PROGRESSIVE SUPRANUCLEAR
PALSY (PSP)
Philip A. Hanna, M.D.
Parkinson's Disease and Movement Disorders Center
New Jersey Neuroscience Institute
Edison, New Jersey
What is Progressive Supranuclear Palsy (PSP)?
Progressive supranuclear palsy (PSP), is a progressive neurological
disorder characterized by parkinsonism and abnormal eye movements. The
parkinsonism manifests as progressive instability while walking
(resulting in frequent falls), stiffness neck and trunk muscles, and
slow movements. Tremor is often not a feature of PSP. Additional
symptoms may include slurred speech, slowness of thinking, sloppy
eating habits, and difficulty swallowing. PSP occurs more common in
men, and the age at onset is typically in the 60's, approximately ten
years later than that of classic Parkinson's disease.
The walking difficulty is often the earliest and most disabling
symptom. The instability is probably due to a combination of
impairment of postural reflexes, stiffness, slowness, and difficulty
with eye movement, particularly looking downwards. After an average of
7 to 9 years, worsening balance often makes walking nearly impossible.
In early stages, levodopa and other drugs which act on dopamine
receptores may produce mild improvement of some of the parkinsonian
symptoms, but the visual, speech and swallowing difficulties often do
not respond to this agent. Treatment is otherwise tailored to specific
symptoms. For example, antidepressant medications such as ProzacŪ
(generic name, fluoxetine), ElavilŪ (amitriptyline), and
TofranilŪ(imipramine)
are sometimes helpful for mood stabilization. Spasms of eyelid
closure, can sometimes be effectively treated with botulinum toxin
injections. Physical therapy designed to relieve stiffness (rigidity)
helps prevent deformities while conditioning exercises help maintain
strength. Walkers, which are weighted in front and the use of shoes
with built-up heels can also help decrease falling backwards.
Society for Progressive Supranuclear Palsy (SPSP), Inc
Johns Hopkins Outpatient Center
601 N. Caroline St., Suite 5065
Baltimore, MD 21287
Tel: 1-800-457-4777; Fax: 410-614-9260
e-mail: spsp@erols.com
http://www.psp.org
Jankovic J. Progressive supranuclear palsy. In: Griffin JW, Johnson
RT, eds. Current Therapy in Neurological Diseases, 5th Edition, Mosby-Year
Book, Inc, Chicago, 1997.
Hanna PA, Cardoso F, Jankovic J. Basal Ganglia and Movement Disorders.
In: Rolak LA, ed. Neurology Secrets, 2nd ed. New York: Hanley and
Belfus, 1998:137-169.
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