PMID- 25964368
OWN - NLM
STAT- MEDLINE
DCOM- 20160211
LR  - 20150515
IS  - 1469-0756 (Electronic)
IS  - 0032-5473 (Linking)
VI  - 91
IP  - 1075
DP  - 2015 May
TI  - Progressive supra-nuclear palsy: frequency of cardinal extrapyramidal features at 
      first presentation.
PG  - 274-7
LID - 10.1136/postgradmedj-2014-132696 [doi]
AB  - OBJECTIVES: Cardinal extrapyramidal features of progressive supranuclear palsy 
      (PSP) help in clinically differentiating this condition from Parkinson's disease 
      and other Parkinsonian syndromes. However, not all extrapyramidal features may be 
      initially present, thus posing a difficulty in early diagnosis. We studied their 
      frequency at the time of first presentation. METHODS: Patients diagnosed 
      clinically with PSP using the National Institute for Neurological Disorders and 
      Society for PSP (NINDS/SPSP) criteria and seen between August 2010 and April 2013 
      were examined for the presence, 'presence with deviation' or absence of six 
      extrapyramidal features: axial rigidity, symmetry, extended posture, backward 
      falls, absence of tremors and lack of levodopa response. RESULTS: Twenty-eight 
      patients (mean (SD) age 64.86 (9.72) years; 16 (57%) men) met the inclusion 
      criteria. Of these, 14% had all six extrapyramidal features associated with PSP, 
      39% had five, 29% had four, 14% had three and 4% had two. The most frequent 
      extrapyramidal sign was axial rigidity (68%). Axial plus peripheral rigidity was 
      found in 18% of patients and peripheral rigidity alone in 14%. Extrapyramidal 
      features were symmetrical in 29% and asymmetrical beyond 1 year in 29%. Body 
      posture was extended in 46% and flexed in 21%. Backward falls were found in 50% 
      and forward falls in 11%. Pill-rolling tremors were observed in 29%. Response to 
      levodopa therapy was poor in 21% and good beyond 6 months in 39%. CONCLUSIONS: 
      Only 14% of PSP patients present with all six cardinal extrapyramidal features. 
      Also, deviations from standard descriptions are common in the initial stages of 
      disease.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not 
      already granted under a licence) please go to 
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Pradhan, Sunil
AU  - Pradhan S
AD  - Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical 
      Sciences, Lucknow, Uttar Pradesh, India.
FAU - Tandon, Ruchika
AU  - Tandon R
AD  - Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical 
      Sciences, Lucknow, Uttar Pradesh, India.
LA  - eng
PT  - Journal Article
DEP - 20150511
PL  - England
TA  - Postgrad Med J
JT  - Postgraduate medical journal
JID - 0234135
RN  - 0 (Antiparkinson Agents)
RN  - 46627O600J (Levodopa)
SB  - IM
MH  - Accidental Falls/statistics & numerical data
MH  - Aged
MH  - Antiparkinson Agents/*therapeutic use
MH  - Diagnosis, Differential
MH  - Disease Progression
MH  - Early Diagnosis
MH  - Female
MH  - Humans
MH  - India/epidemiology
MH  - Levodopa/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Muscle Rigidity/etiology
MH  - Parkinson Disease/complications/*diagnosis/epidemiology/pathology
MH  - Posture
MH  - Practice Guidelines as Topic
MH  - Prevalence
MH  - Supranuclear Palsy, Progressive/complications/*diagnosis/epidemiology/pathology
OTO - NOTNLM
OT  - NEUROLOGY
EDAT- 2015/05/13 06:00
MHDA- 2016/02/13 06:00
CRDT- 2015/05/13 06:00
PHST- 2014/03/23 00:00 [received]
PHST- 2015/03/17 00:00 [accepted]
PHST- 2015/05/13 06:00 [entrez]
PHST- 2015/05/13 06:00 [pubmed]
PHST- 2016/02/13 06:00 [medline]
AID - postgradmedj-2014-132696 [pii]
AID - 10.1136/postgradmedj-2014-132696 [doi]
PST - ppublish
SO  - Postgrad Med J. 2015 May;91(1075):274-7. doi: 10.1136/postgradmedj-2014-132696. 
      Epub 2015 May 11.