Available and future treatments for atypical parkinsonism. A systematic review

Abstract

Aims Success in treating patients with atypical parkinsonian syndromes, namely progressive supranuclear palsy (PSP), cortico‐basal degeneration (CBD), multiple system atrophy (MSA), Parkinson's disease with dementia (PDD), and Lewy body dementia with (LBD), remains exceedingly low. The present work overviews the most influential research literature collected on MEDLINE, ISI Web of Science, Cochrane Library, and Scopus for available treatment in atypical parkinsonisms without time restriction. Discussion Transdermal rotigotine, autologous mesenchymal stem cells, tideglusib, and coenzyme Q10 along with donepezil, rivastigmine, memantine, and the deep brain stimulation have shown some benefits in alleviating symptoms in APS. Moreover, many new clinical trials are ongoing testing microtubule stabilizer, antitau monoclonal antibody, tau acetylation inhibition, cell replacement, selective serotonin reuptake inhibitor, active immunization, inhibition of toxic α‐synuclein oligomers formation, and inhibition of microglia. Conclusion A detailed knowledge of the pathological mechanism underlying the disorders is needed, and disease‐modifying therapies are required to offer better therapeutic options to physician and caregivers of APS patients.

MDS criteria for the diagnosis of progressive supranuclear palsy overemphasize Richardson syndrome

“…In summary, the MDS criteria seem effective in clinicopathological correlations. This is of great importance since novel causal therapeutic approaches (e.g., TAU‐antibody treatment) are arising, which need assignment to the underlying pathology 15 …”

Parkinson‐like early autonomic dysfunction induced by vagal application of DOPAL in rats

“…This autonomic failure of BP regulation of PD is strongly supported by recent finding that lower urinary track and gastrointestinal dysfunction are common in early PD 52–54 and these non‐motor deficits of during early PD development such as autonomic dysfunction are well described in a recent review article 55 . The better understanding of early autonomic dysfunction and underlying mechanisms is definitely required to offer better therapeutic options to PD patients 56,57 …”

<p>Challenges and Opportunities in Atypical Parkinsonian Syndromes: Call to Action</p>

“…6 Recent clinical trials for new therapies failed to demonstrate efficacy on clinical outcome measures. [6][7][8][9] Developing an effective treatment requires an understanding of the causal mechanism and progression of disease. However, like Alzheimer's and Parkinson's disease, the etiology of atypical Parkinsonian syndromes is unknown.…”

“…11 CBD and MSA have at least four and three different phenotype categories, respectively. 7,8 Given the overlapping but distinct clinical features of atypical Parkinsonian syndromes, it is critical to understand the heterogeneity and varied phenotypes in order to improve the diagnostic odyssey these patients face.…”

“…While the average age of onset varies from 55 (MSA) to 60s (PSP and CBD) for atypical Parkinsonian syndromes, Medicare will likely see a growing financial burden as the number of people with atypical Parkinsonian syndromes grows. 3,4,8 The rapid functional decline of patients with atypical Parkinsonian syndromes will also place an economic strain on the Medicaid system, a primary payer for long-term care. Delaying utilization of a skilled nursing facility by one year can save Medicaid approximately $76,000 per patient.…”