[A case of progressive supranuclear palsy showing marked improvements of frontal hypoperfusion, as well as parkinsonism with amitriptyline].

A patient with progressive supranuclear palsy (PSP) showing severe akinesia, postural instability and gait disturbance like frozen gait was treated with amitriptyline (30 mg/day). Four weeks after drug administration, we recognized tendencies for improvement on akinesia, postural instability, frozen gait and vertical gaze palsy. Thereafter, gait disturbance almost disappeared and slow motor response and depression also improved with the amitriptyline for 8 weeks. The changes of cerebral blood flow (CBF) with amitriptyline treatment were evaluated in this case by 123I-IMP single photon emission computed tomography. Before the treatment, clear reduction of CBF was shown in the frontal lobes, especially in the frontal cortices, while this frontal hypoperfusion markedly improved 6 weeks after the treatment. These results, showing marked improvements of frontal hypoperfusion, as well as parkinsonism with amitriptyline treatment, may imply possibilities that these symptoms of PSP result from the frontal hypoperfusion and the improvement of the hypoperfusion with amitriptyline is involved in the improvement of these symptoms.