Objective: To evaluate whether Methylphenidate can improve some symptoms of PSP.

Background: PSP is a neurodegenerative disorder with limited therapeutic options. Methylphenidate[MPH] , a drug used in ADHD and acting via alpha 2 adrenoceptor and dopamine D1 receptors has been shown to improve gait and freezing in advanced Parkinson’s disease.

Methods: 6 patients with a Clinico-radiological diagnosis of PSP were given MPH in gradually titrated doses after the corresponding author serendipitously observed effect of MPH in abolishing constant, loud groaning in a case of PSP.

Results: MPH treatment proved efficacious in treatment of apraxia of eye opening in 1 patient, it improved gait and attention in another and in 1 patient , attention improved with a transient improvement in his decreased verbal output. 2 patients had no improvement in any symptom. Anorexia was almost a universal side effect , it was severe in 1 patient and in rest, food intake was reduced by 30-50%. One patient developed insomnia. No improvement in backward falls, dysphagia, dysarthria.

Conclusions: MPH should be investigated in larger studies in PSP as it may offer us a therapeutic option in a disease where currently we have few options. However even in this study, it was ineffective against backward falls – the main debilitating symptom of PSP and was also accompanied by a high incidence of anorexia. Further studies can shed more light on role of methylphenidate in PSP.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/methylphenidate-in-progressive-supranuclear-palsy-psp-old-drug-new-indications/