How is PSP treated? At this time, there are no medications to cure PSP or to slow its progression. Some symptoms of PSP can be managed successfully with medications for the same symptoms in other conditions. Drugs for Parkinson’ s disease that stimulate the brain’ s dopamine system, particularly carbidopa-levodopa, can be effective in alleviating some of the parkinsonism symptoms in PSP, particularly slowness and stiffness. It has also been found to reduce some of the frequency of falling. Unfortunately, the response to carbidopa-levodopa in PSP is typically not as dramatic or long-lasting as in Parkinson’ s disease. Sometimes having little to no response to carbidopalevodopa after a Parkinson’ s diagnosis can be a sign of an atypical parkinsonism disease such as PSP. Amantadine is another medication often used in Parkinson’ s disease that may have some benefit in PSP, particularly with freezing of gait.
Botox or Myobloc, two types of botulinum toxin, can be useful for people with PSP who experience blepharospasm( forced closure of the eyelids), excessive drooling, involuntary bending or turning of the neck muscles, jaw clenching, or other types of dystonia. Botox injections should be performed only by an experienced neurologist to minimize risks and side effects.
Other medications can be used to manage other symptoms of PSP, such as sleep, urinary, or mood changes. Your doctor will work with you closely to try different medications, timing, and dosages to maximize the benefits for your symptoms while also trying to minimize side effects.
Deep brain stimulation( DBS) is a brain surgery commonly offered to people with Parkinson’ s disease. There have been only relatively small case series as examples of people with PSP undergoing DBS, and in most cases it was because they were misdiagnosed as having Parkinson’ s disease. DBS worsens symptoms for people with PSP, and for this reason, DBS is not recommended for PSP at this time.
Allied health therapies are also important pillars of treatment to address many of the symptoms and challenges faced by people living with PSP. Occupational therapists can assess safety in the home environment and with driving and daily tasks, as well as provide recommendations for strategies and adaptive equipment to support independence and ease of daily activities. As research has shown repeatedly that cardiovascular exercise can slow down progression of motor decline in most neurodegenerative conditions, exercise remains a very important piece of disease management for people with PSP. Physical therapists can teach exercises that are safe to do and help to keep someone active, as well as provide recommendations for appropriate ambulatory equipment. Speech-language pathologists address speech, communication, cognition, and swallowing functions. Clinical social workers and nursing professionals are equally important members of a care team, offering resource connection, help with navigating the healthcare system, and support in decision-making. It is also important to treat anxiety or depression if it is impacting daily functioning and quality of life, which can be done through the use of mood medications and mental health therapy.
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Why is it called“ progressive supranuclear palsy”?“ Progressive” is in the name because of how symptoms change and worsen over time. The term“ supranuclear” refers to the area of the brain that is affected in PSP( at the base of the brain, in the brainstem), that causes the eye problems in PSP. In general,“ palsy” means weakness or paralysis of a part of the body. People with PSP have often difficulty aiming the eyes properly because of weakness or paralysis( palsy) of the muscles that move the eyeballs.