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Progressive Supranuclear Palsy: The Parkinson’s Mimic

Progressive Supranuclear Palsy: The Parkinson’s Mimic

You may have heard of Parkinson’s Disease — a neurological disorder that affects nearly 10 million people worldwide. But did you know that sometimes what seems to be an open and shut case of Parkinson’s Disease might be something much more uncommon? It could be Progressive Supranuclear Palsy (PSP). The two are very similar in how they present themselves, and both can cause serious, life-long problems. But there are subtle differences between the two. Let’s take a deeper look at PSP and its treatment — and how it compares to the treatment of Parkinson’s Disease.

What is PSP?

Progressive Supranuclear Palsy is an uncommon brain disease that significantly affects your motor control. A person with this condition will face serious problems with walking, balance, eye-movement, and swallowing.

The condition is caused by the degradation of brain cells that control body movement. It is a disease that worsens over time and can lead to life-long and life-threatening complications such as pneumonia and difficulty swallowing.

Early symptoms include:

  • Sudden loss of balance while walking, often resulting in falls
  • Muscle stiffness, particularly in the neck
  • Exhaustion and extreme tiredness
  • Changes in personality — irritability, apathy, mood swings
  • Difficulty controlling eye muscles, particularly when looking up or down
  • Blurred or double vision

These symptoms will gradually lead to the patient experiencing:

  • Slurred or slowed speech
  • Dysphagia (trouble swallowing)
  • Reduced blinking reflex — leading to dry and irritated eyes
  • Involuntary closing of the eyes from anywhere from a few seconds to a few hours
  • Disturbed sleep
  • The slowness of thought or memory problems
  • Neck or back pain, joint pain, and headaches

In its most advanced stages, these symptoms progress to increasingly slowed and slurred speech hindering communication. Loss of control in the throat muscles can lead

to severe swallowing issues and may require the insertion of a feeding tube to prevent choking and chest infections. Many patients may also suffer from loss of control over their bladder and bowels. There is also a mental toll — the patient will face problems with thinking, concentration, and memory, though they usually won’t lose complete awareness of themselves.

PSP vs Parkinson’s Disease You may notice that many of the symptoms listed above are similar to those present in patients with Parkinson’s Disease, a more common neurological condition. After all, both PSP and Parkinson’s are characterized by parkinsonism — stiffness, slowness, and clumsiness in movement. In fact, PSP can often be misdiagnosed as Parkinson’s due to how uncommon the disease is. But while the two are similar, they aren’t quite the same.

Symptoms Parkinson’s Disease Progressive Supranuclear Palsy Eye-related Difficulties

Usually presents as double vision, uncontrolled blinking, or excessive blinking

Usually presents as difficulty in upward/downward movement, later stages may develop double vision and involuntary closing of eyes

Tremors Present in over 70% of cases

Present in under 10% of cases

Balance A tendency to bend forwards

A tendency to either stand straight or tilt backward

Problems Swallowing Mild to moderate Moderate to severe

Sense of Smell Degrades over time Tends to remain the same

Brain Chemistry Characterized primarily by a dopamine imbalance

Characterized by a complex interaction by multiple chemicals and brain structures

Treatment of PSP

The treatment of PSP does share some similarities with the treatment of Parkinson’s Disease. However, since some symptoms are present more severely in PSP, there are some specific differences in treatment.

Most patients will be working with a multidisciplinary team of neurologists, social workers, ophthalmologists, dieticians, and therapists (speech, occupation, and physio) to create a treatment plan. There is currently no real cure for PSP, most treatments involve mitigating the symptoms as much as possible. If you suffer from PSP, your treatment plan might include:

  • Medication — Parkinson’s medication may be prescribed to help control your muscle movement. However the effects of these are limited and temporary, usually lasting only two to three years. Antidepressants might also be prescribed to combat the depression and sleep problems that often accompany PSP
  • Physiotherapy — You will be given exercises that help you strengthen your muscles and help you regain a little control over your movements. A physiotherapist can also advise you on specialized equipment such as walking frames to improve balance or special shoes to help prevent slippage
  • Speech and Language Therapy — A therapist will work with you to help manage and overcome speech problems like slurring, as well as dysphagia
  • Occupational Therapy — You will learn how to stay safe and prevent falls and other accidents in your day to day life
  • Dietary Changes — You may be referred to a dietician who can help you maintain a healthy diet while finding foods and liquids that are easier to swallow
  • Eye Care — Loss of control over the eyelids may be treated with small amounts of Botox injected around the eyelid. Botox can help block the muscle spasms in the area. An ophthalmologist may also suggest bifocals or prism lenses to help with downward eye movement
  • Stem Cell Therapy — Autologous Stem Cell Therapy can help treat the disorder at its root cause. Stem cells, which can take on the function of any cell and can accelerate healing at the cellular level, are extracted from the patient’s bone marrow, developed, and then injected intravenously. They can help rebuild degraded brain cells and improve the overall functioning of the patient

Living with Progressive Supranuclear Palsy is difficult and often frightening, but remember that you’re not alone in this experience. Creating a support system both in your personal life and treatment journey can go a long way in helping you cope with the condition. Confide in your friends and family, and look into rehabilitation centers that offer treatment of Parkinson’s Disease and PSP — start building your network of care today.

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