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, Les chutes ont une origine neurologique dans 60% des cas, et les syndromes parkinsoniens représentent la cause la plus fréquente de troubles de la marche et de l'équilibre du sujet âgé. La Paralysie Supranucléaire Progressive de forme Steele-Richardson (PSP-RS) est le 2nd syndrome parkinsonien le plus fréquent, les chutes y sont plus précoces, Le vieillissement de la population constitue un enjeu de santé publique en raison des pathologies qui y sont associées, notamment la démence et les chutes
Chez ces patients les troubles de la marche et de l'équilibre sont d'apparition plus tardifs. L'objectif était la caractérisation clinique, neurophysiologique et l'étude des corrélats anatomiques soustendant ces troubles ,
, Méthode Un 16 patients CAP, 15 patients PSP-RS, et 17 témoins ont été inclus prospectivement au cours d'une étude observationnelle et multicentrique. Tous les sujets ont bénéficié d'un examen clinique, d'un bilan neuropsychologique, d'une analyse quantifiée de la locomotion et du contrôle postural, des mouvements oculomoteurs
, et les sujets sains, a permis de mettre en évidence : 1/ une similarité de la sévérité des troubles de la marche et de l'équilibre avec une atteinte prédominante du contrôle postural dans le sens médio-latéral chez les patients avec PSP-RS 2/ un déclin cognitif plus sévère chez les patients avec CAP, 3/ une atteinte oculomotrice avec une atteinte plus sévère chez les patients avec PSP-RS, 4/ une atrophie corticale frontale, pariétale, cérébelleuse, striatale et mésencéphalique, avec toutefois une atteinte temporale et pariétale prédominante chez les patients CAP et une atteinte mésencéphalique, Résultats La comparaison des données obtenues chez les patients avec un CAP à celles obtenues chez les patients ayant une PSP-RS
, Discussion Les patients avec CAP ont des troubles de la marche et de l'équilibre, dont la sévérité ne semble pas différer de ceux retrouvés chez les patients avec une PSP-RS. Cependant nous retrouvons chez les patients CAP une dégradation moindre du contrôle postural latéral et des troubles oculomoteurs moins sévères, probablement en liens avec une atteinte moins sévère du réseau cortex moteur-thalamus-RLM-cervelet