Progressive Supranuclear Palsy (PSP): An Orthoptic Assessment

Area of Science:

• Neurology
• Ophthalmology
• Diagnostic Imaging

Background:

• Progressive Supranuclear Palsy (PSP) presents with overlapping motor and oculomotor signs with other atypical Parkinsonian disorders, complicating early clinical diagnosis.
• Accurate differentiation is crucial for timely and appropriate patient management.

Purpose of the Study:

• To audit the diagnostic utility of orthoptic oculomotor and eye-tracker assessments in patients with atypical Parkinsonian signs.
• To evaluate the consistency of orthoptic diagnoses with final neurology/neurosurgery diagnoses.

Main Methods:

• Retrospective analysis of 26 patients with atypical Parkinsonian signs undergoing orthoptic oculomotor assessment.
• Orthoptic evaluation included assessment of oculomotor range, doll's head manoeuvre, saccadic velocity, vergence, eyelid signs, and fixation.
• Comparison of orthoptic diagnoses with final neurology/neurosurgery diagnoses.

Main Results:

• Orthoptic assessment correctly identified 'suspected PSP' in 73.68% of cases later confirmed by neurology/neurosurgery.
• In 26.32% of 'suspected PSP' cases, orthoptic findings suggested PSP, but alternative diagnoses were ultimately made.
• Orthoptic diagnoses for 'suspected non-PSP' cases were consistent with final diagnoses in all instances.

Conclusions:

• Orthoptic oculomotor and eye-tracker assessments demonstrate high consistency with final diagnoses, achieving 80.77% concordance.
• Early orthoptic assessment is clinically effective in ruling Progressive Supranuclear Palsy (PSP) in or out, aiding differential diagnosis in atypical Parkinsonian patients.