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PubMed2004

Prevalence of progressive supranuclear palsy in Yonago, Japan.

There have been few reports of the prevalence of progressive supranuclear palsy (PSP): the present study examines its prevalence in Japan and compares the findings with those in Europe and the United States. The prevalence per 100,000 was 5.82 (men, 9.14; women, 2.75), and the 95% confidence interval was 1.78 to 9.86 (men, 1.82-16.47; women, -1.08-6.65). Our data were comparable to those of studies in Europe and the United States.

Aged↗
PubMed1998

Dysfunction of Ib (autogenic) spinal inhibition in patients with progressive supranuclear palsy.

We compared the activity of Ib spinal interneurons in five patients with progressive supranuclear palsy (PSP) with six age-matched control subjects. Stimulation of the medial gastrocnemius nerve at motor threshold intensity activated Ib afferents that in turn inhibit H reflexes from the soleus muscle. Maximum inhibition occurred at interstimulus intervals of 6 and 8 ms for both control subjects and PSP patients and was significantly greater in the PSP patients. Increased Ib activity of PSP patients may be caused by loss of inhibition of Ib interneurons through degeneration of the medullary reticulospinal pathway. The corticospinal pathways, unopposed by the medullary reticulospinal tract, may excessively activate Ib interneurons.

Afferent Pathways↗
PubMed1994

Brain monoamines in progressive supranuclear palsy--comparison with idiopathic Parkinson's disease.

Like idiopathic Parkinson's disease (iPD), Progressive Supranuclear Palsy (PSP) is characterized, inter alia, by a pronounced non-overlapping loss of dopamine (DA) in caudate, putamen and substantia nigra. Unlike iPD, in PSP the striatal DA loss is more severe in the caudate than in the putamen; this may contribute to the higher frequency of cognitive deficits in PSP. In contrast to iPD, in patients with PSP the serotonin (5-HT) levels in the basal ganglia are not significantly reduced, thus resulting in a relative predominance of the inhibitory serotonergic influences on the motor behaviour in these patients. It is suggested that combination of levodopa with a 5-HT receptor blocker may substantially improve the (poor) responsiveness of patients with PSP to DA substitution therapy.

Biogenic Monoamines↗
PubMed1987

Progressive supranuclear palsy with lower motor neuron involvement. A case report.

The clinical picture of progressive supranuclear palsy is relatively constant, including supranuclear ophthalmoplegia, pseudobulbar palsy, axial dystonia in extension, parkinsonian signs, postural instability and dementia. A case is reported, which is unusual in having flexor dystonia of the neck and marked signs of lower motor neuron involvement.

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PubMed1996

Neuropsychological performance, disease severity, and depression in progressive supranuclear palsy.

To investigate the relationship between disease severity, cognitive impairment and depression in progressive supranuclear palsy (PSP) we studied a group of 25 patients who fulfilled strict research criteria and 25 matched controls. Disease severity was judged from the duration of symptoms, level of physical disability using the Columbia Rating Scale (CRS), and the degree of eye movement abnormality. The neuropsychological battery was designed to assess attention and executive function, visual and auditory perception, semantic memory and language production. Although the PSP group were significantly impaired on almost all of these measures, the most profound deficits were on tests of sustained and divided attention. There was no correlation between cognitive impairment and either disease duration or scores on the CRS, but performance on tests of attention correlated significantly with the degree of ocular motor impairment. Depression was found to be common in PSP but did not correlate with any other parameters. It is concluded that the cognitive deficit in PSP is widespread and independent of depression. The association between the severity of eye movement disorder and deficits in sustained and divided attention leads us to postulate that pathology involving the midbrain periaqueductal region may be critical for breakdown in these fundamental processes.

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PubMed1992

Immunohistological study of grumose degeneration of the dentate nucleus in progressive supranuclear palsy.

The grumose degeneration observed in the dentate nuclei of 7 cases of progressive supranuclear palsy (PSP) was studied with a panel of antibodies which included 2 neurofilaments, Tau and ubiquitin. Dentate nucleus neurons were negative with all antibodies except ubiquitin which showed a slightly positive homogeneous pattern of staining. The amorphous material surrounding swollen or normal neurons was strongly positive for neurofilament and subunits and numerous torpedoes were observed in the granular layer of the cerebellar cortex. Our results confirm that grumose degeneration consists in degeneration of terminal axons of Purkinje cells in the dentate nucleus. The positivity of dentate nucleus neurons for ubiquitin may support the concept of synaptic dysfunction between Purkinje cells and dentate nucleus neurons.

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PubMed2001

Strong association of a novel Tau promoter haplotype in progressive supranuclear palsy.

The microtubule associated protein, tau, is found in fibrillar lesions that characterise progressive supranuclear palsy (PSP) and related tauopathies. Mutations in the tau gene in frontotemporal dementia with parkinsonism linked to chromosome 17 (FTDP-17) and genetic association of the H1 haplotype of the tau gene with PSP has firmly established a direct role for tau in disease pathogenesis. However, the functional significance of the tau genetic association in PSP is unknown. We analysed the tau gene promoter sequence and identified two novel single nucleotide polymorphisms. Here we report the genetic association of a novel tau promoter haplotype with PSP which may influence tau transcription.

DNA Mutational Analysis↗
PubMed1997

Dystonia in progressive supranuclear palsy.

OBJECTIVES: To document the nature, distribution, and frequency of dystonic symptoms in progressive supranuclear palsy (PSP). METHODS: Charts and videotapes of all clinically diagnosed patients with PSP seen between 1983 and 1993 were reviewed and the occurrence, nature, and distribution of all dystonic symptoms were recorded. RESULTS: Of 83 identified cases 38 had some dystonic features. Twenty (24%) had blepharospasm (one was induced by levodopa), 22 (27%) had limb dystonia (one was induced by electroconvulsive therapy and another by levodopa), 14 (17%) had axial dystonia in extension, one had oromandibular dystonia induced by levodopa, and two had other cranial dystonias. Six patients had limb dystonia as an early or presenting feature, sometimes leading to misdiagnosis of cortical-basal ganglionic degeneration. All three patients who had postmortem confirmation of the diagnosis had other concurrent disease. One patient with bilateral limb dystonia and blepharospasm had evidence of previous hydrocephalus and severe arteriosclerotic changes. One with arm dystonia also had cerebrovascular disease and one with hemidystonia also had rare swollen chromatolytic neurons in the frontotemporal cortex. CONCLUSIONS: Dystonia is a common manifestation of PSP. Limb dystonia is particularly common and may indicate the presence of concurrent disease. When dystonia occurs in PSP, dopaminergic medication should be cautiously reduced or discontinued to rule out the possibility of treatment induced symptoms.

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PubMed1989

Four cases of progressive supranuclear palsy in patients exposed to organic solvents.

Four cases are described in which Progressive Supranuclear Palsy (PSP) is associated with the use of organic solvents. Two of them are a housewife and an exbanker who had multiple exposure to insecticides (with organic solvent base), followed years later with a diagnosis of PSP. The other two are of lithographers, both of whom worked at the same industrial firm where solvent exposure took place with subsequent development of PSP. The hypothesis that PSP is linked to an environmental toxin is supported by these cases.

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PubMed2003

APOE E4 is a determinant for Alzheimer type pathology in progressive supranuclear palsy.

OBJECTIVE: To assess demographic and genetic determinants of Alzheimer type pathology in progressive supranuclear palsy (PSP). METHODS: From a total of 173 pathologically proven cases of PSP in the Society for PSP Brain Bank, 143 patients (mean age = 74.4 years, ranging from 42 to 98 years) were suitable for genetic and pathologic study. Senile plaques (SPs) and neurofibrillary tangles (NFTs) were counted in five cortical areas, Braak stage was given, and APOE genotype was determined from DNA isolated from frozen brain tissue. The APOE allele frequency in PSP with varying degrees of concomitant Alzheimer type pathology was compared with pure PSP and autopsy controls. The relationship of APOE epsilon4 to quantitative pathologic measures was also assessed. RESULTS: Most patients with PSP (103 cases) had either minimal or no Alzheimer type pathology (Braak stage III or less), but 14 patients had many SPs (>20 per low power field) and a Braak stage of IV or higher consistent with pathologic criteria for AD, and 26 patients had many diffuse plaques with minimal neurofibrillary degeneration (Braak stage III or less) consistent with pathologic aging. Alzheimer type pathology was more frequent in women and older individuals with PSP, and 19 of the 40 patients with PSP with Alzheimer type pathology carried at least one APOE epsilon4 allele. The epsilon4 allele frequency was significantly higher in PSP with AD or pathologic aging than in pure PSP, and APOE epsilon4 correlated with the average maximal density of both neocortical SPs and NFTs. CONCLUSION: APOE epsilon4 is a risk factor for Alzheimer type pathology in PSP. Alzheimer type pathology is an independent process unrelated to PSP in cases with both types of pathologies.

Adult↗
PubMed2003

Atrophy of superior cerebellar peduncle in progressive supranuclear palsy.

BACKGROUND: Pathologic changes in the superior cerebellar peduncles (SCP) are common in progressive supranuclear palsy (PSP), but atrophy of the SCP has never been systematically studied. OBJECTIVE: To investigate the SCP width in PSP cases and controls with morphometric methods. METHODS: The mean width of the SCP in transverse sections of the pons at the level of trigeminal nerve was determined in 48 PSP cases (29 men, 19 women; mean age 72.5 +/- 8.2 years) and 29 age-matched control subjects, many with neurodegenerative disorders that can be clinically mistaken for PSP. As the origin of the SCP is the cerebellar dentate nucleus, correlations were sought between SCP atrophy and severity of grumose degeneration in the dentate nucleus. RESULTS: The average width of the SCP was less in PSP (range 0.09 to 0.24 cm) than in controls (range 0.21 to 0.43 cm; Mann-Whitney U test, p < 0.001), including control cases that had been clinically misdiagnosed as PSP (range 0.26 to 0.41 cm). Severity of SCP atrophy normalized by brain weight correlated with disease duration (Spearman rank order correlation, r = 0.367, p = 0.028), suggesting that SCP atrophy is a relatively early feature of PSP. No correlation was found between grumose degeneration and SCP width. CONCLUSIONS: SCP atrophy is common in PSP and correlates with disease duration. Given that measurements of the SCP are within the resolution of MRI, it remains to be determined if SCP atrophy can be used as a diagnostic marker of PSP.

Adult↗
PubMed1988

Brain amino acids and glutathione in progressive supranuclear palsy.

We measured amino acid contents in autopsied brains of seven patients with progressive supranuclear palsy (PSP) and in control subjects dying without brain disease. Glutathione was also quantitated in rapidly frozen brains of PSP patients, Parkinson's disease (PD) patients, and controls. In PSP, we found glutamic acid markedly increased in the nucleus accumbens; taurine significantly increased in nucleus accumbens, substantia nigra, and globus pallidus; and gamma-aminobutyric acid significantly increased in nucleus accumbens and putamen. Glycerophosphoethanolamine contents were significantly increased in most regions. Glutathione, which is significantly decreased in substantia nigra in PD, was increased in this brain region in PSP, suggesting that different mechanisms may be responsible for destruction of dopaminergic nigrostriatal neurons in these two disorders.

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PubMedDate not supplied

[Semiquantitative evaluation of cranial computerized tomography as diagnostic support in progressive supranuclear palsy].

INTRODUCTION AND OBJECTIVES: Different neuroimaging findings have been described in association with progressive supranuclear palsy (PSP), but their use as diagnostic support in this condition has been the subject of much discussion. PATIENTS AND METHODS: Three radiologists, non-specialists in neuroradiology and with no specific information regarding neuroimaging in Parkinson syndromes, analyzed (without knowing any clinical details) seven cranial CT in five patients diagnosed as probable PSP according to NINDS-SPSS criteria, nine with idiopathic Parkinson's disease, and six persons aged over 55 years who acted as controls. The radiologists were asked to assess 17 variables as absent, moderate or severe. The results were analyzed using the chi squared test for qualitative variables and Fisher's exact test when necessary. RESULTS: The identification of the variables antero-posterior and transversal atrophy of the mid-brain, atrophy of the pons, enlargement of the perimesencephalic cisterns and the quadrigeminal plate and increased size of the third ventricle were considered to be statistically significant in the cases of PSP as compared with other observations. The small number of patients did not permit the establishment of correlation of statistical importance between the radiological parameters and clinical condition. CONCLUSIONS: We present the point of view of non-specialist neuroimaging workers, in these patients. We found that there were six parameters of interest on cranial CT which permitted differentiation of cases of PSP, idiopathic Parkinson's disease and a control population. Four of these parameters did not appear to a severe degree in patients who did not have PSP. These results are partly comparable to those published in the literature.

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PubMed2004

[Glial abnormalities in progressive supranuclear palsy and corticobasal degeneration].

OBJECTIVE: To study pathologic features of glial cells in progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) and to explore their pathologic significance. METHODS: Brain tissues from 2 cases with PSP and 3 cases with CBD, all confirmed by autopsies, were examined by routine neuropathologic methods, Gallyas-Braak staining and tau immunostaining. Brain tissues from 6 Alzheimer's disease cases, 4 cases with Parkinson's disease and 6 elderly with no neurologic abnormality were used as controls. RESULTS: Gallyas-Braak staining demonstrated tuft-shaped astrocytes and coiled-body oligodendroglial cells in the brain tissues of 2 cases with PSP and 3 cases with CBD. The tuft-shaped astrocytes appeared prominently in the frontal and parietal cortex, basal ganglia and grey matter of the brainstem. The coiled-body oligodendroglial cells were distributed widely in the white matter of the frontal and parietal lobes, basal ganglia, brainstem and cerebellum. However, astrocytic plaques, composed of degenerative stubby processes with radiating arrangement, only appeared in the frontal, parietal and cingular cortex, as well as in the striatum of 3 cases with CBD. The astrocytic plaques and tuft-shaped astrocytes coexisted in the same areas, including parietal and cingular cortex and striatum, in CBD. All these glial abnormalities showed tau-positive immunoreaction not found in control cases. CONCLUSIONS: The tuft-shaped astrocytes and coiled-body oligodendroglial cells are common glial morphologic features of both PSP and CBD. Astrocytic plaques are also characteristically seen in CBD.

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PubMed1992

[The thalamic changes in progressive supranuclear palsy].

This report is to investigate neuropathological changes of the thalamus observed in progressive supranuclear palsy. Six autopsy cases were examined. They were 5 males and a female, whose age was between 57 and 72 years old. They developed dementia in various degrees and three of the cases showed periodic stuporous state and akinetic mutism in the last stage. The paraffined thin-sections were stained with hematoxylin-eosin, luxol-fast-blue, Holzer, modified Bielschowsky, Gallyas and anti-tau stainings. The histological changes were evaluated in the aspects of neuronal loss, fibrillary gliosis and neurofibrillary tangles. In conclusion, there were three types in six cases. The first was seen in two cases and that there appeared many Alzheimer's neurofibrillary tangles (NFTs) in medial nuclei, lateral and ventral nuclei as well as zona incerta and reticular nucleus. The second was observed in two cases and that the loss of nerve cells was severe, especially in medial nuclei and the dorsal part of lateral and ventral nuclei and fibrillary gliosis was observed beyond the lesions of neuronal loss. The third was that the appearance of NFTs was moderate in number and neuronal loss was minimal. Moreover, neuronal loss and NFTs of zona incerta were common in these cases. Argentophilic fibrillary inclusions were observed in the neuropil and astrocytes in all cases. It is important to investigate the correlations between neuropathological changes and clinical manifestations, especially in the peculiar type of dementia observed in PSP. The thalamic changes of PSP may play an important role in causing stuporous state and akinetic mutism as well as subcortical dementia.

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PubMed1991

[An autopsy case of progressive supranuclear palsy with olivary hypertrophy].

Clinical and pathologic findings of an autopsy case of progressive supranuclear palsy (PSP) with a 7 year clinical course are described. The patient exhibited clinical findings of typical PSP, cerebellar signs and rhythmical myoclonus that was about 2 Hz and synchronous in the eyes, palate, and pharynx, which is so called palatal myoclonus. Pathological findings compatible with those in PSP i.e. loss of nerve cells, neurofibrillary tangles (NFT), and gliosis were found in the globus pallidum, thalamus, subthalamic nucleus, substantia nigra, locus coeruleus, nucleus of Raphe, reticular formation, dentate nucleus, and inferior olives. Nerve cells in the nucleus basalis were preserved. Distinctive findings included marked degeneration of the dentate nucleus, prominent hypertrophy of the inferior olives, and atrophy and subcortical gliosis of the frontal lobe. Hypertrophy of the inferior olives and palatal myoclonus represent an unusual PSP. It is presumed hypoxic injury unmasked the palatal myoclonus in this setting of dentate nucleus and inferior olivary complex degeneration.

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PubMedDate not supplied

[A trial of progressive supranuclear palsy with carbamazepine].

We present a 61-year old patient with diagnosis of progressive supranuclear palsy. 2 years after the beginning of her complaints the diagnosis was based on the results of neurological examination. The ENG examination (among others vertical gaze paralysis) and the MR examination (2 of 3 criteria were met). The course of the disease was complicated by epilepsy and the treatment with carbamazepine was commenced. A significant improvement of her neurological and mental status was observed. The authors suggest checking this observation on larger number of patients with PSP.

Anticonvulsants↗