A History of Progressive Supranuclear Palsy: From Early Cases to Distinct Diagnosis

Supranuclear palsy (PSP) wasn't always recognized as the unique disorder it is today. Here's a glimpse into its historical journey:

Early Observations (1877-1963):

  • Scattered Cases: While not classified as a distinct condition, individual cases with symptoms suggestive of PSP were reported as early as 1877. French neurologist Jean-Martin Charcot documented a case of a woman with rigidity, movement issues, and eye movement problems [5].

  • Building the Picture: Throughout the following decades, more cases emerged, with researchers like Chavany in 1951 detailing the clinical and pathological features of a patient with a similar presentation [5].

The Birth of PSP (1963-1964):

  • A Defining Moment: The year 1963 marked a turning point. Neurologists John Steele, John Richardson, and Jerzy Olszewski identified a common clinical syndrome in eight patients and the characteristic brain abnormalities upon autopsy in six [1, 3].

  • Debate and a New Name: Initially, they called it "heterogeneous system degeneration" due to the involvement of various brain structures. However, with some uncertainty about the cause, Richardson suggested "progressive supranuclear palsy" (PSP) - a name that stuck [3]. This term highlights the inability to move the eyes upward due to dysfunction in brain regions above the pons (supranuclear).

Evolution and Recognition (1964-Present):

  • Refining the Diagnosis: Since the initial description, research on PSP has grown significantly. The unique cognitive changes associated with PSP, like apathy and slowed thinking, were identified in 1974 by Albert and colleagues [4].

  • Ongoing Challenges: Despite these advancements, PSP can be misdiagnosed as Parkinson's disease due to overlapping symptoms. Efforts continue to improve diagnostic accuracy and develop treatments for this progressive disorder.

The Takeaway:

The recognition of PSP as a distinct disorder is a relatively recent development in neurology. While early observations laid the groundwork, the dedicated work of Steele, Richardson, and Olszewski in the 1960s brought PSP to light. As research continues, our understanding and management of this condition are constantly evolving.