Ayurvedic Management of Parkinson-Plus Syndrome (Multiple System Atrophy - Parkinsonian Type): A Case Report

Parkinson-plus syndromes (PPS), or atypical parkinsonisms, are a group of neurodegenerative movement disorders that mimic idiopathic Parkinson's disease but are distinguished by additional clinical features, a poor or absent response to levodopa, and a more rapidly progressive course. Multiple System Atrophy with predominant Parkinsonism (MSA-P) is one such entity, characterised by akinetic-rigid parkinsonism, early postural instability with falls, autonomic dysfunction, and bulbar speech involvement. Modern management remains largely symptomatic and unsatisfactory. Case Report: A 72-year-old male with a two-year history of progressive gait disturbance, right lower-limb weakness, slurred speech, dysphagia, tremors and autonomic symptoms, poorly responsive to conventional anti-parkinsonian therapy, who was diagnosed with MSA-P. The presentation correlated with Vatavyadhi featuring Avarana (obstruction of Vata by Kapha) and features described under Sushrutokta Ardita Lakshana. Methodology: The patient was managed with a sequential Panchakarma protocol comprising Deepana-Pachana, Shirodhara, Nasya, Koshtashodhana, Sarvanga Abhyanga with Shashtika Shali Pinda Sweda, and Yoga Basti (Mustadi Rajayapana Basti with Ashwagandha Ghrita Anuvasana). Conclusion: Following treatment, the patient showed improvement in muscle power (Right lower limb from Grade 3/5 to 4/5), reduction in tremor, improved gait and balance, reduced freezing episodes, better sleep and mood, and an overall reduction in total symptom score from 39/68 to 18/68 on a structured symptom-scoring assessment.