5 Types of PSP and Treatment (Neurologist Study-Guide, Oct 2013)

“Continuum” is a journal published by the American Academy of Neurology.  Its subtitle is “Lifelong Learning in Neurology.”  It’s a study-guide for neurologists.  Every year or maybe every other year they have an issue devoted to movement disorders.  Within that issue, there’s always an article on three parkinsonian syndromes — PSP, MSA, and CBD.  This year’s article has two authors — Dr. Irene Litvan, who was the keynote speaker at our October 2012 atypical parkinsonism symposium, and Dr. David Williams, a rising star in the atypical parkinsonism community.  (Unfortunately for us, Dr. Williams lives in Australia.)

The study-guide is available at no charge online:


Continuum (Minneap Minn). 2013 Oct; 19(5 Movement Disorders): 1189–1212.
Parkinsonian Syndromes
David R. Williams, MD, MBBS, PhD, FRACP and Irene Litvan, MD, FAAN

The PSP-related section of the study-guide has three parts:

#1 – an explanation of the five clinical subtypes of PSP, which are:

  • Richardson syndrome
  • Progressive supranuclear palsy-parkinsonism
  • Progressive supranuclear palsy-pure akinesia with gait freezing
  • Progressive supranuclear palsy-corticobasal syndrome
  • Progressive supranuclear palsy-frontotemporal dementia

Videos are available of someone with Richardson syndrome (Dr. Litvan is heard/seen) and of someone with PSP-parkinsonism (Dr. Williams is heard/seen).  Other than the videos, I think most of the explanation of the five subtypes and both of the case write-ups will include too much medical lingo for many in our group.

#2 – a very short section on “natural history.”  This is easy-to-read.

#3 – treatment paradigm.  I suggest you concentrate on this section.  Though it has quite a bit of medical jargon, I think it’s understandable.  Interesting to me is the suggestion to use solifenacin (Vesicare) for bladder issues.  I first heard about this prescription medication years ago from a local PSP support group member.  A suggestion is also made about using botox for various symptoms.  We didn’t try botox of neurogenic bladder, but we did use it to good effect for treatment of dystonic postures and severe rigidity.