Parkinsonian Syndrome Diagnosed via Novel Alpha-Synuclein Skin Biopsy in a Patient Presenting With Catatonic Symptoms

The differential diagnosis of neurocognitive and psychiatric disorders, particularly when symptoms overlap significantly, poses a substantial challenge in clinical practice. Parkinson's disease (PD), Lewy body dementia, and catatonia are distinct conditions that can present with similar motor and cognitive symptoms, complicating accurate diagnosis and effective treatment. We report the case of a 45-year-old male patient who presented for electroconvulsive therapy (ECT) evaluation. He was initially diagnosed with major depressive disorder with catatonic features. The clinical overlap between psychomotor retardation due to severe depression and bradykinesia, characteristic of PD, led to a reevaluation of the initial diagnosis. A novel diagnostic tool, the alpha-synuclein skin biopsy, was utilized and it revealed the presence of alpha-synuclein pathology. This ultimately led to the diagnosis of parkinsonian syndrome. The positive alpha-synuclein biopsy result was pivotal in distinguishing between catatonia and parkinsonian syndrome, facilitating the initiation of appropriate treatment. The patient's subsequent improvement underscores the importance of considering neurodegenerative etiologies in patients with atypical or treatment-resistant psychiatric symptoms. This case underscores the need for a comprehensive, multidisciplinary approach to evaluating patients with overlapping psychiatric and neurological symptoms. Integrating novel diagnostic tools, such as the alpha-synuclein biopsy, into clinical practice may enhance diagnostic accuracy and improve patient outcomes.