Progressive Supranuclear Palsy

What is progressive supranuclear palsy?

Progressive supranuclear palsy (PSP) is a complex condition that affects the brain.

• Progressive means that symptoms will keep getting worse over time.
• Supranuclear refers to the part of the brain affected by the disorder. It's the section above small areas called nuclei in the brainstem.
• Palsy is a disorder that results in weakness of certain muscles.

PSP affects your ability to walk normally by impairing your balance. It also affects the muscles controlling your eyes. It makes it hard to focus and see things clearly.

PSP is rare. It may be easily mistaken for Parkinson disease, which is much more common and has similar symptoms. But with PSP, speech and trouble swallowing are usually affected much more than with Parkinson disease. Problems moving the eyes, especially looking downward, are also more common in PSP. And unlike people with Parkinson disease, people with PSP are more likely to lean backward (and fall backward) rather than forward.

PSP is more common in men than women. Most of the time, it affects people in late middle age or older.

PSP symptoms continue to get worse, and the condition can't be cured. Problems that result from worsening symptoms can be life-threatening. An example is pneumonia from breathing in food particles while choking during eating.

What causes progressive supranuclear palsy?

PSP occurs when brain cells in several areas of the brain become damaged. But experts don't understand how and why these cells are damaged.

What are the symptoms of progressive supranuclear palsy?

Symptoms of PSP tend to start out subtly. Then, over time, they become more noticeable and severe. Often, the first sign is a problem with balance while walking. You may fall a lot or find that you feel a bit rigid or uncomfortable when you walk.

These are also early signs of PSP:

• Becoming more forgetful and cranky
• Having unusual emotional outbursts, like crying or laughing at unexpected times
• Becoming angry for no real reason
• Tremors in the hands
• Trouble controlling eye movements
• Blurred vision
• Slurred speech
• Trouble swallowing
• Dementia
• Depression
• Trouble directing your eyes where you want them to go
• Inability to control the eyelids, such as unwanted blinking or being unable to open your eyes
• Trouble holding someone's gaze

How is progressive supranuclear palsy diagnosed?

A careful assessment of symptoms can diagnose PSP. But it is often hard to diagnose in its early stages, as it may mimic Parkinson disease or an inner ear infection. This is because balance is so affected by PSP. Diagnosis often includes ruling out other health problems.

Balance problems and changes in gait are the clearest symptoms that can identify PSP. This is especially true when combined with an inability to control or move the eyes.

How is progressive supranuclear palsy treated?

No medicine or procedure can cure PSP or completely control its symptoms. But there are strategies and methods that can help manage many of the symptoms. These include:

• Certain medicines. Medicines used to treat Parkinson disease may improve balance and flexibility of the muscles. These include levodopa, which may be used along with other medicines. Some of the older types of antidepressants, such as amitriptyline, fluoxetine, and imipramine, can also help ease symptoms.
• Special glasses with prisms. These may improve your vision.
• A weighted tool that helps you walk more easily. It can prevent you from falling backward.
• Physical therapy and exercise. These may slightly improve flexibility in some people.
• Feeding tube. You may need a feeding tube if your symptoms are advanced and swallowing becomes too hard. This tube goes from an opening in the skin of your abdomen into the stomach. It provides you with needed nutrition.

What are possible complications of progressive supranuclear palsy?

PSP can cause serious complications when symptoms affect your ability to swallow. You could easily choke on food or breathe food into your lungs. Balance problems increase your fall risk and the danger of suffering a serious injury to the head or breaking a bone.

Living with progressive supranuclear palsy

There is no known cure for PSP. But medicines and devices can help you live with the symptoms. Speech and physical therapy can improve function. Work with your healthcare provider to find ways to make walking safer and improve your vision. Also, it is important that you do not breathe in food particles (aspirate) while you are eating. It could be life-threatening.

When should I call my healthcare provider?

It may be easy to try to brush off initial symptoms as being a little clumsy or maybe having an ear infection. But it's a good idea to see a healthcare provider at the earliest sign of symptoms, especially if you have problems with your eyes or vision.

Always seek advice from your healthcare provider if you or your caregiver notice sudden or major changes in your symptoms.

Key points about progressive supranuclear palsy

• Experts are still working to understand more about PSP and to find more effective ways to treat it.
• PSP is a progressive disease, but certain medicines can help manage some of its symptoms.
• Complications from PSP can be life-threatening. Ongoing medical follow-up is important.
• Be aware of suspicious symptoms and talk with your healthcare provider right away if you notice any problems with your eyes, vision, swallowing, or balance.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are and when they should be reported.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions, especially after office hours and on weekends and holidays.