Donepezil and Selegiline to Improve Balance Control in Early Progressive Supranuclear Palsy

Background: No single pharmacologic treatment has proven effective for the symptomatic management of progressive supranuclear palsy. Methods: We report a case of postural instability and falls secondary to PSP of the Parkinson's subtype and initial monotherapy with donepezil 10 mg daily for 3 months followed by a novel investigation of selegiline in combination for 6 additional months. Fall frequency, clinical pull testing and computerized dynamic posturography were used to assess response. Results: After 3 months of donepezil, fall frequency decreased from approximately 5 to 1 per week and an initially pathologic pull-test had normalized. Posturographic improvements occurred with donepezil monotherapy and after 3 and 6 months of combination therapy with selegiline. Clinical improvements were observed over the course of more than one year. Conclusions: Improvements in clinical and posturographic measures of balance control were observed with donepezil monotherapy and, to a minimal extent, with the addition of selegeline.