The information on this website is not intended for diagnosis or treatment. Please consult your physician for health concerns.

+90 850 321 50 00

Progressive Supranuclear Palsy (PSP)

Atypical parkinsonism with vertical gaze palsy and early falls

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Nöroloji department. Book Appointment →

What is Progressive Supranuclear Palsy (PSP)?

PSP is a sporadic 4R-tauopathy with characteristic pathology in the basal ganglia, brainstem and cerebellum.

Estimated prevalence is 5–7 per 100,000; mean onset age is 60–65 years.

Several clinical phenotypes are recognized: PSP-Richardson syndrome (classic), PSP-parkinsonism, PSP-progressive gait freezing, PSP-corticobasal syndrome, PSP-frontal, PSP-speech/language.

Diagnosis is clinical, supported by MRI showing midbrain atrophy ('hummingbird sign'), and the 2017 MDS-PSP criteria.

Median survival is 6–9 years from symptom onset; no disease-modifying therapy is currently available.

Symptoms

Vertical supranuclear gaze palsy (especially downgaze) — pathognomonic when present
Postural instability with backward falls within the first year
Symmetric parkinsonism with axial rigidity, poor levodopa response
Behavioral and cognitive changes: apathy, disinhibition, executive dysfunction, frontal-subcortical pattern
Pseudobulbar features: dysarthria, dysphagia, emotional incontinence
Eyelid abnormalities: blepharospasm, apraxia of lid opening or closure
Procerus sign (worried frown), reduced blinking, applause sign
Falls leading to fractures and head trauma — early disability

Risk Factors

Sporadic disease in the great majority — modest age-related risk
Rare familial forms with MAPT (tau) mutations
Specific MAPT haplotype (H1/H1) overrepresented in PSP
Possible environmental contributions (atypical parkinsonism clusters in Guadeloupe linked to annonacin)
No clear protective or modifiable risk factors identified

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Recurrent falls within first year of parkinsonism, especially backward falls
  • Early difficulty with downward gaze, frequent meal/drink spillage from impaired downgaze
  • Symmetric parkinsonism poorly responsive to levodopa
  • Rapid cognitive decline with prominent apathy and behavioral change
  • Frequent choking on food or drink (early dysphagia warning)

Treatment Methods

01
Detailed neurologic and ophthalmologic assessment; brain MRI for midbrain atrophy
02
Symptomatic levodopa trial (high doses up to 1000–1500 mg/day) — usually limited but worth attempting
03
Botulinum toxin for blepharospasm, apraxia of eyelid opening, dystonia
04
Multidisciplinary rehabilitation: physical therapy emphasizing fall prevention, occupational therapy, speech and swallow therapy
05
Antidepressants (SSRIs) for mood symptoms; cautious use of atypical antipsychotics for severe behavioral problems
06
Walking aids (weighted walkers preferred to prevent backward falls), home modifications, fall-proofing
07
Advance care planning, palliative care involvement; PEG feeding decisions when dysphagia advances

Which Department to Visit?

You can visit our Nöroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Nöroloji Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

Book AppointmentContact Us

Related Health Topics

Other articles from the same department you may want to explore.

Progressive Supranuclear Palsy and Tau Pathology

Nöroloji

PSP is a tauopathy presenting with progressive vertical supranuclear gaze palsy, balance disturbance and frequent falls; it can be confused with Parkinson's disease but does not respond to levodopa.

Headache and Migraine

Nöroloji

What you need to know about headache types, migraine attacks, and triggering factors.

Low Back Pain

Nöroloji

Learn about the most common causes of low back pain, risk factors, and appropriate treatment approaches.

Neck Pain and Cervical Disc Herniation

Nöroloji

Learn about the symptoms and treatment options for cervical disc herniation and problems in the neck region.

Epilepsy

Nöroloji

Accurate information about epilepsy, types of seizures, and recommendations for patients and families.

Parkinson Disease

Nöroloji

Parkinson disease is caused by progressive degeneration of dopaminergic neurons and alpha-synuclein accumulation; well-timed therapy substantially improves function and quality of life.

Alzheimer's Disease and Dementia

Nöroloji

Information about early signs, diagnosis, and the care process for Alzheimer's and other types of dementia.

Multiple Sclerosis (MS)

Nöroloji

What is multiple sclerosis, who is at risk, and which treatments are applied?

Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.