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The following diseases resemble Parkinson's disease but are not PD. They are often classified as "Parkinson's Plus" because of their similarity in symptom to PD. In most cases these diseases do not respond to Levodopa treatment. Normally, a signal that one of these diseases may be active is the lack of response to Levodopa and a faster than expected progression. In almost all cases there is no drug therapy other than PD therapy which is of very limited value. Surgery, such as thalamotomy and pallidotomy, are of very limited value. Pallidotomy has shown about a two month period with reduced symptoms and then the patient reverts to conditions prior to the surgery. Here is a partial list of "Parkinson's Plus" diseases. Shy-Drager Syndrome: A condition in which the earliest and most severe symptoms are those of insufficiency of the autonomic nervous system: dizziness on standing, bladder difficulty and impotence. These autonomic symptoms are followed by PD symptoms such as rigidity, tremor, bradykinesia, postural instability and gait difficulty. Striatonigral Degeneration (SND): The patient becomes stiff and slow and develops difficulty with balance and walking. Usually patients do not have tremor. The damage is in the striatum and not the substantia nigra. Progressive Supranuclear Palsy (PSP): Patients develop paralysis of their eye movements, difficulty in speaking, rigidity and senility. This disorder causes changes in the brain that are similar to those of PD, but are even more extensive. Olivopontocerebellar Degeneration (OPCA): Patients have difficulty with balance and walking, often called ataxia. There may exist an action or postural tremor, but they do not have rigidity or bradykinesia. The disorder results from a deterioration of certain structures in the nervous system including the cerebellum, the pons( a part of the brainstem) and the olive (a part of the brainstem). Muiltisystem Atrophy (MSA): OPCA and SND are often lumped together under MSA. If the symptoms show problems with blood pressure, control of urinary bladder and sexual disfunction it is called "Shy-Drager." The above discriptions are from two books: Parkinson's Disease, A Guide for Patient and Family by Roger Duvoisin, MD and Parkinson's Disease, The Complete Guide for Patients and Caregivers by Abraham Lieberman, MD. I caution all of you with PD thinking you have PD+. These are classified as rare and then the books say that about 20% of those with PD are later diagnosed as PD+. The books also classify these diseases as NOT PD. That is why they do not respond to anti-parkinson drug therapy, such as levodopa. Secondly, they progress much faster than PD. And thirdly, little if any, research is being done on these diseases. There is a PSP society in the US. It is called PSPS. I will forward the address when I am able to find it. I know that PSPS has been working to get more government funding for research. Again I caution all of you with PD. I have almost all of the symptoms defined for each of the PD+ diseases. My difference is that I respond to Levodopa in the form of Sinemet. I also respond to Permax and other anti-parkinson medications. Finally, most neurologists do not say PD+. They may hint at "Atypical PD" and even then they may be only frustrated with their inability to control the patient with drug therapy. If you suspect PD+ ask your doctor point blank about the diagnosis. If you get a wishy-washy answer, get a second opinion from an expert. PD+ is serious and an improper diagnosis in either direction can be disasterous for the patient and family. Regards, Alan Bonander ([log in to unmask])