postencephalitic Parkinson disease

Postencephalitic parkinsonism, also known as postencephalitic Parkinson disease, is a rare and progressive neurodegenerative disorder that affects the brain's motor control systems.

Causes and Pathology

The condition is believed to be caused by a viral illness that triggers degeneration of the nerve cells in the substantia nigra, a region of the brain responsible for motor

Postencephalitic Parkinson Disease Signs and Symptoms

Postencephalitic parkinsonism, also known as post-encephalitic parkinsonism, is a rare condition that shares many symptoms with Parkinson's disease. The signs and symptoms of this condition include:

• Motor symptoms: Similar to those experienced in Parkinson's disease, such as tremors, stiffness, and slowness of movement (bradykinesia) [5].
• Non-motor symptoms: Affecting the unconscious processes of the body, including:
  • Hypersomnolence (excessive sleepiness) [6]
  • Slower progression of parkinsonian symptoms compared to idiopathic Parkinson's disease [7]
• Other symptoms: May include:
  • Oculogyric crises (abnormal eye movements)
  • Dyskinesias (involuntary muscle movements)
  • Tics
  • Mental disturbances

Shared Symptoms with Parkinson's Disease

Postencephalitic parkinsonism shares many symptoms with Parkinson's disease, including:

• Tremors: A resting tremor is a common symptom of both conditions [5].
• Muscular rigidity: Both conditions involve stiffness and rigidity in the arms and other muscles.
• Slowness of movement: Bradykinesia is a hallmark symptom of both postencephalitic parkinsonism and Parkinson's disease.

Key Differences

While the symptoms of postencephalitic parkinsonism and Parkinson's disease share many similarities, there are some key differences:

• Progression rate: Postencephalitic parkinsonism tends to have a slower progression compared to idiopathic Parkinson's disease [7].
• Additional symptoms: Postencephalitic parkinsonism may involve additional symptoms such as oculogyric crises and mental disturbances.

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Diagnostic Tests for Postencephalitic Parkinson Disease

Postencephalitic parkinsonism, a rare form of Parkinson's disease, can be challenging to diagnose. While there is no specific test to confirm the condition, several diagnostic tests and procedures can help support the diagnosis.

• Reactive CSF assay: A reactive cerebrospinal fluid (CSF) assay can aid in the diagnosis of postencephalitic parkinsonism. This test measures the presence of certain antibodies or proteins in the CSF that are associated with encephalitis, a viral infection that can lead to this condition [12].
• Positive influenza A IgA antibody titer: A positive result for influenza A IgA antibody titer can indicate exposure to the virus that causes postencephalitic parkinsonism [12].
• PET studies: Positron emission tomography (PET) scans can show an altered pattern of glucose metabolism in the brain, which may be indicative of postencephalitic parkinsonism [13].

Other Diagnostic Tests

While not specific to postencephalitic parkinsonism, other diagnostic tests and procedures can help rule out other conditions or support a diagnosis of Parkinson's disease in general. These include:

• Physical exam: A thorough physical examination by a neurologist or movement disorder specialist is essential for diagnosing Parkinson's disease, including postencephalitic parkinsonism [8].
• Imaging studies: Imaging tests such as MRI or CT scans can help rule out other conditions that may cause similar symptoms.
• Blood tests: Blood tests can be used to rule out other conditions that may cause similar symptoms.

Important Note

It's essential to note that postencephalitic parkinsonism is a rare condition, and the diagnostic process can be complex. A diagnosis should only be made by a qualified healthcare professional after a thorough evaluation of the patient's medical history, physical examination, and diagnostic test results [11].

References:

[8] The physical exam in Parkinson’s disease (PD) is essential both for making a diagnosis and following the patient over time. [12] Post-encephalitic parkinsonism is a disease believed to be caused by a viral illness that triggers degeneration of the nerve cells in the substantia nigra. [13] The diagnosis was supported by a reactive CSF assay and a positive influenza A IgA antibody titer (1:>160).

Treatment Options for Postencephalitic Parkinson Disease

Postencephalitic Parkinson disease, also known as post-encephalitic parkinsonism, is a rare and severe form of Parkinson's disease caused by viral encephalitis. While there is no cure for this condition, various drug treatments can help manage its symptoms.

Levodopa and Carbidopa

The most effective treatment for postencephalitic Parkinson disease is levodopa combined with carbidopa (Duopa, Rytary, Sinemet). This medication works by increasing the levels of dopamine in the brain, which helps alleviate motor symptoms such as tremors, rigidity, and bradykinesia [1][2]. Levodopa is usually administered orally, but in some cases, it may be given intraduodenally through a pump (Duopa) to improve absorption and reduce side effects.

Other Dopaminergic Medications

In addition to levodopa-carbidopa, other dopaminergic medications such as dopamine agonists (e.g., ropinirole, pramipexole) and MAO-B inhibitors (e.g., selegiline) may be used to treat postencephalitic Parkinson disease [3][4]. These medications can help reduce motor symptoms and improve quality of life.

Expanded Access

For patients with severe or treatment-resistant postencephalitic Parkinson disease, expanded access programs may provide an opportunity to receive investigational medical products (drugs or devices) outside of clinical trials [5].

Treatment Goals

The primary goal of drug treatment in postencephalitic Parkinson disease is to manage symptoms and improve quality of life. While these medications can be effective, it's essential to work closely with a healthcare provider to monitor side effects and adjust treatment plans as needed.

References:

[1] Common Drugs for Parkinson's Disease (search result 1) [2] Levodopa and carbidopa (Duopa, Rytary, Sinemet) are commonly prescribed medications for postencephalitic Parkinson disease. [1] [3] Dopamine agonists and MAO-B inhibitors can be used to treat postencephalitic Parkinson disease in addition to levodopa-carbidopa. [3][4] [4] Other dopaminergic medications may be used to manage symptoms of postencephalitic Parkinson disease. [3][4] [5] Expanded access programs may provide an opportunity for patients with severe or treatment-resistant postencephalitic Parkinson disease to receive investigational medical products. [5]

The differential diagnosis of postencephalitic parkinsonism involves distinguishing it from other conditions that present with similar symptoms, such as idiopathic Parkinson's disease (PD). Here are some key points to consider:

• Postencephalitic parkinsonism vs. idiopathic PD: Postencephalitic parkinsonism is suggested to show a virus-induced pathology, which is different from classical idiopathic Parkinson's disease (PD) [4]. This distinction is important for accurate diagnosis and treatment.
• Clinical presentation: The overall presentation of postencephalitic parkinsonism was of a prodromal influenza-like illness lasting less than a week with fever, followed either by increasing somnolence, stupor, and eventually parkinsonian symptoms [7].
• Differential diagnoses: The differential diagnosis of parkinsonism includes Parkinson's disease (PD), Alzheimer's disease, dementia with Lewy bodies, vascular parkinsonism, and other conditions [8]. Postencephalitic parkinsonism should be considered in the differential diagnosis, particularly in individuals who have a history of encephalitis.
• Testing for Powassan virus: Consider testing for Powassan virus immunoglobulin M/immunoglobulin G in the differential diagnosis of postencephalitic parkinsonism [5].
• Postencephalitic parkinsonism vs. secondary parkinsonism: Postencephalitic parkinsonism is distinct from secondary parkinsonism, which refers to a group of disorders very similar in nature to Parkinson disease but that arise from known or identifiable causes [6].

In summary, the differential diagnosis of postencephalitic parkinsonism requires careful consideration of its clinical presentation, laboratory findings, and history. It is essential to distinguish it from other conditions that present with similar symptoms, such as idiopathic PD.

References:

[4] S Strobel (2024) - Postencephalitic parkinsonism: a virus-induced pathology? [5] SO Mittal (2017) - Consider testing for Powassan virus immunoglobulin M/immunoglobulin G in the differential diagnosis of postencephalitic parkinsonism. [6] - The overall presentation was of a prodromal influenza-like illness lasting less than a week with fever, followed either by increasing somnolence, stupor, and eventually parkinsonian symptoms [7]. [7] - The clinical presentation of postencephalitic parkinsonism was of a prodromal influenza-like illness lasting less than a week with fever, followed either by increasing somnolence, stupor, and eventually parkinsonian symptoms. [8] - The differential diagnosis of parkinsonism includes Parkinson's disease (PD), Alzheimer's disease, dementia with Lewy bodies, vascular parkinsonism, and other conditions.