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
- 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 isn't fatal. But symptoms do
continue to get worse and it 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?
Experts basically understand how
PSP happens. But they don't understand why it happens. PSP occurs when brain cells in an
area of the brain stem become damaged. But how and why these cells are damaged isn't
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
- 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
- Special glasses with prisms. These may improve your
- 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
What are possible complications of progressive supranuclear
PSP can cause serious complications
when symptoms affect your ability to swallow. You could easily choke on food or breathe
food into your lungs. And being more likely to fall raises the risk 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. Work with your healthcare
provider to find ways to make walking safer and improve your vision. PSP is not fatal.
But 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
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 itself isn't life threatening. But
its complications can be.
- Be aware of suspicious symptoms and talk with your healthcare provider if you notice any problems with your eyes, vision, or balance.
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 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 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.
- 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 provider if you have questions.
Online Medical Reviewer:
Joseph Campellone MD
Online Medical Reviewer:
Raymond Kent Turley BSN MSN RN
Date Last Reviewed:
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