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Published online before print January 16, 2008, doi:10.1212/01.wnl.0000304134.33380.1e)
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Received August 8, 2007
Accepted October 16, 2007

Why do patients with PSP fall?

K. Liao MS, J. Wagner MD, A. Joshi MS, I. Estrovich BS, M. F. Walker MD, M. Strupp MD, and R. J. Leigh MD*

From the Neurology Service and Daroff-Dell’Osso Laboratory (K.L., A.J., I.E., M.F.W., R.J.L.), Veterans Affairs Medical Center and University Hospitals, Case Western Reserve University, Cleveland, OH; and Department of Neurology (J.W., M.S.), Ludwig Maximillians University of Munich, Germany.


* To whom correspondence should be addressed. E-mail: rjl4{at}case.edu.

ABSTRACT

Background: Patients with progressive supranuclear palsy (PSP) fall frequently, beginning early in the course of their disease. Abnormal vestibulospinal reflexes are suspected, but the angular vestibulo-ocular reflex, which is mediated by the labyrinthine semicircular canals, survives late into the course of the disease.

Objective: To test the hypothesis that otolithic-mediated reflexes are abnormal in PSP.

Methods: We tested otolith-ocular reflexes (the translational vestibulo-ocular reflex [tVOR]) during combined rotation-translation in nine patients with PSP and nine age-matched control subjects; subjects viewed far and near targets. We also tested click-induced otolith-spinal reflexes (vestibular-evoked myogenic potentials [VEMPs]) in 10 patients with PSP and 30 age-matched controls.

Results: All patients with PSP had small tVOR responses during near viewing that were, on average, only 12% of those of control subjects (p = 0.001). Patients with PSP also showed a reduction of the amplitude of VEMPs compared to control subjects (median [range]: 54.3 [16.8 to 214] vs 149 [11.6 to 466], p = 0.001).

Conclusions: Taken together, these results indicate that abnormal otolith-mediated reflexes may be at least partly responsible for frequent falls in progressive supranuclear palsy, and deserve further study.






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