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Central nervous system
Central nervous system


Progressive supranuclear palsy

Definition:

Progressive supranuclear palsy is a movement disorder that occurs from damage to certain nerve cells in the brain.



Alternative Names:

Dementia-nuchal dystonia; Richardson-Steele-Olszewski syndrome; Palsy - progressive supranuclear



Causes:

Progressive supranuclear palsy is a condition that causes symptoms similar to those of Parkinson's disease .

It involves damage to many cells of the brain. Many areas are affected, including the part of the brainstem where cells that control eye movement are located. Also affected is an area of the brain that controls steadiness when you walk. The frontal lobes of the brain are also affected, leading to personality changes.

The cause of the damage to the brain cells is unknown. The disease gets worse over time.

People with this condition have deposits in brain tissues that look like those found in patients with Alzheimer's disease . There is a loss of tissue in most areas of the brain and in some parts of the spinal cord.

The disorder is most often seen in people over 60 years old, and is somewhat more common in men.



Symptoms:

Symptoms may include any of the following:

  • Changes in expressions of the face
  • Deeply lined face
  • Difficulty moving the eyes, lack of control over the eyes, or problems keeping the eyes open
  • Different sized pupils
  • Difficulty swallowing
  • General slowness of movement (bradykinesia)
  • Jaw or face jerks or spasms
  • Loss of coordination , unsteady gait (walking pattern)
  • Mild-to-moderate dementia
  • Personality changes
  • Repeated falls
  • Slow or stiff movements
  • Speech difficulties, such as low voice volume, inability to say words clearly, slow speech
  • Stiffness and rigid movement in the neck, middle of the body, arms, and legs
  • Tremor
  • Vision difficulty -- unable to look up or down without bending the neck


Exams and Tests:

An exam of the nervous system (neurological examination) may show:

  • Dementia that is getting worse
  • Difficulty walking
  • Limited eye movements, especially up and down movements
  • Normal vision, hearing, feeling, and control of movement
  • Stiff and uncoordinated movements like those of Parkinson's disease

The health care provider may do the following tests to rule out other diseases:



Treatment:

The goal of treatment is to control symptoms. There is no known cure for progressive supranuclear palsy.

Levodopa or other drugs block the action of a nervous system chemical called acetylcholine. They may temporarily reduce some symptoms, such as rigid limbs or slow movements. But these medications are usually not as effective as they are for Parkinson's disease.

Many people with this condition will eventually need around-the-clock care and monitoring as they lose brain functions.



Outlook (Prognosis):

Treatment sometimes can reduce symptoms for a period of time, but the condition will get worse. Brain function will decline over time. Death commonly occurs in 5 to 7 years.

Newer drugs are being studied to treat this condition.



Possible Complications:
  • Blood clot in veins (deep vein thrombosis ) due to limited movement
  • Injury from falling
  • Lack of control over vision
  • Loss of brain functions over time
  • Pneumonia due to┬átrouble swallowing
  • Poor nutrition (malnutrition)
  • Side effects from medications


When to Contact a Medical Professional:

Call your health care provider if you often fall, and if you have a stiff neck/body and vision problems.

Also, call if a loved one has been diagnosed with progressive supranuclear palsy and the condition has declined so much that you can no longer care for the person at home.



References:

Jankovic J. Movement disorders. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 71.

Mazorra L, Cadogan MP. Progressive supranuclear palsy. J Gerontol Nurs. 2012;38(3):8-11.




Review Date: 5/28/2014
Reviewed By: Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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