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PSP stands for progressive supranuclear palsy. It is a relatively rare neurological condition, and as the name suggests, progressive. It is a progressively deteriorating condition and is characterised by a supranuclear gaze palsy, which people have difficulty with their vertical, their up and downgaze. It was first diagnosed in Toronto in 1950, by Drs. Steele, Richardson, who noticed people had difficulty with their supranuclear gaze. In 1964, Drs. Steele, Richardson and Olszewski actually got the description and all the signs and symptoms of progressive supranuclear palsy. It was known as the Steele-Richardson-Olszewski Syndrome. In the 1950s in Toronto, Dr Clifford Richardson noticed a supranuclear gaze palsy, and in 1964, the three neurologists got together and that was the first time that all the symptoms were characterised, and it was then called progressive supranuclear palsy, PSP for short.

People have difficulty with their upward and downward gaze. One of the main characteristics of PSP is that people have eye problems. So this may start off that people will report they are having blurred vision, double vision, and as time goes on, people find it difficult to look down. So if they are looking down to try and eat, they find it difficult to look down to see food on their plate, which leads to us calling it the dirty tie syndrome, when people drop food because they cannot actually see they are putting it up into their mouth. Difficulty going downstairs, because if you cannot look down when you are going downstairs. People also have trouble with eye-opening. Often, if you are speaking to people, you will think they might be asleep, we call it blepharospasm when the eye keeps itself shut.

The treatment for that, some people have Botox, which paralyses a bit of the muscle so that easier eye-opening. Also, people may, when they are talking to you, they might start closing their eyes. There is a lot of problems associated with eye-opening, eye closure and general vision. With Parkinson's, the medication is very effective. The main medication we use is Levodopa; however, when Levodopa is given to people with PSP, there is not any response. The dose is often increased quite drastically and still, there is no response, which helps give us a differential diagnosis.

Fatigue can have an overwhelming effect on the person's quality of life, carrying out their activities of daily living, if they have hospital appointments to go to and actually judging appointments later on in the day.  It cannot be underestimated how much effort goes into getting somebody up, getting them washed and dressed, and getting them ready to go off for the appointment. Often people will need a rest before they go out.