Symptoms and Signs of Progressive Supranuclear Palsy (PSP)

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 12/2/2021

Doctor's Notes on Progressive Supranuclear Palsy (PSP)

Progressive supranuclear palsy (also referred to as PSP or Steele-Richardson-Olszewski syndrome) is a rare progressive and degenerative disease of the brain (nerve cells) that affects movement and gait (control of walking). PSP is a rare disease and it usually develops in people aged 60 years or older. The cause of PSP is unknown, though in a very few cases it seems to run in families. 

Symptoms of progressive supranuclear palsy usually appear slowly and may include

Over time, additional symptoms of progressive supranuclear palsy may include

  • balance problems,
  • stiff or awkward steps while walking,
  • slow movements,
  • frequent falls,
  • visual problems and eye movement problems,
  • behavior or personality changes,
  • memory loss,
  • apathy,
  • slowed thinking,
  • inappropriate laughing or crying,
  • angry or aggressive outbursts,
  • slurred speech,
  • difficulty swallowing,
  • mask-like facial expression (no expression),
  • muscle spasms, and
  • in later stages, urinary incontinence.

What Is the Treatment for Progressive Supranuclear Palsy (PSP)?

There is currently no effective medical treatment for progressive supranuclear palsy (PSP) and symptoms usually do not respond to medications. Medications used to treat similar symptoms in Parkinson’s patients are often tried in patients with PSP but rarely provide any benefit. Medications often tried in PSP include:

  • Botulinum toxin (Botox) for eye and face problems 
  • Levodopa for gait problems 
  • Ropinirole for shaking and slow movements 
  • Antidepressants for mood stabilization and pain relief

Patients may also need supportive care and therapy to help with progressing symptoms. Physical therapy, occupational therapy, and respiratory therapy may all be involved in the care of advanced PSP patients. Patients often need walking and other assistive devices to try to prevent falls. Patients and families may need home care professionals to help with daily care activities in severe cases. If patients have trouble swallowing, they may need a feeding tube (gastrostomy tube) placed to get adequate hydration and nutrition.

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.