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Barcelona Progressive Supranuclear Palsy (PSP) Registry: Clinical, Oculomotor, and Cerebrospinal Fluid Markers; from
Celia Painous1,2, Manel Fernández2, Ana Cámara1,2
1Unitat de Parkinson i altres Trastorns del Moviment, Servei de Neurologia, Hospital Clínic de Barcelona; FRCB-IDIBAPS, Institut de Neurosciències, CIBERNED, ISCIII, ERN-RND, UBNeuro, Barcelona, Spain.
Background:
Timely and accurate diagnosis of progressive supranuclear palsy (PSP) remains challenging.
Objective:
To assess diagnostic certainty and progression biomarkers in the PSP spectrum from "suggestive of" (so-PSP) category as proxy of early disease, to definite (neuropathologically confirmed) cases.
Methods:
Multicenter, prospective, longitudinal study of 131 participants (so-PSP, n = 23; definite, n = 5) with oculometric (n = 47) and cerebrospinal fluid (CSF) biomarkers (n = 75), compared with control (n = 18) and Parkinson's disease (PD) subjects (n = 12).
Results:
Anti-saccade velocities were significantly reduced in so-PSP versus PD and controls. CSF α-synuclein seed amplification assay (asyn-SAA) was positive in 20% of PSP cases (vs. 100% PD and 0% controls). Longitudinally (median of 1.3 years), all probable/possible-PSP cases retained their diagnosis regardless of CSF asyn-SAA result. In so-PSP, worse saccades' variables and negative/low-fluorescence-positive asyn-SAA at baseline related to longitudinal diagnosis reinforcement. Clinical scales and neurofilament light chain (NfL) predicted shorter survival.
Conclusions:
Quantitative oculometry and negative/low-fluorescence-positive CSF asyn-SAA predict diagnostic validation in so-PSP. In probable/possible-PSP, positive CSF asyn-SAA may suggest copathology, although confirmation requires larger pathological studies. © 2025 International Parkinson and Movement Disorder Society.
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