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Atypical parkinsonian syndromes: a general neurologist's perspective
Author(s) -
Deutschländer A. B.,
Ross O. A.,
Dickson D. W.,
Wszolek Z. K.
Publication year - 2018
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13412
Subject(s) - corticobasal degeneration , progressive supranuclear palsy , frontotemporal lobar degeneration , primary progressive aphasia , frontotemporal dementia , medicine , semantic dementia , pathology , c9orf72 , posterior cortical atrophy , differential diagnosis , dementia with lewy bodies , neuroscience , neuroimaging , atrophy , synucleinopathies , parkinsonism , magnetic resonance imaging , disease , dementia , psychology , parkinson's disease , radiology , psychiatry , alpha synuclein
The differential diagnosis of atypical parkinsonian syndromes is challenging. These severe and often rapidly progressive neurodegenerative disorders are clinically heterogeneous and show significant phenotypic overlap. Here, clinical, imaging, neuropathological and genetic features of multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration and frontotemporal lobar degeneration ( FTLD ) are reviewed. The terms corticobasal degeneration and FTLD refer to pathologically confirmed cases of corticobasal syndrome and frontotemporal dementia ( FTD ). Frontotemporal lobar degeneration clinically presents as the behavioral variant FTD , semantic variant primary progressive aphasia ( PPA ), non‐fluent agrammatic variant PPA , logopenic variant PPA and FTD associated with motor neuron disease. While progressive supranuclear palsy and corticobasal syndrome have been called Parkinson‐plus syndromes in the past, they are now classified as FTD ‐related disorders, reflecting that they pathologically differ from α‐synucleinopathies like multiple system atrophy and Parkinson disease. The contribution of genetic factors to atypical parkinsonian syndromes is increasingly recognized. Genes involved in the etiology of FTLD include MAPT , GRN and C9orf72 . Novel neuroimaging techniques, including tau positron emission tomography imaging, are being investigated. Multimodal magnetic resonance imaging approaches and automated magnetic resonance imaging volume segmentation techniques are being evaluated for optimized differential diagnosis. Current treatment options are symptomatic, and disease modifying therapies are under active investigation.