Palsy is a class of neuro-degenerative disorders affecting many people worldwide. Frequently seen among the geriatric population, palsy is not necessarily endemic to older generation or a specific race, infact they have also been reported in much younger populations, although the reason may be different (trauma/abuse). Progressive supranuclear palsy is a type of palsy, specific to older populations, wherein certain sections of the brain die due to various, yet unknown reasons. The most plausible explanation for PSP found is the variation in the tau protein synthesis that leads to collapse of neurological cells in the brain.
The prominence of this factor has been studied in many patients, however it hasn’t been accepted as the primary cause for PSP, instead scientists believe tau protein variation may play an assisting role in PSP. The initial symptoms of PSP are similar to Parkinson’s disease, which involves frequent loss of balance, forward stoop, frequent collisions while walking, etc. Visual symptoms, i.e. nystagmus, inability to frequently close eyelids, difficult in focusing near objects, double vision and difficulty in moving eye in a vertical axis, are some of the primary symptoms that differentiate palsy from Parkinson’s disease. In the later stages a patient may exhibit behavioral changes, dementia, swallowing difficulties and speech slurring, to name a few.
In extreme cases, paralysis and inability to move the neck is also reportedly seen. PSP is confirmed with an MRI of the brain, where brain clots or decay show affirmative signs. PSP diagnosed patients often have a window of 4-10 years, on an average 7 years until their death. The disorder has the prefix “Progressive” for the very same reason that PSP once diagnosed, is sure to result in total brain death for the patient in the near future.
Treatments or cure for PSP do not exist as of date, symptomatic relief can however be provided to patients to ease their discomfort and pain. Treatment wise patients are segregated into levodopa responsive (in case Parkinsonism is accompanied with PSP) and levodopa unresponsive. Sometimes levodopa unresponsiveness is also used as a differentiating test for PSP from Parkinson’s, however a majority of medical practitioners believe both conditions can coexist in individuals. Migraine medications are given to ease headaches, which are frequent and cause much discomfort later on. OnabotulinumtoxinA is also administered as injections to ease dystonia and muscle rigidity. Methylcellulose eye drops are administered to patients with conjunctivitis, this is because PSP patients’ exhibit lower eyelid blink rate, thereby increasing their susceptibility to eye infection.
The prevalence of PSP is moderately high, with various statistics showing occurrence among one in 16,000 to one in 100,000. Many famous celebrity cases of PSP has generated interest in the market worldwide, developed nations are the best in diagnosing patients with PSP, whereas in developing nations patients are usually confused or broadly labeled as regular palsy. The market for PSP therefore lies majorly in North Americas and Europe. Product wise the sales of Parkinson’s disease medicines have seen large sales in the Asia-Pacific region, together with migraine treatments and eye infections market. Large populations have been observed to be the major cause, as PSP and Parkinson’s have no racial or genotypic specificities. Rehabilitation centers and nursing homes for PSP patients have seen success in the U.S and Europe along with Canada and Australia. Such centers are on the rise recently in Asia too.
Some of the major manufacturers of levodopa/carbidopa are: Merck & Co, Aton Pharmaceuticals Inc., Bristol Myers Squibb Co., etc. Migraine drugs include anti-inflammatory and pain management drugs, some of these manufacturers include: GlaxoSmithKline PLC, Novartis AG, Teva Pharmaceutical Industries Ltd., etc.
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