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June 1982

Amitriptyline in the Management of Progressive Supranuclear Palsy

Author Affiliations

Veterans Administration Medical Center St Cloud, MN 56301

Arch Neurol. 1982;39(6):387-388. doi:10.1001/archneur.1982.00510180065029

To the Editor.—  Progressive supranuclear palsy (PSP) is a progressive disorder of the nervous system1 based on heterogenous degeneration of the midbrainstem, basal ganglia, and cerebellum. Symptoms include vertical gaze impairment, pseudobulbar palsy, nuchal dystonia, and dementia. Delayed appearance of eye signs confuses diagnosis, and these patients are sometimes thought to have Parkinson's disease or postencephalitic parkinsonism.2

Report of a Case.—  A 54-year-old man came to the Deer Lodge Hospital, Winnepeg, Manitoba, in 1978. At that time bradykinesia, tremor, and diplopia contributed to the diagnostic impression of parkinsonism. He was given a combination of levodopa and carbidopa (Sinemet), with lessening of symptoms. During the following year, he began to experience behavioral and thought disturbance suggestive of reactive depression. Bromocriptine and amitriptyline hydrochloride were added to his regimen in 1979. There was improvement in walking, but not in depressive symptoms.In the following ten months, ambulation was increasingly unsteady