Parkinson plus syndromes.

ABSTRACT

Parkinson plus syndrome was first described in 1997 and it is accounted for 10 per cant of parkisonian patients. In Thailand there was no such case documented. We thus reported th first three patients with Parkinson plus syndrome in Thailand. Two patients (60 years old man and 51 years old woman) presented with classical parkinsonism which few years later developed cerebellar and brainstem signs (dysarthria, nystagmus, dysdiadocholinesia and progressivedysphagia).Computed brain scanning showed marked atrophy of brainstem and cerebellum. They were both diagnosed as olivopontocerebellar atrophy variety of Parkinson plus syndrome. The first patient was deteriorated in the neurological deficits that needed to be confined in bed six years later but his intellectual function was still preserved. The third patient, a 51 years old man presented with parkinsonism that was not responsed to levodopa therapy, then 2 years later he developed myoclonus of the left arm, progressive dysarthria, gait difficulty and deterioration of his intellectual function. Magnetic resonance imaging of the brain showed marked atrophy of brainstem, cerebellum, basal ganglia and cerebral cortex. Single photon emission tomography showed bilateral decreased perfusion of both parietal lobes and basal ganglia. Multiple system atrophy category of Parkinson plus syndrome was diagnosed. He was still survived at his fifth years of illness but in a dependent state at home. Patient with Parkinson plus syndrome must be diagnosed from parkinsonism because it has differ natural history treatment and prognosis.