly disappeared in the 1920s. Known as sleeping
sickness in the United States, this disease killed one third of its victims and
led to post-encephalitic parkinsonism in many others. This resulted in a
particularly severe form of movement disorder that appeared sometimes years
after the initial illness. (In 1973,
neurologist Oliver Sacks published
Awakenings, an account of his work in the late 1960s with surviving
post-encephalitic patients in a New York hospital. Using the then-experimental
drug levodopa, Dr. Sacks was able to temporarily "awaken" these patients from
their statue-like state). In rare cases, other viral infections, including
western equine encephalomyelitis, eastern equine encephalomyelitis, and Japanese
B encephalitis, have caused parkinsonian symptoms.
- Drug-induced parkinsonism. A reversible form of
parkinsonism sometimes results from use of certain drugs, such as chlorpromazine
and haloperidol (Haldol),
which are prescribed for patients with psychiatric disorders. Some drugs
used for stomach disorders [metoclopramide
(Reglan, Octamide, Maxolon)], high blood pressure
[reserpine
(Harmonyl)], and epilepsy (valproate) may also produce parkinsonian symptoms. Stopping the
medication or lowering the dosage of these medications usually causes the
symptoms to go away.
- Toxin-induced parkinsonism. Some toxins — such as
manganese dust, carbon disulfide, and carbon monoxide — can cause parkinsonism.
The chemical MPTP also causes a permanent form of parkinsonism that closely
resembles Parkinson's disease. Investigators discovered this reaction in the 1980s when heroin
addicts in California who had taken an illicit street drug contaminated with
MPTP began to develop severe parkinsonism. This discovery, which showed that a
toxic substance could damage
the brain and produce parkinsonian symptoms, caused a dramatic breakthrough in
Parkinson's research: for the first time, scientists were able to simulate
Parkinson's disease in
animals and conduct studies to increase understanding of the disease.
- Arteriosclerotic parkinsonism. Sometimes known as
pseudoparkinsonism, vascular parkinsonism, or atherosclerotic parkinsonism, arteriosclerotic
parkinsonism involves damage to the brain due to multiple small
strokes. Tremor
is rare in this type of parkinsonism, while dementia — the loss of mental skills
and abilities — is common. Antiparkinsonian drugs are of little help to patients
with this form of parkinsonism.
- Parkinsonism-dementia complex of Guam. This disease occurs among the Chamorro populations of Guam and the Mariana Islands and may be accompanied by a
motor neuron disease resembling
amyotrophic lateral sclerosis (Lou Gehrig's
disease). The course of the disease is rapid, with death typically occurring
within 5 years.
- Post-traumatic parkinsonism. Also known as
post-traumatic encephalopathy or "punch-drunk syndrome," parkinsonian symptoms
can sometimes develop after a severe head injury or frequent head trauma that results from boxing or other
activities. This type of trauma also can cause a form of dementia called
dementia pugilistica.
- Essential tremor. Essential tremor, sometimes called
benign essential
tremor or familial tremor, is a common condition that tends to run in families
and progresses slowly over time. The tremor is usually equal in both hands and
increases when the hands are moving. The tremor may involve the head but usually
spares the legs. Patients with essential tremor have no other parkinsonian
features. Essential tremor is not the same as Parkinson's disease, and usually does not lead to
it, although in some cases the two conditions may overlap in one person.
Essential tremor does not respond to levodopa or most other Parkinson's disease drugs, but it can
be treated with other medications.
- Normal pressure hydrocephalus.
Normal pressure hydrocephalus (NPH) is an
abnormal increase of cerebrospinal fluid
(CSF) in the brain's ventricles, or cavities. It occurs if the normal flow of
CSF throughout the brain and spinal cord is blocked in some way. This causes the
ventricles to enlarge, putting pressure on the brain. Symptoms include problems
with walking, impaired bladder control leading to urinary frequency or
incontinence, and progressive mental
impairment and dementia. The person also may have a general slowing of movements
or may complain that his or her feet feel "stuck." These symptoms may sometimes
be mistaken for Parkinson's disease. Brain scans,
intracranial pressure monitoring, and other
tests can help to distinguish NPH from Parkinson's disease and other disorders. NPH can sometimes
be treated by surgically implanting a CSF
shunt that drains
excess cerebrospinal fluid into the abdomen, where it is absorbed.
- Progressive supranuclear palsy.
Progressive supranuclear palsy (PSP), sometimes called
Steele-Richardson-Olszewski syndrome, is a rare, progressive brain disorder that
causes problems with control of gait and balance. People often tend to fall
early in the course of PSP. One of the most obvious signs of the disease is an
inability to move the eyes properly. Some patients describe this effect as a
blurring. PSP patients often show alterations of mood and behavior, including
depression and apathy as well as mild dementia. The symptoms of PSP are caused
by a gradual deterioration of brain cells in the brainstem. It is often
misdiagnosed because some of its symptoms are very much like those of
Parkinson's disease, Alzheimer's disease, and other brain disorders. PSP symptoms usually do not
respond to medication.
- Corticobasal degeneration. Corticobasal degeneration results from
atrophy
of multiple areas of the brain, including the
cerebral cortex and the basal
ganglia. Initial symptoms may first appear on one side of the body, but
eventually affect both sides. Symptoms are similar to those found in Parkinson's
disease,
including rigidity, impaired balance and coordination, and dystonia. Other
symptoms may include cognitive and visual-spatial impairments,
apraxia (loss of
the ability to make familiar, purposeful movements), hesitant and halting
speech, myoclonus (muscular
jerks), and dysphagia (difficulty swallowing).
Unlike Parkinson's disease, corticobasal degeneration usually does not respond to medication.
- Multiple system atrophy. Multiple system atrophy (MSA) refers to a set of slowly progressive
disorders that affect the central and autonomic nervous systems. MSA may have
symptoms that resemble Parkinson's disease. It also may take a form that primarily produces poor
coordination and slurred speech, or it may have a mixture of these symptoms.
Other symptoms may include breathing and swallowing difficulties, male
impotence, constipation, and urinary difficulties. The
disorder previously called Shy-Drager syndrome refers to MSA with prominent
orthostatic hypotension — a fall in blood pressure every time the person stands
up. MSA with parkinsonian symptoms is sometimes referred to as striatonigral
degeneration, while MSA with poor coordination and slurred speech is sometimes
called olivopontocerebellar atrophy.
- Dementia with Lewy bodies.
Dementia with Lewy bodies
is a neurodegenerative disorder associated with abnormal protein deposits (Lewy
bodies) found in certain areas of the brain. Symptoms can range from traditional
parkinsonian symptoms, such as bradykinesia, rigidity, tremor, and shuffling
gait, to symptoms similar to those of Alzheimer's disease. These symptoms may
fluctuate, or wax and wane dramatically. Visual hallucinations may be one of the
first symptoms, and patients may suffer from other psychiatric disturbances such
as delusions and depression. Cognitive problems also occur early in the course
of the disease. Levodopa and other antiparkinsonian medications can help with
the motor symptoms of dementia with Lewy bodies, but they may make hallucinations
and delusions worse.
- Parkinsonism accompanying other conditions. Parkinsonian symptoms may also
appear in patients with other, clearly distinct
neurological disorders such as
Wilson's disease,
Huntington's disease, Alzheimer's disease,
spinocerebellar
ataxias, and Creutzfeldt-Jakob disease. Each of these disorders has specific
features that help to distinguish them from Parkinson's disease.
MSA, corticobasal degeneration, and progressive supranuclear palsy are
sometimes referred to as "Parkinson's-plus" diseases because they have the
symptoms of Parkinson's disease plus additional features.
Next: How is Parkinson's Disease Diagnosed? »
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