Progressive Supranuclear Palsy

A few points are shared about a neurological condition which is somewhat similar but not always quite similar to Parkinson’s. Generally, when we talk about Parkinson’s disease, we understand it as the typical affliction with signs which can be attributed to Parkinson’s.

However, there are a few slight variations to Parkinson’s disease – sometimes they are classified as atypical Parkinson’s. One such atypical Parkinson’s condition is called PSP – Progressive Supranuclear Palsy. In this condition, the disease mimics some (not all) symptoms and signs of Parkinson’s disease. In terms of numbers, PSP is less common than the typical Parkinson’s.

Progressive Supranuclear Palsy (PSP) is an uncommon brain disorder that affects movement, control of walking (gait) and balance, speech, swallowing, vision, mood and behaviour, and thinking. The disease results from damage to nerve cells in the brain.

The disorder’s long name indicates that the disease worsens (progressive) and causes weakness (palsy) by damaging certain parts of the brain above nerve cell clusters called nuclei (supranuclear). These nuclei mainly control eye movements. One of the classic signs of the disease is an inability to aim and move the eyes properly, which individuals may experience as blurring of vision.

One thing common in such neurological conditions is that they are age-related and can occur as one gets older. Secondly, they are progressive in nature i.e. the conditions get worse with time.

Thirdly, there is no known cause so far and there is no hereditary trait as such. Fourthly, there is no cure (not yet anyway!) – What we have are medicines or drugs which can help alleviate the symptoms and help maintain a reasonable degree of quality of life.

Fifthly, what is critical for the PSP sufferer as with Parkinson’s – is the support network of the family unit, the neurologist (a specialist physician in neurology), caregivers/ nurses and various therapists. The latter can include physiotherapists, speech therapists, and occupational therapists.

There is thus hope on the one hand and reality on the other. Anyone can be affected by such neurological conditions. One is not alone in such a situation.

Here are some tips:

1. Maintain a daily diary/register of what is happening to the patient.
2. Family members or caregivers can do this
3. Use this when taking the patient to the neurologist or therapist!

So what should one watch out for in patients with PSP?

1. Problems with swallowing food or liquids into the windpipe instead of into the food pipe. Encourage eating slowly with pauses
2. Imbalance problems – remember that with PSP one tends to fall backwards – do everything pro-actively to avoid falls and breaking bones/injuries,
3. Speech gets slurred and inaudible. Practice with a speech therapist.
4. Sight problems – lack of ability to focus with the eyes and see things properly – something more apparent in PSP patients when looking from top to bottom (than when looking sideways from one side to the other). Some eye muscle exercises can help.
5. Inability to write legibly. Practice handwriting repeatedly and slowly
Regular visits to be seen by a specialist physician doctor. Best to go with relatives/ caregiver and diary
6. Ensure personal affairs are attended to e.g. power of attorney, will, finance, documentation etc.
7. You are not alone – so join a Parkinson’s patient support group!

Dr Harshvadan Maroo, FPSK, FRPharmS

Dr. Harshvadan Maroo is a renowned and respected Senior Pharmacist based in Nairobi, Kenya. He is also an active member of the Parkinson’s support group PSG in Nairobi.

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Hellen Mwithiga

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