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. 1999 Oct;75(888):579–584. doi: 10.1136/pgmj.75.888.579

Progressive supranuclear palsy (Steele-Richardson-Olszewski disease)

H Morris 1, N Wood 1, A Lees 1
PMCID: PMC1741377  PMID: 10621897

Abstract

Progressive supranuclear palsy is a neurodegenerative disease which affects the brainstem and basal ganglia. Patients present with disturbance of balance, a disorder of downward gaze and L-DOPA-unresponsive parkinsonism and usually develop progressive dysphagia and dysarthria leading to death from the complications of immobility and aspiration. Treatment remains largely supportive but, potentially, treatments based on cholinergic therapy may be useful. As in Alzheimer's disease, the neuronal degeneration is associated with the deposition of hyperphosphorylated tau protein as neurofibrillary tangles but there are important distinctions between the two diseases. Evidence from familial fronto-temporal dementia with parkinsonism linked to chromosome 17 suggests that tau protein deposition is a primary pathogenic event in some neurodegenerative diseases. The understanding of the mechanism of tau deposition in progressive supranuclear palsy is likely to be of importance in unravelling its aetiology.


Keywords: progressive supranuclear palsy; Steele-Richardson-Olszewski disease; tau protein

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Selected References

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  1. Aiba I., Hashizume Y., Yoshida M., Okuda S., Murakami N., Ujihira N. Relationship between brainstem MRI and pathological findings in progressive supranuclear palsy--study in autopsy cases. J Neurol Sci. 1997 Nov 25;152(2):210–217. doi: 10.1016/s0022-510x(97)00166-4. [DOI] [PubMed] [Google Scholar]
  2. Albert M. L., Feldman R. G., Willis A. L. The 'subcortical dementia' of progressive supranuclear palsy. J Neurol Neurosurg Psychiatry. 1974 Feb;37(2):121–130. doi: 10.1136/jnnp.37.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blin J., Mazetti P., Mazoyer B., Rivaud S., Ben Ayed S., Malapani C., Pillon B., Agid Y. Does the enhancement of cholinergic neurotransmission influence brain glucose kinetics and clinical symptomatology in progressive supranuclear palsy? Brain. 1995 Dec;118(Pt 6):1485–1495. doi: 10.1093/brain/118.6.1485. [DOI] [PubMed] [Google Scholar]
  4. Bower J. H., Maraganore D. M., McDonnell S. K., Rocca W. A. Incidence of progressive supranuclear palsy and multiple system atrophy in Olmsted County, Minnesota, 1976 to 1990. Neurology. 1997 Nov;49(5):1284–1288. doi: 10.1212/wnl.49.5.1284. [DOI] [PubMed] [Google Scholar]
  5. Brooks D. J., Ibanez V., Sawle G. V., Quinn N., Lees A. J., Mathias C. J., Bannister R., Marsden C. D., Frackowiak R. S. Differing patterns of striatal 18F-dopa uptake in Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy. Ann Neurol. 1990 Oct;28(4):547–555. doi: 10.1002/ana.410280412. [DOI] [PubMed] [Google Scholar]
  6. Brown J., Lantos P., Stratton M., Roques P., Rossor M. Familial progressive supranuclear palsy. J Neurol Neurosurg Psychiatry. 1993 May;56(5):473–476. doi: 10.1136/jnnp.56.5.473. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Brusa A., Mancardi G. L., Bugiani O. Progressive supranuclear palsy 1979: an overview. Ital J Neurol Sci. 1980 Oct;1(4):205–222. doi: 10.1007/BF02336701. [DOI] [PubMed] [Google Scholar]
  8. CHAVANY J. A., van BOGAERT L., GODLEWSKI S. Sur un syndrome de rigidité a predominance axiale, avec perturbation des automatismes oculopalpebraux d'origine encephalitique. Presse Med. 1951 Jul 4;59(45):958–962. [PubMed] [Google Scholar]
  9. Conrad C., Andreadis A., Trojanowski J. Q., Dickson D. W., Kang D., Chen X., Wiederholt W., Hansen L., Masliah E., Thal L. J. Genetic evidence for the involvement of tau in progressive supranuclear palsy. Ann Neurol. 1997 Feb;41(2):277–281. doi: 10.1002/ana.410410222. [DOI] [PubMed] [Google Scholar]
  10. Daniel S. E., de Bruin V. M., Lees A. J. The clinical and pathological spectrum of Steele-Richardson-Olszewski syndrome (progressive supranuclear palsy): a reappraisal. Brain. 1995 Jun;118(Pt 3):759–770. doi: 10.1093/brain/118.3.759. [DOI] [PubMed] [Google Scholar]
  11. Davis P. H., Bergeron C., McLachlan D. R. Atypical presentation of progressive supranuclear palsy. Ann Neurol. 1985 Apr;17(4):337–343. doi: 10.1002/ana.410170406. [DOI] [PubMed] [Google Scholar]
  12. Davis P. H., Golbe L. I., Duvoisin R. C., Schoenberg B. S. Risk factors for progressive supranuclear palsy. Neurology. 1988 Oct;38(10):1546–1552. doi: 10.1212/wnl.38.10.1546. [DOI] [PubMed] [Google Scholar]
  13. Dickson D. W. Neurodegenerative diseases with cytoskeletal pathology: a biochemical classification. Ann Neurol. 1997 Oct;42(4):541–544. doi: 10.1002/ana.410420403. [DOI] [PubMed] [Google Scholar]
  14. Dubois B., Pillon B., Legault F., Agid Y., Lhermitte F. Slowing of cognitive processing in progressive supranuclear palsy. A comparison with Parkinson's disease. Arch Neurol. 1988 Nov;45(11):1194–1199. doi: 10.1001/archneur.1988.00520350032011. [DOI] [PubMed] [Google Scholar]
  15. Fearnley J. M., Lees A. J. Ageing and Parkinson's disease: substantia nigra regional selectivity. Brain. 1991 Oct;114(Pt 5):2283–2301. doi: 10.1093/brain/114.5.2283. [DOI] [PubMed] [Google Scholar]
  16. Foster N. L., Aldrich M. S., Bluemlein L., White R. F., Berent S. Failure of cholinergic agonist RS-86 to improve cognition and movement in PSP despite effects on sleep. Neurology. 1989 Feb;39(2 Pt 1):257–261. doi: 10.1212/wnl.39.2.257. [DOI] [PubMed] [Google Scholar]
  17. Ghika J., Tennis M., Hoffman E., Schoenfeld D., Growdon J. Idazoxan treatment in progressive supranuclear palsy. Neurology. 1991 Jul;41(7):986–991. doi: 10.1212/wnl.41.7.986. [DOI] [PubMed] [Google Scholar]
  18. Goedert M., Jakes R., Spillantini M. G., Hasegawa M., Smith M. J., Crowther R. A. Assembly of microtubule-associated protein tau into Alzheimer-like filaments induced by sulphated glycosaminoglycans. Nature. 1996 Oct 10;383(6600):550–553. doi: 10.1038/383550a0. [DOI] [PubMed] [Google Scholar]
  19. Goetz C. G. An early photographic case of probable progressive supranuclear palsy. Mov Disord. 1996 Nov;11(6):617–618. doi: 10.1002/mds.870110604. [DOI] [PubMed] [Google Scholar]
  20. Golbe L. I., Davis P. H., Lepore F. E. Eyelid movement abnormalities in progressive supranuclear palsy. Mov Disord. 1989;4(4):297–302. doi: 10.1002/mds.870040402. [DOI] [PubMed] [Google Scholar]
  21. Golbe L. I., Rubin R. S., Cody R. P., Belsh J. M., Duvoisin R. C., Grosmann C., Lepore F. E., Mark M. H., Sachdeo R. C., Sage J. I. Follow-up study of risk factors in progressive supranuclear palsy. Neurology. 1996 Jul;47(1):148–154. doi: 10.1212/wnl.47.1.148. [DOI] [PubMed] [Google Scholar]
  22. Golbe L. I. The epidemiology of PSP. J Neural Transm Suppl. 1994;42:263–273. doi: 10.1007/978-3-7091-6641-3_20. [DOI] [PubMed] [Google Scholar]
  23. Hardman C. D., Halliday G. M., McRitchie D. A., Morris J. G. The subthalamic nucleus in Parkinson's disease and progressive supranuclear palsy. J Neuropathol Exp Neurol. 1997 Feb;56(2):132–142. doi: 10.1097/00005072-199702000-00003. [DOI] [PubMed] [Google Scholar]
  24. Hardman C. D., McRitchie D. A., Halliday G. M., Cartwright H. R., Morris J. G. Substantia nigra pars reticulata neurons in Parkinson's disease. Neurodegeneration. 1996 Mar;5(1):49–55. doi: 10.1006/neur.1996.0007. [DOI] [PubMed] [Google Scholar]
  25. Hauw J. J., Daniel S. E., Dickson D., Horoupian D. S., Jellinger K., Lantos P. L., McKee A., Tabaton M., Litvan I. Preliminary NINDS neuropathologic criteria for Steele-Richardson-Olszewski syndrome (progressive supranuclear palsy). Neurology. 1994 Nov;44(11):2015–2019. doi: 10.1212/wnl.44.11.2015. [DOI] [PubMed] [Google Scholar]
  26. Hauw J. J., Verny M., Delaère P., Cervera P., He Y., Duyckaerts C. Constant neurofibrillary changes in the neocortex in progressive supranuclear palsy. Basic differences with Alzheimer's disease and aging. Neurosci Lett. 1990 Nov 13;119(2):182–186. doi: 10.1016/0304-3940(90)90829-x. [DOI] [PubMed] [Google Scholar]
  27. Hughes A. J., Daniel S. E., Kilford L., Lees A. J. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992 Mar;55(3):181–184. doi: 10.1136/jnnp.55.3.181. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Hutton M., Lendon C. L., Rizzu P., Baker M., Froelich S., Houlden H., Pickering-Brown S., Chakraverty S., Isaacs A., Grover A. Association of missense and 5'-splice-site mutations in tau with the inherited dementia FTDP-17. Nature. 1998 Jun 18;393(6686):702–705. doi: 10.1038/31508. [DOI] [PubMed] [Google Scholar]
  29. Juncos J. L., Hirsch E. C., Malessa S., Duyckaerts C., Hersh L. B., Agid Y. Mesencephalic cholinergic nuclei in progressive supranuclear palsy. Neurology. 1991 Jan;41(1):25–30. doi: 10.1212/wnl.41.1.25. [DOI] [PubMed] [Google Scholar]
  30. Litvan I., Agid Y., Calne D., Campbell G., Dubois B., Duvoisin R. C., Goetz C. G., Golbe L. I., Grafman J., Growdon J. H. Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP international workshop. Neurology. 1996 Jul;47(1):1–9. doi: 10.1212/wnl.47.1.1. [DOI] [PubMed] [Google Scholar]
  31. Litvan I., Blesa R., Clark K., Nichelli P., Atack J. R., Mouradian M. M., Grafman J., Chase T. N. Pharmacological evaluation of the cholinergic system in progressive supranuclear palsy. Ann Neurol. 1994 Jul;36(1):55–61. doi: 10.1002/ana.410360112. [DOI] [PubMed] [Google Scholar]
  32. Litvan I. Cholinergic approaches to the treatment of progressive supranuclear palsy. J Neural Transm Suppl. 1994;42:275–281. doi: 10.1007/978-3-7091-6641-3_21. [DOI] [PubMed] [Google Scholar]
  33. Litvan I., Gomez C., Atack J. R., Gillespie M., Kask A. M., Mouradian M. M., Chase T. N. Physostigmine treatment of progressive supranuclear palsy. Ann Neurol. 1989 Sep;26(3):404–407. doi: 10.1002/ana.410260318. [DOI] [PubMed] [Google Scholar]
  34. Litvan I., Sastry N., Sonies B. C. Characterizing swallowing abnormalities in progressive supranuclear palsy. Neurology. 1997 Jun;48(6):1654–1662. doi: 10.1212/wnl.48.6.1654. [DOI] [PubMed] [Google Scholar]
  35. Mailliot C., Sergeant N., Bussière T., Caillet-Boudin M. L., Delacourte A., Buée L. Phosphorylation of specific sets of tau isoforms reflects different neurofibrillary degeneration processes. FEBS Lett. 1998 Aug 21;433(3):201–204. doi: 10.1016/s0014-5793(98)00910-7. [DOI] [PubMed] [Google Scholar]
  36. Mesulam M. M., Geula C., Bothwell M. A., Hersh L. B. Human reticular formation: cholinergic neurons of the pedunculopontine and laterodorsal tegmental nuclei and some cytochemical comparisons to forebrain cholinergic neurons. J Comp Neurol. 1989 May 22;283(4):611–633. doi: 10.1002/cne.902830414. [DOI] [PubMed] [Google Scholar]
  37. Nieforth K. A., Golbe L. I. Retrospective study of drug response in 87 patients with progressive supranuclear palsy. Clin Neuropharmacol. 1993 Aug;16(4):338–346. doi: 10.1097/00002826-199308000-00006. [DOI] [PubMed] [Google Scholar]
  38. Ohara S., Kondo K., Morita H., Maruyama K., Ikeda S., Yanagisawa N. Progressive supranuclear palsy-like syndrome in two siblings of a consanguineous marriage. Neurology. 1992 May;42(5):1009–1014. doi: 10.1212/wnl.42.5.1009. [DOI] [PubMed] [Google Scholar]
  39. Parent A., Cicchetti F. The current model of basal ganglia organization under scrutiny. Mov Disord. 1998 Mar;13(2):199–202. doi: 10.1002/mds.870130202. [DOI] [PubMed] [Google Scholar]
  40. Pollak P., Benabid A. L., Limousin P., Benazzouz A., Hoffmann D., Le Bas J. F., Perret J. Subthalamic nucleus stimulation alleviates akinesia and rigidity in parkinsonian patients. Adv Neurol. 1996;69:591–594. [PubMed] [Google Scholar]
  41. Rascol O., Sabatini U., Simonetta-Moreau M., Montastruc J. L., Rascol A., Clanet M. Square wave jerks in parkinsonian syndromes. J Neurol Neurosurg Psychiatry. 1991 Jul;54(7):599–602. doi: 10.1136/jnnp.54.7.599. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Rascol O., Sieradzan K., Peyro-Saint-Paul H., Thalamas C., Brefel-Courbon C., Senard J. M., Ladure P., Montastruc J. L., Lees A. Efaroxan, an alpha-2 antagonist, in the treatment of progressive supranuclear palsy. Mov Disord. 1998 Jul;13(4):673–676. doi: 10.1002/mds.870130411. [DOI] [PubMed] [Google Scholar]
  43. Revesz T., Sangha H., Daniel S. E. The nucleus raphe interpositus in the Steele-Richardson-Olszewski syndrome (progressive supranuclear palsy). Brain. 1996 Aug;119(Pt 4):1137–1143. doi: 10.1093/brain/119.4.1137. [DOI] [PubMed] [Google Scholar]
  44. Roy S., Datta C. K., Hirano A., Ghatak N. R., Zimmerman H. M. Electron microscopic study of neurofibrillary tangles in Steele-Richardson-Olszewski syndrome. Acta Neuropathol. 1974;29(2):175–179. doi: 10.1007/BF00684775. [DOI] [PubMed] [Google Scholar]
  45. STEELE J. C., RICHARDSON J. C., OLSZEWSKI J. PROGRESSIVE SUPRANUCLEAR PALSY. A HETEROGENEOUS DEGENERATION INVOLVING THE BRAIN STEM, BASAL GANGLIA AND CEREBELLUM WITH VERTICAL GAZE AND PSEUDOBULBAR PALSY, NUCHAL DYSTONIA AND DEMENTIA. Arch Neurol. 1964 Apr;10:333–359. doi: 10.1001/archneur.1964.00460160003001. [DOI] [PubMed] [Google Scholar]
  46. Siderowf A. D., Galetta S. L., Hurtig H. I., Liu G. T. Posey and Spiller and progressive supranuclear palsy: an incorrect attribution. Mov Disord. 1998 Jan;13(1):170–174. doi: 10.1002/mds.870130133. [DOI] [PubMed] [Google Scholar]
  47. Steele J. C. Progressive supranuclear palsy. Historical notes. J Neural Transm Suppl. 1994;42:3–14. [PubMed] [Google Scholar]
  48. Tetrud J. W., Golbe L. I., Forno L. S., Farmer P. M. Autopsy-proven progressive supranuclear palsy in two siblings. Neurology. 1996 Apr;46(4):931–934. doi: 10.1212/wnl.46.4.931. [DOI] [PubMed] [Google Scholar]
  49. Troost B. T., Daroff R. B. The ocular motor defects in progressive supranuclear palsy. Ann Neurol. 1977 Nov;2(5):397–403. doi: 10.1002/ana.410020509. [DOI] [PubMed] [Google Scholar]
  50. VERHAART W. J. Degeneration of the brain stem reticular formation, other parts of the brain stem and the cerebellum; an example of heterogenous systemic degeneration of the central nervous system. J Neuropathol Exp Neurol. 1958 Apr;17(2):382–391. doi: 10.1097/00005072-195804000-00021. [DOI] [PubMed] [Google Scholar]
  51. de Yébenes J. G., Sarasa J. L., Daniel S. E., Lees A. J. Familial progressive supranuclear palsy. Description of a pedigree and review of the literature. Brain. 1995 Oct;118(Pt 5):1095–1103. doi: 10.1093/brain/118.5.1095. [DOI] [PubMed] [Google Scholar]
  52. van Zagten M., Lodder J., Kessels F. Gait disorder and parkinsonian signs in patients with stroke related to small deep infarcts and white matter lesions. Mov Disord. 1998 Jan;13(1):89–95. doi: 10.1002/mds.870130119. [DOI] [PubMed] [Google Scholar]

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