Do any of the new brain operations for Parkinson’ s work for PSP?
Not so far, unfortunately. The operations for Parkinson’ s disease fall into two categories. One is based on the theory that the basal ganglia( the group of nuclei that control movement) are overactive. At present, the most common operation to dampen down this overactivity is subthalamic nucleus stimulation. The previous approach, pallidotomy, is rarely performed now. In PSP, however, the output area of the basal ganglia is damaged, so its activity is already dampened. The operation would only make things worse.
There are, however, trials now in progress in people with PSP to test stimulation of the area of the brain that serves balance— the pedunculopontine nucleus( PPN). The PPN is in the brainstem, which is an area tightly packed with critical circuitry. The procedure seems to be acceptably safe and does seem to help the balance problem in some patients with Parkinson’ s disease, but the overall improvement in patients is still undetermined.
In patients with Parkinson’ s, there is also an operation that attempts to replace the lost dopamine-producing brain cells. This operation is unlikely to work for PSP because, while in Parkinson’ s, most of the movement problem is caused by loss of the main dopamine-producing nucleus( the substantia nigra), the movement problems in PSP are caused by the loss of many additional nuclei. Many of those other nuclei receive their input from the substantia nigra, so replacing only the first link in the chain would not help much. In addition, at this point, it would cause too much trauma to the brain to replace cells in all of the nuclei involved in PSP.
An exciting experiment in progress in Milan, Italy, but one that has only a slim chance of success, is the injection of stem cells directly into the arteries feeding the brain. This project is still in the very early phases designed to test its safety. If it succeeds, then a large project will test for benefit. The intent is not to replace lost cells, as the injections land in random spots, but to stimulate the brain to produce its own growth factors to repair the damage of PSP.
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What about other non-drug treatment?
Formal physical therapy is worth a trial in PSP, especially with the goal of teaching the patient to use gait-assistive devices, such as a walker.
Certain exercises done in the home on a regular schedule can keep the joints limber. Exercise also has a clear psychological benefit that improves a sense of well-being for anyone with a chronic illness. For specific exercises, consult one of the books for patients with Parkinson’ s disease or the pamphlets distributed by the national Parkinson organizations.
The special balance problems in PSP dictate caution in performing any exercises while standing. Many useful exercises can be performed seated in a chair or lying on a mat. Using a stationary bicycle is usually feasible as long as there is help in mounting and dismounting safely. The best strategy is to have an evaluation and treatment plan from a physical therapist or physiatrist( a physician specializing in rehabilitation of chronic conditions).