Progressive Supranuclear Palsy (PSP)

Confirming a PSP diagnosis can be complicated. It causes degeneration in your brain, affecting how you walk, think, swallow and move your eyes. These signs and other symptoms can vary from person to person.

And they can also overlap with symptoms of another brain disorder, Parkinson’s disease. So, it’s easy to confuse these two conditions. Both damage areas of the brain that affect movement, causing you to be stiff, walk slower and have trouble balancing.

But PSP usually progresses (gets worse) faster than Parkinson’s disease and doesn’t respond as well to drug therapies. Tremors aren’t as common with PSP, but swallowing and speaking problems are more severe.

PSP is a chronic condition, which means you’ll have it all your life. And some of its symptoms can be life-threatening. It can sometimes cause you to get aspiration pneumonia, choke or have a serious fall.

There are also several different types of PSP. The two most common are Richardson syndrome (PSP-RS) and Parkinsonism variants (PSP-P). That’s why it’s important to work with healthcare providers who can recognize the symptoms of PSP and know which type it is. Working with an experienced team can help you get the most personalized treatment possible.

Meet Your PSP Care Team

When you come to Cleveland Clinic for PSP diagnosis and treatment, you’ll benefit from our team-based approach to care. Our skilled neurologists with experience in brain and movement disorders will lead your care team. This team is also made up of healthcare providers from other specialties, like:

• Radiologists.
• Physical therapists.
• Occupational therapists.
• Speech language therapists.
• Social workers.
• Psychologists.
• Psychiatrists.

What to expect during your first appointment

Your first appointment will be with a neurologist. They’ll begin by asking you a few questions, like:

• When did your symptoms start?
• What are they like?
• How long have you had them?

They’ll also want to know if you’ve had any changes in your mood or behavior, like depression, apathy, irritability or sudden emotional outbursts.

Then, they’ll do a physical exam and go over your medical history with you. You’ll also have a neurological exam to test your movements, walking, memory, concentration and ability to understand language, among other things.

There are no specific tests that can absolutely confirm that you have PSP, but we may do a brain MRI and a PET scan to look for abnormalities in your brain tissue. These tests can help us pinpoint what’s going on.

Treating a chronic condition, like PSP, is about managing your symptoms. Our expert care team is ready to help you live as comfortably as possible. We might recommend:

Medications

Your neurologist may prescribe:

• Antidepressant drugs to treat depression and relieve pain.
• Botulinum toxin (Botox^®, Xeomin^®, Dysport^® and Myobloc^®) injected into the muscles around your eyes to treat involuntary eye-closing.
• Drugs for Parkinson’s disease, which may help for a short time with balance, stiff muscles and slow movements.

Other therapies

In addition to medications, there are other ways we can help you manage the symptoms and stress of PSP. We might recommend:

• Counseling to help cope with mental health issues.
• Physical therapy to help keep your joints and muscles relaxed and improve your balance.
• Occupational therapy to help you improve skills for daily activities, like eating, writing and dressing.
• Speech and language therapy to help with talking and swallowing challenges.

Support for your family

Coping with the progression of PSP can be challenging — not only for you, but for your family, too. The condition can lead to severe disabilities and sometimes complications within several years. We’re here to support those you love throughout this journey. We might suggest:

• Talking to a counselor or joining a support group.
• Talking about your wishes when the condition reaches late stages (advance care planning).
• Arranging for in-home care services.
• Taking advantage of no-cost programs, like a lending library and educational presentations to help your family learn more about PSP.
• Learning about ways to modify your home for safety.
• Finding alternate housing, such as assisted-living facilities and nursing homes.

Taking the Next Step

Hearing you have a progressive rare brain disorder is life-changing for you and your loved ones. But you don’t have to face PSP alone. Cleveland Clinic’s specialists will focus on you and offer the most innovative ways to manage this condition and slow it down as much as possible. And we’ll offer compassionate support to your family, too, helping them cope with their new role as caregivers. We’re here for you and your loved ones from the moment you reach out to us with as much help as you need.