DaTSCAN is helpful only when the differential is idiopathic PD vs. atypical/drug-induced parkinsonism. In suspected PSP/MSA/CBD it is usually normal or symmetrically reduced → low yield. Order MRI first (sagittal T1 + axial T2/FLAIR) looking for hummingbird, hot-cross-bun, putaminal rim, or asymmetric cortical atrophy.

Rapid dose-escalation trial: 100/25 mg tid → increase by 100–200 mg every 3–4 days up to 1000–1200 mg/day (with carbidopa) for ≥4 weeks. <10–20% sustained improvement → “levodopa-resistant” and strongly supports atypical diagnosis.

Any patient with early falls, poor levodopa response, symmetrical onset, rapid progression, or atypical features within the first 3 years. Earlier referral = higher chance of correct diagnosis and trial enrolment.

At diagnosis. These are life-limiting illnesses with median survival 6–9 years. Early palliative care improves quality of life, reduces caregiver burden, and does not shorten survival.

Amantadine 100 mg bid–tid can reduce falls and rigidity in some PSP patients (≈30% moderate response). Botulinum toxin is first-line for blepharospasm, limb dystonia (MSA), and sialorrhoea.

All patients should see speech therapy at diagnosis. Percutaneous endoscopic gastrostomy (PEG) is frequently required in PSP/MSA (dysphagia + aspiration risk). Early discussion improves outcomes.

Yes — many trials now accept “probable” diagnoses and even mixed phenotypes. See our Clinical Trials page for live filtered links.

Yes — 2025–2027 pipeline includes tau-lowering ASOs, LRRK2 inhibitors, GCase activators, and alpha-synuclein immunotherapies (Phase 2/3).