Parkinson plus syndromes

There are number of  ''Parkinson plus'' Syndromes, which are characterized by their relative lack of response to therapy with levodopa/carbidopa

1.Parkinsonism + Vertical gaze palsy = Supranuclear palsy
2.Parkinsonism + prominent ataxia = olivopontocerebellar palsy
3. Parkinsonism + prominent orthostatic hypotension = Shy-Drager syndrome (now called multiple- system atrophy)

A useful mnemonic is to think of Mr. Parkinson as fine BRITish gentleman

Bradykinesia
Rigidity (cogwheel)
Instability (postural)
Tremor (resting)

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