No single pharmacologic treatment has proven effective for the symptomatic management of
progressive supranuclear palsy.Progressive Supranuclear Palsy (PSP) is an atypical parkinsoniansyndrome characterized by early falls and non-responsiveness tolevodopa. The importance of providing beneficial results of individualmedication trials, particularly if objective data is available, cannot beoverlooked in the absence of an evidence-based approach to PSPtreatment. Further investigation into the combined use ofacetylcholine, dopamine and noradrenaline modulators to reduce fallsin early PSP is warranted.Improvement of medial lateral balance control during recovery wasunexpected; a cholinergic modulation of the cerebellum, which isinvolved in the refinement of lateral stability, is also possible as it
displays connections with the PPN. Improvement was perceived by the patient and observed by thecaregiver, mainly in response to donepezil, with a clinically significant,progressive reduction in backward falls. This observation supports therole of a cholinergic intervention in postural sensory integration by thethalamus or in attentional cortical mechanisms, under the control ofthe PPN and the nucleus basalis of Meynert, respectively.Contributions of PPN-thalamic cholinergic projections in posturalsensory integration in Parkinson's disease has been recently observedthrough a correlation between increased postural sway, established as a
risk of falling, and reduced thalamic acetylcholinesterase activity.
Emmanuelle Pourcher, Donepezil and Selegiline to Improve Balance Control in Early Progressive Supranuclear Palsy
Last date updated on July, 2014