What are the treatment options for progressive supranuclear palsy (PSP)?

Updated: Sep 24, 2018
  • Author: Stephen M Bloomfield, MD; Chief Editor: Selim R Benbadis, MD  more...
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Pharmacologic agents remain the mainstay of treatment of PSP, though the results are frequently disappointing.

Carbidopa/levodopa reduces bradykinesia and rigidity in perhaps one third of patients. However, even at high doses dopaminergic therapies usually provide only a mild, temporary improvement of parkinsonian symptoms. This is likely due to the loss of dopamine receptors in the striatum. At present, no medication provides contued relief in such patients. [29] Dopamine agonists rarely help and are most likely to cause hallucinations and confusion. Sometimes, the reduction of bradykinesia may lead to an increase in falling because of postural instability. Therefore, physical therapy and rehabilitation should focus on gait training, and the use of assistive devices such as walkers should be considered. [30]

Emotional incontinence may respond to anticholinergic agents and tricyclic antidepressants. A small controlled study of donepezil reported modest benefit for the cognitive symptoms at the expense of worsening activities of daily living (ADL) and motor scores. [31] Zolpidem has been reported to improve both motor symptoms and ocular findings, but this effect was transient. [32]

Blepharospasm can be treated with botulinum toxin injections. Botulinum toxin injections can also be useful if drooling of saliva is a disabling symptom. Dry eyes can be treated with topical lubricants. Noradrenergic agonists such as idazoxan may benefit some patients. However, sympathomimetic and other adverse effects commonly limit its usefulness. Adrenal transplantation and pallidotomy have not been helpful. Monitoring for swallowing difficulties with a modified barium swallow test allows for appropriate dietary modification or percutaneous endoscopic gastrostomy tube placement to reduce aspiration risk.

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