Progressive supranuclear palsy is a degenerative disease of the brain in specific areas. Sometimes it is referred to as Parkinsons Disases Plus Disorder. The average age of onset is 60 years old, but it can occur in 40year olds and older. It may have a slight dominance in males versus females.

It is characterized by paralysis of the eyes in vertical gaze - either they cannot look up or they cannot look down. Patients have expressionless faces as if they were wearing a mask. They have trouble articulating what they mean, trouble with the content of their speech, some hyperactive jaw jerking, and possibly a lack of emotional control. They may walk with instability and have a stiff neck. Dementia may also be present. It differs from Parkinsons disease in that patients walk straight and are not bent over, there is no tremor, and they tend to fall backwards. 

Patients with this disorder tend to have many falls. The inability to adjust vertical gaze makes falls for frequent. Their speech is slurred, and they have difficulty eating.  They may exhibit personality changes.

Diagnosis is made by clinical features on examination.  Treatment is with a multidisciplinary approach, involving many doctors working as a team to best treat each patient. 

Lindsey Parker, PA-C and Justin F. Fraser, MD