Expert: Mary Gordon - 10/15/2009

Question
my mom has progressive supra nuclear palls, she  complains about nervousness, agitation and her head constantly moving. I would like to know what i can do to calm her down? She currently takes a muscle relaxer tizandine. I just would like some solutions on how to make her comfortable.


Answer
Hi Kim, the dementia that can come from progressive supranuclear palsy (PSP)is different than the dementia from Alzheimers.

Here is some good information.
http://www.curepsp.org/doc_library/1217970611/Some%20Answers.pdf

You will note that an antidepressant called elavil (amitriptyline) sometimes helps with both mood issues as well as aspects of the movement problems. Other antidepressants I've heard used include imipramine (Tofranil), fluoxetine (Prozac), sertraline (Zoloft), bupropion (Wellbutrin.
Many of these have antianxiety properties as well. )

You need to discuss this with her specialist, as I do understand your concern. You want her to be as comfortable and happy as possible, with the best quality of life she can have, for as long as she is able.

You will probably need to try different drugs at various doses to find something that works for her - everyone's situation is different and everyone reacts differently to each medication. No one will be the answer for everyone, and all medications have side effects. Her specialist should be willing to work with you to help your mom at least feel less nervous and distressed. If the specialist is not helpful, ask for a referral to someone who is willing to assist you - her upset IS something that needs to be addressed, whether by medical means, or by other strategies and supports.

You mention that she is using a muscle relaxant called tizandine. I don't know what else has been tried. Only a few drugs have been found to have any effect on the physical symptoms of PSP, and even then the results are modest and tend to be short term. Drugs that appear to have some benefit include L-dopa, amantadine, amitriptyline, desipramine, and yohimbine. Botulinum toxin can sonmetimes be used to treat muscle spasms from PSP. Again, these are things that should be discussed with her neurologist.

Hope this helps.

Mary G.