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Review
. 2021 Oct;21(5):376-383.
doi: 10.1136/practneurol-2020-002794. Epub 2021 Jul 2.

Progressive supranuclear palsy: diagnosis and management

James B Rowe  1   2 , Negin Holland  3   4 , Timothy Rittman  3   4
Affiliations
Review

Progressive supranuclear palsy: diagnosis and management

James B Rowe et al. Pract Neurol. 2021 Oct.

Abstract

Treating patients with progressive supranuclear palsy (PSP) is both effective and rewarding. This review aims to share our experience in the proactive management of PSP, considering the patient, the family and the medical context in which the illness unfolds. There are many opportunities to assist your patients, ameliorate their symptoms, reduce their risks and harm, and guide them through the complex medical, social and legal minefield that characterises life with chronic neurological illness. We summarise the challenges of early diagnosis, consider PSP mimics and the role of investigations in excluding these, and discuss the available pharmacological and non-pharmacological treatment strategies to tackle the common and challenging symptoms of PSP. The best treatment will be patient centred and as part of a multidisciplinary team.

Keywords: cognition; dementia; movement disorders; supranuclear palsy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Left: ‘Round-the-houses’ sign, illustrated for a downward saccade. Note the lateral curvature of downward path of eye movement (yellow arrows). The velocity may also be slow. Right: the face gives many clues to the diagnosis: as shown by this gentleman, there may be retrocollis, raised eyebrows and frontalis overactivity. People with PSP may have a rather fixed smile, with lips drawn back rather than up. The eyebrows sometimes appear knitted together (not shown). For video clips of other signs of PSP, refer to the ‘quick links to further information section’. PSP, progressive supranuclear palsy.
Figure 2
Figure 2
MRI and DaTscan features in PSP (A) and examples of MRI features of alternative diagnoses for PSP-like presentations (B), with arrows highlighling the salient feature or anomaly. MSA, multiple system atrophy; PSP, progressive supranuclear palsy.
See this image and copyright information in PMC

References

    1. Coyle-Gilchrist ITS, Dick KM, Patterson K, et al. . Prevalence, characteristics, and survival of frontotemporal lobar degeneration syndromes. Neurology 2016;86:1736–43. 10.1212/WNL.0000000000002638 - DOI - PMC - PubMed
    1. Murley AG, Coyle-Gilchrist I, Rouse MA. Redefining the multidimensional clinical phenotypes of frontotemporal lobar degeneration syndromes. Brain 2020;143:1555–71. 10.1093/brain/awaa097. [Epub ahead of print: 01 May 2020]. - DOI - PMC - PubMed
    1. Steele JC, Richardson JC, Olszewski J. Progressive supranuclear palsy. A heterogeneous degeneration involving the brain stem, basal ganglia and cerebellum with vertical gaze and pseudobulbar palsy, nuchal dystonia and dementia. Arch Neurol 1964;10:333–59. 10.1001/archneur.1964.00460160003001 - DOI - PubMed
    1. Höglinger GU, Respondek G, Stamelou M, et al. . Clinical diagnosis of progressive supranuclear palsy: the movement disorder Society criteria. Mov Disord. 2017;32:853–64. 10.1002/mds.26987 - DOI - PMC - PubMed
    1. Imaging and atypical parkinsonism - ACNR | Paper & Online Neurology Journal ACNR | Paper & Online Neurology Journal. Available: https://www.acnr.co.uk/2015/01/imaging-and-atypical-parkinsonism/ [Accessed 11 Jan 2021].

MeSH terms