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Bissolotti L, Rota M, Calza S, Romero-Morales C, Alonso-Pérez JL, López-Bueno R, Villafañe JH. Gender-Specific Differences in Spinal Alignment and Muscle Power in Patients with Parkinson's Disease. Diagnostics (Basel) 2024; 14:1143. [PMID: 38893669 PMCID: PMC11171582 DOI: 10.3390/diagnostics14111143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is an advancing neurodegenerative disorder characterized by spinal anomalies and muscular weakness, which may restrict daily functional capacities. A gender-focused examination of these effects could provide valuable insights into customized rehabilitation strategies for both sexes. PURPOSE This study investigates the influence of spinal alignment on lower-limb function during the sit-to-stand (STS) movement in patients with Parkinson's disease compared to healthy individuals. METHODS A cross-sectional study was conducted with 43 consecutive patients with PD (25 males and 18 females; average age 73.7 ± 7.1 years) and 42 healthy controls (22 males and 20 females; average age 69.8 ± 6.0 years). Assessments included the International Physical Activity Questionnaire (IPAQ), Hoehn and Yahr staging, and measurements of vertical deviations from several spinal landmarks. Lower-limb muscle power during the STS task was evaluated using the Muscle Quality Index (MQI). RESULTS Both absolute (Watts) and relative (Watts/Kg) muscle power in the lower limbs were notably decreased in the PD group compared to the control group. Within the PD cohort, muscle power showed a negative relationship with age and a positive association with the degree of lumbar lordosis (PL-L3). Importantly, gender-specific analysis revealed that male patients with PD had significantly higher lower-limb muscle power compared to female patients with PD, highlighting the need for gender-tailored therapeutic approaches. CONCLUSIONS The findings suggest that preserving lumbar lordosis is crucial for maintaining effective lower-limb muscle biomechanics in individuals with Parkinson's disease.
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Affiliation(s)
- Luciano Bissolotti
- Fondazione Teresa Camplani Casa di Cura Domus Salutis, 25123 Brescia, Italy;
| | - Matteo Rota
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (M.R.); (S.C.)
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (M.R.); (S.C.)
| | - Carlos Romero-Morales
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
| | - José Luís Alonso-Pérez
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, C/Inocencio García 1, 38300 La Orotava, Canary Islands, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Onelife Center, Multidisciplinary Pain Treatment Center, 28925 Alcorcón, Spain
| | - Rubén López-Bueno
- Department of Physical Medicine and Nursing, University of Zaragoza, 50009 Zaragoza, Spain;
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46100 Valencia, Spain
| | - Jorge Hugo Villafañe
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
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Gandolfi M, Artusi CA, Imbalzano G, Camozzi S, Crestani M, Lopiano L, Tinazzi M, Geroin C. Botulinum Toxin for Axial Postural Abnormalities in Parkinson's Disease: A Systematic Review. Toxins (Basel) 2024; 16:228. [PMID: 38787080 PMCID: PMC11125648 DOI: 10.3390/toxins16050228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/23/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Axial postural abnormalities (APAs), characterized by their frequency, disabling nature, and resistance to pharmacological treatments, significantly impact Parkinson's disease and atypical Parkinsonism patients. Despite advancements in diagnosing, assessing, and understanding their pathophysiology, managing these complications remains a significant challenge. Often underestimated by healthcare professionals, these disturbances can exacerbate disability. This systematic review assesses botulinum toxin treatments' effectiveness, alone and with rehabilitation, in addressing APAs in Parkinson's disease, utilizing MEDLINE (PubMed), Web of Science, and SCOPUS databases for source material. Of the 1087 records retrieved, 16 met the selection criteria. Most research has focused on botulinum toxin (BoNT) as the primary treatment for camptocormia and Pisa syndrome, utilizing mostly observational methods. Despite dose and injection site variations, a common strategy was using electromyography-guided injections, occasionally enhanced with ultrasound. Patients with Pisa syndrome notably saw consistent improvements in APAs and pain. However, studies on the combined effects of botulinum toxin and rehabilitation are limited, and antecollis is significantly under-researched. These findings recommend precise BoNT injections into hyperactive muscles in well-selected patients by skilled clinicians, avoiding compensatory muscles, and underscore the necessity of early rehabilitation. Rehabilitation is crucial in a multidisciplinary approach to managing APAs, highlighting the importance of a multidisciplinary team of experts.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (S.C.); (M.C.)
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, 37134 Verona, Italy
- Neurorehabilitation Unit, AOUI Verona, 37134 Verona, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (C.A.A.); (G.I.); (L.L.)
- SC Neurology 2U, AOU Città della Salute e della Scienza, 10126 Turin, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (C.A.A.); (G.I.); (L.L.)
- SC Neurology 2U, AOU Città della Salute e della Scienza, 10126 Turin, Italy
| | - Serena Camozzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (S.C.); (M.C.)
| | - Mauro Crestani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (S.C.); (M.C.)
| | - Leonardo Lopiano
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (C.A.A.); (G.I.); (L.L.)
- SC Neurology 2U, AOU Città della Salute e della Scienza, 10126 Turin, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (S.C.); (M.C.)
| | - Christian Geroin
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, 37134 Verona, Italy;
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Ronconi G, Gatto DM, Ariani M, Codazza S, Ingravalle F, Ferriero G, Coraci D, Ferrara PE. Is there any relationship between scoliosis, cervical pain and postural imbalance in Parkinson's disease? A cross-sectional pilot study. Eur J Transl Myol 2024. [PMID: 38634751 DOI: 10.4081/ejtm.2024.12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
Parkinson's disease (PD) is defined by progressive worsening of gait, posture, and balance, as well as disability in daily life activities, and improvement in chronic musculoskeletal pain, particularly neck pain associated with worsening of balance. The study's goal is to look into the relationship between scoliosis, balance, and cervical pain in Parkinson's disease patients. Cross-sectional, pilot study. The study included 16 Parkinson's patients. Neck cervical pain was measured using the pain visual analogue scale and the short form McGill pain questionnaire, while dynamic balance was assessed using static balance, Tinetti, Berg Balance, and the Short Physical Performance Battery scales (SPPB). Cobb angles are measured on a whole-spine standard X-ray to assess spinal scoliosis.An observational statistical analysis was performed with patients subdivided into two groups: non-scoliosis (NS) and true scoliosis (TS) based on whether they presented a Cobb's angle below or ≥10°. Neck pain was reported by 37% (n=3) of participants in the NS group versus 50% (n=4) in the TS group. Neck pain was more prevalent in patients with a disease duration of less than 48 months (n=6; 75.0% vs n=1; 12.5%; p-value < 0.05). Scoliosis, cervical pain, and postural imbalance are all significant but often overlooked Parkinson's disease complaints.
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Affiliation(s)
| | - Dario Mattia Gatto
- Department of Neurosciences, Sense Organs and Thorax, Catholic University of the Sacred Heart, Rome.
| | - Mariantonietta Ariani
- Department of Neurosciences, Sense Organs and Thorax, Catholic University of the Sacred Heart, Rome.
| | - Sefora Codazza
- University Polyclinic Foundation A. Gemelli IRCCS, Rome.
| | - Fabio Ingravalle
- Hospital Health Management Area, Local Health Authority "Roma 6", Albano Laziale.
| | - Giorgio Ferriero
- Unit of Physical and Rehabilitation Medicine, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Varese, Italy; Department of Biotechnology and Life Sciences, University of Insubria, Varese, Como.
| | - Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua.
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Artusi CA, Geroin C, Nonnekes J, Aquino C, Garg D, Dale ML, Schlosser D, Lai Y, Al‐Wardat M, Salari M, Wolke R, Labou VT, Imbalzano G, Camozzi S, Merello M, Bloem BR, Capato T, Djaldetti R, Doherty K, Fasano A, Tibar H, Lopiano L, Margraf NG, Moreau C, Ugawa Y, Bhidayasiri R, Tinazzi M. Predictors and Pathophysiology of Axial Postural Abnormalities in Parkinsonism: A Scoping Review. Mov Disord Clin Pract 2023; 10:1585-1596. [PMID: 38026508 PMCID: PMC10654876 DOI: 10.1002/mdc3.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/09/2023] [Accepted: 08/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Postural abnormalities involving the trunk are referred to as axial postural abnormalities and can be observed in over 20% of patients with Parkinson's disease (PD) and in atypical parkinsonism. These symptoms are highly disabling and frequently associated with back pain and a worse quality of life in PD. Despite their frequency, little is known about the pathophysiology of these symptoms and scant data are reported about their clinical predictors, making it difficult to prompt prevention strategies. Objectives We conducted a scoping literature review of clinical predictors and pathophysiology of axial postural abnormalities in patients with parkinsonism to identify key concepts, theories and evidence on this topic. Methods We applied a systematic approach to identify studies, appraise quality of evidence, summarize main findings, and highlight knowledge gaps. Results Ninety-two articles were reviewed: 25% reported on clinical predictors and 75% on pathophysiology. Most studies identified advanced disease stage and greater motor symptoms severity as independent clinical predictors in both PD and multiple system atrophy. Discrepant pathophysiology data suggested different potential central and peripheral pathogenic mechanisms. Conclusions The recognition of clinical predictors and pathophysiology of axial postural abnormalities in parkinsonism is far from being elucidated due to literature bias, encompassing different inclusion criteria and measurement tools and heterogeneity of patient samples. Most studies identified advanced disease stage and higher burden of motor symptoms as possible clinical predictors. Pathophysiology data point toward many different (possibly non-mutually exclusive) mechanisms, including dystonia, rigidity, proprioceptive and vestibular impairment, and higher cognitive deficits.
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Affiliation(s)
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Jorik Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourDepartment of RehabilitationNijmegenThe Netherlands
| | - Camila Aquino
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, and Department of Community Health SciencesUniversity of CalgaryCalgaryABCanada
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India. Department of NeurologyVardhman Mahavir Medical College and Safdarjung HospitalNew DelhiIndia
| | - Marian L. Dale
- Oregon Health & Science UniversityDepartment of NeurologyPortlandORUSA
| | - Darbe Schlosser
- Graduate Student in the Motor Learning Program at Teachers CollegeColumbia UniversityNew YorkNYUSA
| | - Yijie Lai
- Department of Neurosurgery, Center for Functional NeurosurgeryRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mohammad Al‐Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
| | - Mehri Salari
- Department of NeurologyShahid Beheshti University of Medical SciencesTehranIran
| | - Robin Wolke
- Department of NeurologyUKSH, Christian‐Albrechts‐UniversityKielGermany
| | | | - Gabriele Imbalzano
- Department of Neuroscience Rita Levi MontalciniUniversity of TurinTorinoItaly
| | - Serena Camozzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Marcelo Merello
- Movement Disorders ServiceFLENI, CONICETBuenos AiresArgentina
| | - Bastiaan R. Bloem
- Department of NeurologyRadboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
| | - Tamine Capato
- Department of NeurologyRadboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
- University of São PauloDepartment of Neurology, Movement Disorders CenterSão PauloBrazil
| | - Ruth Djaldetti
- Department of Neurology, Rabin Medical Center, Petah Tikva; Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Karen Doherty
- Department of NeurologyRoyal Victoria HospitalBelfastUnited Kingdom
- Centre for Medical EducationQueens University BelfastBelfastUnited Kingdom
| | - Alfonso Fasano
- Division of NeurologyUniversity of TorontoTorontoONCanada
- Krembil Brain InstituteTorontoONCanada
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria ShulmanMovement Disorders Clinic, Toronto Western Hospital, UHNTorontoONCanada
| | - Houyam Tibar
- Service de Neurologie B et de Neurogénétique Hôpital des Spécialités OTO‐Neuro‐OphtalmologiqueIbn Sina University Hospital, Medical School of Rabat, Mohamed 5 University of RabatRabatMorocco
| | - Leonardo Lopiano
- Department of Neuroscience Rita Levi MontalciniUniversity of TurinTorinoItaly
| | - Nils G. Margraf
- Department of NeurologyUKSH, Christian‐Albrechts‐UniversityKielGermany
| | - Caroline Moreau
- Expert Center for Parkinson's Disease, Neurological Department, Inserm UMR 1172Lille University HospitalLilleFrance
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of MedicineFukushima Medical UniversityFukushimaJapan
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyBangkokThailand
- The Academy of ScienceThe Royal Society of ThailandBangkokThailand
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
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5
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Demircan EN, Köse N, Çakmaklı GY, Aksoy S, Göçmen R, Zengin HY, Elibol B. Do cervical stabilization exercises change the effects of conventional exercises in patients with Parkinson's disease? Neurol Res 2023; 45:936-946. [PMID: 37608568 DOI: 10.1080/01616412.2023.2249699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/15/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES The aim of this study was to examine whether cervical stabilization exercises (CSEs) change the effects of conventional exercises (CEs) in patients with PD. METHODS Twenty-five patients with PD were randomized into two groups. While the experimental group (EG) received CSEs in addition to CEs, the control group (CG) received only CEs. Both programs lasted 8 weeks. Eighteen participants were able to complete the study. The outcomes were the changes in posture, cervical joint position sense (JPS), balance assessment, 10-m walking tests (10MWT), and the Timed Up & Go (TUG) test. RESULTS At the end of the study, significant improvement was observed in both groups in terms of trunk rotation angle and pelvic asymmetry, the time parameter of TUG, and the 10MWT (p < 0.05). In the EG, greater improvement was detected in the Berg Balance Scale, static posturography, postural alignment, JPS, and the cadence parameter of TUG (p < 0.05). DISCUSSION CEs and CSEs could improve walking speed and posture in patients with PD, but if CSEs are added to CEs, greater improvements could be achieved in JPS and postural control.(Clinical Trials ID: NCT03854747).
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Affiliation(s)
- Emine Nur Demircan
- Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Nezire Köse
- Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Gül Yalçın Çakmaklı
- Faculty of Medicine, Department of Neurology, Hacettepe University, Ankara, Turkey
| | - Songül Aksoy
- Faculty of Health Sciences, Department of Audiology, Lokman Hekim University, Ankara, Turkey
| | - Rahşan Göçmen
- Faculty of Medicine, Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Hatice Yağmur Zengin
- Faculty of Medicine, Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Bülent Elibol
- Faculty of Medicine, Department of Neurology, Hacettepe University, Ankara, Turkey
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6
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Ledda C, Panero E, Dimanico U, Parisi M, Gandolfi M, Tinazzi M, Geroin C, Marchet F, Massazza G, Lopiano L, Artusi CA. Longitudinal Assessment of Botulinum Toxin Treatment for Lateral Trunk Flexion and Pisa Syndrome in Parkinson's Disease: Real-life, Long-Term Study. Toxins (Basel) 2023; 15:566. [PMID: 37755992 PMCID: PMC10536312 DOI: 10.3390/toxins15090566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/04/2023] [Accepted: 09/09/2023] [Indexed: 09/28/2023] Open
Abstract
Lateral trunk flexion (LTF) and its severe form, called Pisa syndrome (PS), are highly invalidating axial postural abnormalities associated with Parkinson's disease (PD). Management strategies for LTF lack strong scientific evidence. We present a real-life, longitudinal study evaluating long-term efficacy of botulinum toxin (BoNT) injections in axial muscles to reduce LTF and PS in PD. A total of 13 PD patients with LTF > 5° received ultrasound- and electromyography-guided BoNT injections every 4 months. Seven untreated matched PD patients with LTF served as controls and their changes in posture after 18 months were compared with those of seven patients continuing BoNT over 12 months. 53.8% of patients continued the BoNT injections for at least 12 months. Various individual LTF responses were observed. Overall, BoNT-treated patients obtained a not statistically significant improvement of LTF of 17 ± 41% (p = 0.237). In comparison, the seven untreated PD patients suffered a deterioration in LTF over 12 months by 36 ± 45% (p = 0.116), showing a significantly different trajectory of posture change (p = 0.026). In conclusion, repeated BoNT injections in axial muscles showed varying effects in managing PD-associated LTF, suggesting that: (a) a relevant number of patients with LTF can benefit from BoNT; (b) long-term treatment could prevent LTF worsening; (c) an instrumented, personalized approach is important; and (d) there is a need for prospective, long-term studies.
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Affiliation(s)
- Claudia Ledda
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (C.L.); (L.L.)
- Neurology 2 Unit, AOU Città della Salute e Della Scienza, 10126 Turin, Italy
| | - Elisa Panero
- Physical Medicine and Rehabilitation Unit, Department of Orthopedics, Traumatology and Rehabilitation, University of Turin, 10126 Turin, Italy; (E.P.); (G.M.)
| | - Ugo Dimanico
- Physical Medicine and Rehabilitation Unit, Department of Orthopedics, Traumatology and Rehabilitation, University of Turin, 10126 Turin, Italy; (E.P.); (G.M.)
| | - Mattia Parisi
- Department of Neurology, Ospedale Rivoli, Rivoli, 10098 Turin, Italy;
| | - Marialuisa Gandolfi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (M.G.); (M.T.); (C.G.)
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, 37129 Verona, Italy
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (M.G.); (M.T.); (C.G.)
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (M.G.); (M.T.); (C.G.)
| | - Francesco Marchet
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy;
| | - Giuseppe Massazza
- Physical Medicine and Rehabilitation Unit, Department of Orthopedics, Traumatology and Rehabilitation, University of Turin, 10126 Turin, Italy; (E.P.); (G.M.)
| | - Leonardo Lopiano
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (C.L.); (L.L.)
- Neurology 2 Unit, AOU Città della Salute e Della Scienza, 10126 Turin, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (C.L.); (L.L.)
- Neurology 2 Unit, AOU Città della Salute e Della Scienza, 10126 Turin, Italy
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7
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Matar E, Bhatia K. Dystonia and Parkinson's disease: Do they have a shared biology? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:347-411. [PMID: 37482398 DOI: 10.1016/bs.irn.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Parkinsonism and dystonia co-occur across many movement disorders and are most encountered in the setting of Parkinson's disease. Here we aim to explore the shared neurobiological underpinnings of dystonia and parkinsonism through the clinical lens of the conditions in which these movement disorders can be seen together. Foregrounding the discussion, we briefly review the circuits of the motor system and the neuroanatomical and neurophysiological aspects of motor control and highlight their relevance to the proposed pathophysiology of parkinsonism and dystonia. Insight into shared biology is then sought from dystonia occurring in PD and other forms of parkinsonism including those disorders in which both can be co-expressed simultaneously. We organize these within a biological schema along with important questions to be addressed in this space.
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Affiliation(s)
- Elie Matar
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences, Queen Square, London, United Kingdom; Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Kailash Bhatia
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences, Queen Square, London, United Kingdom
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8
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Geroin C, Artusi CA, Nonnekes J, Aquino C, Garg D, Dale ML, Schlosser D, Lai Y, Al-Wardat M, Salari M, Wolke R, Labou VT, Imbalzano G, Camozzi S, Merello M, Bloem BR, Capato T, Djaldetti R, Doherty K, Fasano A, Tibar H, Lopiano L, Margraf NG, Moreau C, Ugawa Y, Bhidayasiri R, Tinazzi M. Axial Postural Abnormalities in Parkinsonism: Gaps in Predictors, Pathophysiology, and Management. Mov Disord 2023; 38:732-739. [PMID: 37081741 DOI: 10.1002/mds.29377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
| | - Jorik Nonnekes
- Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Camila Aquino
- Department of Clinical Neurosciences, and Department of Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Marian L Dale
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Darbe Schlosser
- Motor Learning Program, Teachers College, Columbia University, New York, New York, USA
| | - Yijie Lai
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mohammad Al-Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Mehri Salari
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Robin Wolke
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | | | - Gabriele Imbalzano
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
| | - Serena Camozzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marcelo Merello
- Movement Disorders Service, FLENI, CONICET, Buenos Aires, Argentina
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Tamine Capato
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Neurology, Movement Disorders Center, University of São Paulo, São Paulo, Brazil
| | - Ruth Djaldetti
- Department of Neurology, Rabin Medical Center, Petah Tikva Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karen Doherty
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
- Centre for Medical Education, Queens University Belfast, Belfast, UK
| | - Alfonso Fasano
- Krembil Brain Institute, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Houyam Tibar
- Service de Neurologie B et de Neurogénétique Hôpital des Spécialités OTO-Neuro-Ophtalmologique, Ibn Sina University Hospital, Medical School of Rabat, Mohamed 5 University of Rabat, Rabat, Morocco
| | - Leonardo Lopiano
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
- Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Nils G Margraf
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Caroline Moreau
- Neurological Department, Expert Center for Parkinson's Disease, Inserm UMR 1172, Lille University Hospital, Lille, France
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Roongroj Bhidayasiri
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Biassoni E, Kreshpa W, Massa F, D'Amico F, Bauckneht M, Arnaldi D, Pardini M, Orso B, Girtler N, Brugnolo A, Morbelli S, Tinazzi M, Nobili F, Mattioli P. Right posterior hypometabolism in Pisa syndrome of Parkinson’s disease: A key to explain body schema perception deficit? Parkinsonism Relat Disord 2023; 110:105371. [PMID: 36989658 DOI: 10.1016/j.parkreldis.2023.105371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/22/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Pisa syndrome (PS) is a trunk postural abnormality in Parkinson's disease (PD). Its pathophysiology is still debated: peripheral and central mechanisms have been hypothesized. OBJECTIVE To investigate the role of nigrostriatal dopaminergic deafferentation and of brain metabolism impairment in the onset PS in PD patients. METHODS We retrospectively selected 34 PD patients who developed PS (PS+) and who had previously undergone dopamine transporter (DaT)-SPECT and/or brain F-18 fluorodeoxyglucose PET (FDG-PET). PS + patients were divided considering leaning body side in left ((l)PS+) or right ((r)PS+). DaT-SPECT specific-to-non-displaceable binding ratio (SBR) of striatal regions (BasGan V2 software) were compared between 30 PS+ and 60 PD patients without PS (PS-) as well as between 16 (l)PS+ and 14 (r)PS + patients. Voxel-based analysis (SPM12) was used to compare FDG-PET among 22 PS+, 22 PS- and 42 healthy controls (HC) and between 9 (r)PS+ and 13 (l)PS+. RESULTS No significant DaT-SPECT SBR differences were found between PS+ and PS- groups or between (r)PD+ and (l)PS + subgroups. Compared to HC, significant hypometabolism in PS+ was found in bilateral temporal-parietal regions, mainly in the right hemisphere, whereas the right Brodmann area 39 (BA39) was relatively hypometabolic both in the (r)PS+ and in the (l)PS+. BA39 and bilateral posterior cingulate cortex were significantly hypometabolic in PS + than in PS- group. CONCLUSIONS As a hub of the network supervising the body schema perception, the involvement of the right posterior hypometabolism supports the hypothesis PS is a result of a somatosensory perceptive deficit rather than a nigrostriatal dopaminergic unbalance.
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Cao S, Cui Y, Jin J, Li F, Liu X, Feng T. Prevalence of axial postural abnormalities and their subtypes in Parkinson's disease: a systematic review and meta-analysis. J Neurol 2023; 270:139-151. [PMID: 36098837 DOI: 10.1007/s00415-022-11354-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Axial postural abnormalities, mainly involving the spinal deformities, are disabling symptoms of Parkinson's disease (PD). However, the prevalence of axial postural abnormalities in PD and their clinical correlates remain unclear. The present study aimed to conduct a systematic review and meta-analysis of the prevalence of overall and subtypes of axial postural abnormalities in PD. METHODS PubMed, Embase, Web of Science and Cochrane databases were searched up to 31st March, 2022. We identified studies that reported the prevalence of axial postural abnormalities in PD. The pooled estimate of prevalence was calculated using a random effect model. Subgroup analysis and meta-regression were performed. RESULTS There were 19 studies met the inclusion criteria. The overall prevalence of axial postural abnormalities in PD was 22.1% (95% CI 19.7-24.5%). The prevalence of each subtype of axial postural abnormalities was 19.6% for scoliosis (95% CI 10.6-28.7%), 10.2% for camptocormia (95% CI 7.7-12.7%), 8% for Pisa syndrome (95% CI 4.7-11.4%), and 7.9% for antecollis (95% CI 3.9-11.9%). Subgroup analysis showed that the measuring method of axial postural abnormalities exerted significant effects on prevalence estimates. Axial postural abnormalities in PD were associated with older age, longer disease duration, higher H-Y stage, greater levodopa equivalent daily dose, more severe motor symptoms, motor fluctuations, and akinetic-rigid subtype. CONCLUSIONS Axial postural abnormalities, which include scoliosis, camptocormia, Pisa syndrome, and antecollis, are not uncommon in patients with PD. Future research on axial postural abnormalities should be based on uniform diagnostic criteria and measuring methods.
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Affiliation(s)
- Shuangshuang Cao
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurology, Yidu Central Hospital of Weifang, Shandong, China
| | - Yusha Cui
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianing Jin
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Fangfei Li
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xin Liu
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Tao Feng
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
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11
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Eker A, Kaymakamzade B, Diker S, Cumaogulları O, Yigitoglu PH. Axial posture disorders in Parkinson's disease: Clinical correlates and future treatment directions1. J Back Musculoskelet Rehabil 2022; 35:1321-1328. [PMID: 35964166 DOI: 10.3233/bmr-210263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Postural disorders are frequently observed in Parkinson's disease (PD). The underlying mechanisms that cause postural disorders are not fully understood and the majority of these disorders have no response to antiparkinsonian treatments. These disabling conditions require further investigation to better understand the underlying mechanisms in order to develop effective treatments. OBJECTIVE The aim of this study was to investigate the frequency of axial postural disorders in PD and to determine the associated clinical risk factors. METHODS In this single-center clinical trial, the data of PD patients were reviewed retrospectively. The frequencies of postural disorders were determined, and the demographic clinical characteristics of the patients were compared. RESULTS The records of 127 patients with idiopathic PD were analyzed. Axial posture disorders were found in 42.6% of patients. Patients with axial posture disorders were older when the disease onset was detected, amongst these patients the condition was also longer lasting. The mean levodopa dose was higher in the patients with posture disorders. The initial symptom was bradykinesia and the Hoehn and Yahr's score was ⩾ 3 in the majority of the patients with posture disorder. Additionally, constipation, hallucinations, postural instability, and falls were significantly more common in patients with posture disorders. CONCLUSION Posture disorders were observed in nearly half of PD patients and were more frequently observed in patients with an advanced condition. In addition, our investigation has found that it is crucial to follow up with patients who present with bradykinesia for the development of postural disorder.
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Affiliation(s)
- Amber Eker
- Department of Neurology, Faculty of Medicine, Eastern Mediterranean University, Famagusta, North Cyprus, Mersin 10, Turkey
| | - Bahar Kaymakamzade
- Department of Neurology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Sevda Diker
- Department of Neurology, Faculty of Medicine, Cyprus International University, Nicosia, Cyprus
| | - Ozge Cumaogulları
- Eastern Mediterranean University Faculty of Medicine, Famagusta, North Cyprus, Mersin 10, Turkey
| | - Pembe Hare Yigitoglu
- Department of Physical Medicine and Rehabilitation, Near East University Faculty of Medicine, Nicosia, Cyprus
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Lu WJ, Fan JQ, Yan MY, Mukaeda K, Zhuang LX, Wang LL. Effect of electroacupuncture for Pisa syndrome in Parkinson’s disease: A case report. World J Clin Cases 2022; 10:11023-11030. [PMID: 36338234 PMCID: PMC9631139 DOI: 10.12998/wjcc.v10.i30.11023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/15/2022] [Accepted: 09/16/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pisa syndrome (PS) refers to marked lateral flexion of the trunk with a Cobb angle greater than 10°, which is typically mobile and can be resolved by lying down. PS is one of the most common postural deformities secondary to Parkinson’s disease (PD) and can aggravate scoliosis in the advanced stages of PD.
CASE SUMMARY Here, we present the case of a 53-year-old woman who presented with lateral curvature for 6 mo. Full spine X-ray films in the correct position showed that the thoracolumbar spine was bent to the right without any rotation of the vertebrae. The patient was diagnosed with Pisa syndrome. After receiving a month’s treatment with electroacupuncture, the Cobb angle decreased from 18.14° to 13.41°.
CONCLUSION This case demonstrates that electroacupuncture can effectively improve Pisa syndrome secondary to PD with few side effects and a low risk of recurrence. Additionally, early accurate diagnosis and timely intervention are meaningful for the prognosis of PS.
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Affiliation(s)
- Wei-Jing Lu
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Jing-Qi Fan
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Ming-Yue Yan
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Keiko Mukaeda
- International College, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Li-Xing Zhuang
- The Parkinson's Clinic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Li-Li Wang
- The Parkinson's Clinic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
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13
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Brogren E, Dahlin LB, Franzen E, Lindholm B. Striatal hand deformities in Parkinson's disease ‐ hand surgical perspectives. Mov Disord Clin Pract 2022; 9:1047-1054. [PMID: 36339303 PMCID: PMC9631849 DOI: 10.1002/mdc3.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/04/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background The knowledge about striatal hand deformities (SHD) in Parkinson's disease (PD), has recently increased but need more attention due to their early impact on dexterity. The focus of clinical studies has been on the staging of SHD severity and neurological features. However, a hand surgical perspective has not been considered. Objectives Our purpose was to examine SHD in patients with PD using hand surgical assessment methods and the recommended staging of SHD. Methods In this observational study, a specialist in neurological physiotherapy examined 100 consecutive PD patients and identified 35 with suspected SHD, who were then examined by two hand surgeons. Their hands were clinically evaluated for severity of SHD, according to a previous proposed staging, focusing on metacarpophalangeal (MCP) joint flexion, presence of intrinsic and extrinsic tightness, as well as other hand deformities. Results Three kinds of deformities were identified among 35 included patients: surgical diagnoses unrelated to PD (n = 5), SHD (n = 23), and PD related hand deformities with increased extrinsic tightness (n = 10); three of these 10 patients had also contralateral SHD, thus are included in SHD group. In addition to previously described MCP joint flexion, swan neck deformity and z‐thumb deformity, we found in most hands finger “clefting,” abduction of the little finger and/or an increased intrinsic tightness, indicating pathology of intrinsic muscles of the hand involved in SHD. Conclusions SHD diagnosed with a modified staging method, including features of intrinsic and extrinsic hand deformities, should be considered in PD to implement early and more accurate treatment.
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Affiliation(s)
- Elisabeth Brogren
- Department of Hand Surgery Skåne University Hospital Malmö Sweden
- Department of Translational Medicine Lund University Malmö Sweden
| | - Lars B. Dahlin
- Department of Hand Surgery Skåne University Hospital Malmö Sweden
- Department of Translational Medicine Lund University Malmö Sweden
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden Sweden
| | - Erika Franzen
- Division of Physiotherapy, Department of Neurobiology Care Sciences and Society Stockholm Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physical Therapy Karolinska University Hospital Stockholm Sweden
| | - Beata Lindholm
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics Skåne University Hospital Malmö/Lund Sweden
- Department of Clinical Sciences, Clinical Memory Research Unit Lund University Malmö Sweden
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Role of the Gut–Brain Axis, Gut Microbial Composition, Diet, and Probiotic Intervention in Parkinson’s Disease. Microorganisms 2022; 10:microorganisms10081544. [PMID: 36013962 PMCID: PMC9412530 DOI: 10.3390/microorganisms10081544] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 02/07/2023] Open
Abstract
Parkinson’s disease (PD) is the second-most prevalent neurodegenerative or neuropsychiatric disease, affecting 1% of seniors worldwide. The gut microbiota (GM) is one of the key access controls for most diseases and disorders. Disturbance in the GM creates an imbalance in the function and circulation of metabolites, resulting in unhealthy conditions. Any dysbiosis could affect the function of the gut, consequently disturbing the equilibrium in the intestine, and provoking pro-inflammatory conditions in the gut lumen, which send signals to the central nervous system (CNS) through the vagus enteric nervous system, possibly disturbing the blood–brain barrier. The neuroinflammatory conditions in the brain cause accumulation of α-syn, and progressively develop PD. An important aspect of understanding and treating the disease is access to broad knowledge about the influence of dietary supplements on GM. Probiotics are live microorganisms which, when administered in adequate amounts, confer a health benefit on the host. Probiotic supplementation improves the function of the CNS, and improves the motor and non-motor symptoms of PD. Probiotic supplementation could be an adjuvant therapeutic method to manage PD. This review summarizes the role of GM in health, the GM–brain axis, the pathogenesis of PD, the role of GM and diet in PD, and the influence of probiotic supplementation on PD. The study encourages further detailed clinical trials in PD patients with probiotics, which aids in determining the involvement of GM, intestinal mediators, and neurological mediators in the treatment or management of PD.
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15
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Bissolotti L, Rota M, Calza S, Sanchez Romero EA, Battaglino A, Villafañe JH. Relationship between Lower Limbs Performance and Spinal Alignment in Parkinson’s Disease Patients: An Observational Study with Cross Sectional Design. J Clin Med 2022; 11:jcm11133775. [PMID: 35807060 PMCID: PMC9267576 DOI: 10.3390/jcm11133775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/15/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
Parkinson’s disease (PD) is a progressive neurodegenerative disease determining spinal deformities and muscle rigidity, weakness and dystonia that can be related to a change in muscular output during sit-to-stand tasks (STS). Purpose: The aim of this study was to determine the impacts of spinal alignment on lower limbs performance during STS tasks in Parkinson’s disease (PD) patients and healthy controls. Methods: In total, 43 consecutive PD patients (“PD” Group, 25 males and 18 females; age 73.7 ± 7.1) and 42 people not affected by any type of neurological disease (“CON” Group, 22 males, 20 females; age 69.8 ± 6.0) participated in the observational study. The clinical assessment included: IPAQ (International Physical Activity Questionnaire), Hoehn Yahr score, plumb-line distance from the spinous process of C7, kyphosis apex and the spinous process of L3 and S1. We used the Muscle Quality Index test (MQI) to assess muscle power output during STS in both groups. Results: The MQI test measurements of absolute and relative lower limb power was significantly lower in the PD group, in addition to a negative correlation with age and a positive correlation with PL-L3 in that group of patients. Conclusions: A final consideration regarding our results leads to the possibility that the preservation of lumbar lordosis may be one of the factors for maintaining efficient biomechanics of the lower limb muscles, with the preservation of the physiological contractile characteristics of these muscles being the objective for a multidisciplinary rehabilitation based on postural exercises of the spine and a program of training exercises for the lower limb muscles.
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Affiliation(s)
- Luciano Bissolotti
- Rehabilitation Service, Fondazione Teresa Camplani Casa di Cura Domus Salutis, 25123 Brescia, Italy;
- LARIN: Neuromuscular and Adapted Physical Activity Laboratory, 25123 Brescia, Italy
| | - Matteo Rota
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (M.R.); (S.C.)
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (M.R.); (S.C.)
| | - Eleuterio A. Sanchez Romero
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Correspondence: (E.A.S.R.); (J.H.V.); Tel.: +39-393-9064-922 (E.A.S.R.); Fax: +34-633-115-328 (E.A.S.R.)
| | | | - Jorge H. Villafañe
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy;
- Correspondence: (E.A.S.R.); (J.H.V.); Tel.: +39-393-9064-922 (E.A.S.R.); Fax: +34-633-115-328 (E.A.S.R.)
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16
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Masaki M, Kasahara M, Takeuchi M, Minakawa K, Inagaki Y, Ogawa Y, Sato Y, Yokota M, Maruyama S, Usuki R, Azuma S, Obinata S. Comparison of the mass and amount of intramuscular non-contractile tissue of the trunk and lower extremity muscles between patients with Parkinson’s disease and community-dwelling older adults. Neurol Sci 2022; 43:3629-3640. [DOI: 10.1007/s10072-021-05828-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
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17
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Thangavelu K, Hayward JA, Pachana NA, Byrne GJ, Mitchell LK, Wallis GM, Au TR, Dissanayaka NN. Designing Virtual Reality Assisted Psychotherapy for Anxiety in Older Adults Living with Parkinson's Disease: Integrating Literature for Scoping. Clin Gerontol 2022; 45:235-251. [PMID: 31903862 DOI: 10.1080/07317115.2019.1709597] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: This review integrates literature to discuss the potential use of virtual reality (VR) in treatment of anxiety in Parkinson's disease (PD) and inform next steps.Methods: A systematic search was performed to identify studies of VR use in PD, using four databases. Data were reported in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analyzes extension for Scoping Reviews (PRISMA-ScR).Results: Thirty-two studies met the inclusion criteria with four VR studies from the same study group directly assessing the effects of anxiety on motor symptoms in PD. Primary studies implementing a VR protocol in PD identified focus areas of understanding and alleviating freezing of gait (FOG), balance training, and cognitive and motor rehabilitation, and informed design considerations.Conclusion: VR in PD studies suggested established feasibility. With appropriate design considerations, a VR based protocol could improve anxiety outcomes in PD.Clinical implications: VR in PD provides control of a patient's field of view, which can be exploited to induce specific responses, provide visual feedback, analysis of patient actions, and introduce safe challenges in the context of training. VR assisted Cognitive Behavioral Therapy (CBT) tailored to suit subtypes of anxiety disorders in PD have the potential to improve the efficacy and effectiveness of psychotherapy in PD.
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Affiliation(s)
- Karthick Thangavelu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Joshua A Hayward
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Mental Health Service, Royal Brisbane & Woman's Hospital, Brisbane, Australia
| | | | - Guy M Wallis
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Tiffany R Au
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,School of Psychology, The University of Queensland, Brisbane, Australia.,Department of Neurology, Royal Brisbane & Woman's Hospital, Brisbane, Australia
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Spathopoulou A, Edenhofer F, Fellner L. Targeting α-Synuclein in Parkinson's Disease by Induced Pluripotent Stem Cell Models. Front Neurol 2022; 12:786835. [PMID: 35145469 PMCID: PMC8821105 DOI: 10.3389/fneur.2021.786835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/24/2021] [Indexed: 11/22/2022] Open
Abstract
Parkinson's disease (PD) is a progressive, neurodegenerative disorder characterized by motor and non-motor symptoms. To date, no specific treatment to halt disease progression is available, only medication to alleviate symptoms can be prescribed. The main pathological hallmark of PD is the development of neuronal inclusions, positive for α-synuclein (α-syn), which are termed Lewy bodies (LBs) or Lewy neurites. However, the cause of the inclusion formation and the loss of neurons remain largely elusive. Various genetic determinants were reported to be involved in PD etiology, including SNCA, DJ-1, PRKN, PINK1, LRRK2, and GBA. Comprehensive insights into pathophysiology of PD critically depend on appropriate models. However, conventional model organisms fall short to faithfully recapitulate some features of this complex disease and as a matter-of-fact access to physiological tissue is limiting. The development of disease models replicating PD that are close to human physiology and dynamic enough to analyze the underlying molecular mechanisms of disease initiation and progression, as well as the generation of new treatment options, is an important and overdue step. Recently, the establishment of induced pluripotent stem cell (iPSC)-derived neural models, particularly from genetic PD-variants, developed into a promising strategy to investigate the molecular mechanisms regarding formation of inclusions and neurodegeneration. As these iPSC-derived neurons can be generated from accessible biopsied samples of PD patients, they carry pathological alterations and enable the possibility to analyze the differences compared to healthy neurons. This review focuses on iPSC models carrying genetic PD-variants of α-syn that will be especially helpful in elucidating the pathophysiological mechanisms of PD. Furthermore, we discuss how iPSC models can be instrumental in identifying cellular targets, potentially leading to the development of new therapeutic treatments. We will outline the enormous potential, but also discuss the limitations of iPSC-based α-syn models.
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Takahashi M, Shimokawa T, Koh J, Takeshima T, Yamashita H, Kajimoto Y, Mori A, Ito H. Efficacy and safety of istradefylline in patients with Parkinson's disease presenting with postural abnormalities: Results from a multicenter, prospective, and open-label exploratory study in Japan. J Neurol Sci 2022; 432:120078. [PMID: 34923334 DOI: 10.1016/j.jns.2021.120078] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/10/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022]
Abstract
Postural abnormalities in Parkinson's disease (PD) can devastatingly impair the quality of life, especially in patients with advanced disease, and are generally refractory to dopaminergic agents. The objective of this exploratory study was to investigate the efficacy and safety of istradefylline for the treatment of postural abnormalities in PD. In this open-label, 24-week, single-arm prospective trial, PD patients with postural abnormalities experiencing the wearing-off phenomenon on levodopa-containing therapies were enrolled and received a starting dose of 20 mg/day istradefylline orally for 4 weeks, which was then increased to 40 mg/day. The primary endpoint was the change from baseline to week 24 in the 14-item Unified Dystonia Rating Scale (UDRS) total score. Pivotal secondary endpoints were changes in the sub-items of UDRS, Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III, and adverse drug reactions (ADRs). Overall, 24/31 enrolled patients completed the study; mean (standard deviation) age and duration of motor complications were 73.3 (7.7) years and 3.2 (4.4) years, respectively. Mean (95% confidence interval [CI]) change in the UDRS total score was 4.84 (1.97, 7.71; P = 0.002), with significant improvements in the neck, right distal arm and hand, and trunk severity scores. Mean (95% CI) change in the MDS-UPDRS part III score was 7.84 (4.34, 11.34; P < 0.001). The most common ADRs were malaise, dyskinesia exacerbation, and visual hallucinations in 2 (6.5%) patients each. This exploratory study demonstrated that istradefylline could be efficacious for postural abnormalities and was generally well tolerated in patients with PD experiencing the wearing-off phenomenon with levodopa-containing therapies.
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Affiliation(s)
- Makio Takahashi
- Department of Neurology, Kitano Hospital, The Tazuke-Kofukai Medical Research Institute, Osaka, Japan.
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
| | - Jinsoo Koh
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
| | | | - Hirofumi Yamashita
- Department of Neurology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | | | - Akihisa Mori
- Medical Affairs Department, Kyowa Kirin Co., Ltd., Tokyo, Japan
| | - Hidefumi Ito
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
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Measurement Issue in Antecollis. Tremor Other Hyperkinet Mov (N Y) 2022; 12:31. [PMID: 36311955 PMCID: PMC9562782 DOI: 10.5334/tohm.723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Antecollis is defined as an involuntary forward flexion of the neck. Previous reports have measured the neck flexion angles based on the line perpendicular to the ground. This led to an inflation of the neck flexion angles in patients who had combined forward truncal flexions, especially upper camptocormia. Methods: We examined the neck flexion angles and the upper camptocormia angle in the published photographs of antecollis. MEDLINE search was conducted using the following search terms: antecollis OR anterocollis. Lateral-view photographs of patients diagnosed with antecollis were collected. Neck flexion angles were measured with the classic ‘perpendicular method’ and the ‘antecollis method’ we developed. Results: Nine patient photographs were identified. While antecollis was the only described postural abnormality in eight cases, these patients exhibited upper camptocormia angles of 45° or larger. The mean neck flexion angle measured with the antecollis method was 49.7°, while the perpendicular method yielded 103.4°. Discussion: Upper camptocormia should be considered in the evaluation of antecollis. We propose a new method to measure neck flexion in relation to the torso, instead of the vertical line.
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Pandey S, Chouksey A, Pitakpatapee Y, Srivanitchapoom P. Movement Disorders and Musculoskeletal System: A Reciprocal Relationship. Mov Disord Clin Pract 2021; 9:156-169. [DOI: 10.1002/mdc3.13390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sanjay Pandey
- Department of Neurology Govind Ballabh Pant Postgraduate Institute of Medical Education and Research New Delhi India
| | - Anjali Chouksey
- Department of Neurology Christian Medical College Vellore India
| | - Yuvadee Pitakpatapee
- Department of Medicine, Division of Neurology, Faculty of Medicine, Siriraj Hospital Mahidol University Bangkok Thailand
| | - Prachaya Srivanitchapoom
- Department of Medicine, Division of Neurology, Faculty of Medicine, Siriraj Hospital Mahidol University Bangkok Thailand
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22
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Tarolli CG, Lizarraga KJ. Approach to the Patient with Gait Disturbance. Semin Neurol 2021; 41:717-730. [PMID: 34826874 DOI: 10.1055/s-0041-1726355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The assessment of patients presenting with disorders of gait can be a daunting task for neurologists given the broad potential localization and differential diagnosis. However, gait disorders are extremely common in outpatient neurology, and all neurologists should be comfortable with the assessment, triage, and management of patients presenting with difficulty walking. Here, we aim to present a manageable framework for neurologists to approach the assessment of patients presenting with gait dysfunction. We suggest a chief complaint-based phenomenological characterization of gait, using components of the neurological history and examination to guide testing and treatment. We present the framework to mirror the outpatient visit with the patient, highlighting (1) important features of the gait history, including the most common gait-related chief complaints and common secondary (medical) causes of gait dysfunction; (2) gait physiology and a systematic approach to the gait examination allowing appropriate characterization of gait phenomenology; (3) an algorithmic approach to ancillary testing for patients with gait dysfunction based on historical and examination features; and (4) definitive and supportive therapies for the management of patients presenting with common neurological disorders of gait.
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Affiliation(s)
- Christopher G Tarolli
- Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Center for Health + Technology (CHeT), Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Karlo J Lizarraga
- Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Center for Health + Technology (CHeT), Department of Neurology, University of Rochester Medical Center, Rochester, New York.,Departamento Academico de Neurociencias, Facultad de Medicina, Universidad Nacional de San Agustin de Arequipa, Arequipa, Peru
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Hallett M, DelRosso LM, Elble R, Ferri R, Horak FB, Lehericy S, Mancini M, Matsuhashi M, Matsumoto R, Muthuraman M, Raethjen J, Shibasaki H. Evaluation of movement and brain activity. Clin Neurophysiol 2021; 132:2608-2638. [PMID: 34488012 PMCID: PMC8478902 DOI: 10.1016/j.clinph.2021.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/07/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
Clinical neurophysiology studies can contribute important information about the physiology of human movement and the pathophysiology and diagnosis of different movement disorders. Some techniques can be accomplished in a routine clinical neurophysiology laboratory and others require some special equipment. This review, initiating a series of articles on this topic, focuses on the methods and techniques. The methods reviewed include EMG, EEG, MEG, evoked potentials, coherence, accelerometry, posturography (balance), gait, and sleep studies. Functional MRI (fMRI) is also reviewed as a physiological method that can be used independently or together with other methods. A few applications to patients with movement disorders are discussed as examples, but the detailed applications will be the subject of other articles.
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Affiliation(s)
- Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA.
| | | | - Rodger Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | | | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Stephan Lehericy
- Paris Brain Institute (ICM), Centre de NeuroImagerie de Recherche (CENIR), Team "Movement, Investigations and Therapeutics" (MOV'IT), INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Masao Matsuhashi
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate, School of Medicine, Japan
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, Japan
| | - Muthuraman Muthuraman
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing unit, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jan Raethjen
- Neurology Outpatient Clinic, Preusserstr. 1-9, 24105 Kiel, Germany
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Zhang LY, Cao B, Wei QQ, Ou RW, Zhao B, Yang J, Wu Y, Shang HF. Camptocormia in patients with multiple system atrophy at different disease durations: frequency and related factors. BMC Neurol 2021; 21:181. [PMID: 33910524 PMCID: PMC8080355 DOI: 10.1186/s12883-021-02210-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/14/2021] [Indexed: 02/08/2023] Open
Abstract
Background Camptocormia is common in patients with multiple system atrophy (MSA). The current study was aimed at assessing the frequency of camptocormia and its related factors in MSA patients with different disease durations. Also, the impact of camptocormia on disability was evaluated. Methods A total of 716 patients were enrolled in the study. They were classified into three groups based on disease duration (≤ 3, 3–5, ≥ 5 years). Specific scales were used to evaluate the motor and non-motor symptoms. Disease severity was assessed using the Unified Multiple System Atrophy Rating Scale (UMSARS). The binary logistic regression model was used to explore the factors related to camptocormia. To analyze the impact of camptocormia on disability in patients with disease duration less than 5 years, propensity score matching (PSM) and stratified Cox regression analysis were used. Results In the current study, we found that the frequency of camptocormia was 8.9, 19.7 and 19.2% when the disease duration was ≤3, 3–5, ≥ 5 years, respectively. In the disease duration ≤3 years group, we found that MSA-parkinsonian subtype (MSA-P) (OR = 2.043, P = 0.043), higher total UMSARS score (OR = 1.063, P < 0.001), older age of onset (OR = 1.047, P = 0.042), and lower score on the frontal assessment battery (FAB) (OR = 0.899, P = 0.046) were associated with camptocormia. Only greater disease severity was associated with camptocormia in the group of patients with disease duration 3–5 years (OR = 1.494, P = 0.025) and in the group of patients with disease duration ≥5 years (OR = 1.076, P = 0.005). There was no significant impact of camptocormia on disability in patients with a disease duration of < 5 years (HR = 0.687, P = 0.463). Conclusion The frequency of camptocormia increased with prolonged disease duration. Disease severity was related to camptocormia at different stages of the disease. The MSA-P subtype, older age of onset, and lower FAB score were associated with camptocormia in the early stage of the disease.
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Affiliation(s)
- Ling Yu Zhang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Bei Cao
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qian-Qian Wei
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ru Wei Ou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Bi Zhao
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jing Yang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ying Wu
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hui Fang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Varrecchia T, Castiglia SF, Ranavolo A, Conte C, Tatarelli A, Coppola G, Di Lorenzo C, Draicchio F, Pierelli F, Serrao M. An artificial neural network approach to detect presence and severity of Parkinson's disease via gait parameters. PLoS One 2021; 16:e0244396. [PMID: 33606730 PMCID: PMC7894951 DOI: 10.1371/journal.pone.0244396] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/08/2020] [Indexed: 01/16/2023] Open
Abstract
Introduction Gait deficits are debilitating in people with Parkinson’s disease (PwPD), which inevitably deteriorate over time. Gait analysis is a valuable method to assess disease-specific gait patterns and their relationship with the clinical features and progression of the disease. Objectives Our study aimed to i) develop an automated diagnostic algorithm based on machine-learning techniques (artificial neural networks [ANNs]) to classify the gait deficits of PwPD according to disease progression in the Hoehn and Yahr (H-Y) staging system, and ii) identify a minimum set of gait classifiers. Methods We evaluated 76 PwPD (H-Y stage 1–4) and 67 healthy controls (HCs) by computerized gait analysis. We computed the time-distance parameters and the ranges of angular motion (RoMs) of the hip, knee, ankle, trunk, and pelvis. Principal component analysis was used to define a subset of features including all gait variables. An ANN approach was used to identify gait deficits according to the H-Y stage. Results We identified a combination of a small number of features that distinguished PwPDs from HCs (one combination of two features: knee and trunk rotation RoMs) and identified the gait patterns between different H-Y stages (two combinations of four features: walking speed and hip, knee, and ankle RoMs; walking speed and hip, knee, and trunk rotation RoMs). Conclusion The ANN approach enabled automated diagnosis of gait deficits in several symptomatic stages of Parkinson’s disease. These results will inspire future studies to test the utility of gait classifiers for the evaluation of treatments that could modify disease progression.
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Affiliation(s)
- Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone Rome, Rome, Italy
- * E-mail:
| | - Stefano Filippo Castiglia
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone Rome, Rome, Italy
| | | | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone Rome, Rome, Italy
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone Rome, Rome, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
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Use of Botulinum Neurotoxin in Parkinson's Disease: A Critical Appraisal. Toxins (Basel) 2021; 13:toxins13020087. [PMID: 33503872 PMCID: PMC7910947 DOI: 10.3390/toxins13020087] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Abstract
For well over 30 years, the botulinum neurotoxin (BoNT) has been used for a large number of indications, some of which however have not been licensed. Admittedly, approval varies in many countries and this permits a large spectrum for evaluation. Thus, BoNT is used for patients with Parkinson’s disease (PD) and other Parkinson’s syndromes (PS) in varying degrees of frequency. We have to distinguish between (1) indications that are either approved or (2) those not approved, (3) indications that might be a result of PS and (4) finally those which appear independent of PS. The most important indication for BoNT in PS patients is probably sialorrhea, for which approval has been granted in the majority of countries. Cervical dystonia is a frequent symptom in PS, with anterocollis as a specific entity. A further indication is blepharospasm in the different forms, especially the inhibition of eyelid opening in atypical PS. The use of BoNT in cases of camptocormia, the Pisa syndrome and neck rigidity is still a matter of debate. In dystonia of the extremities BoNT can be recommended, especially in dystonia of the feet. One well-known indication, for which however sufficient data are still lacking, involves treating tremor with BoNT. As to autonomic symptoms: Focal hyperhidrosis and detrusor hyperactivity can be mentioned, in this last case BoNT has already been approved. A number of further but rare indications such as freezing-of-gait, dyskinesia, and dysphagia will be discussed and evaluated.
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Youm C, Kim Y, Noh B, Lee M, Kim J, Cheon SM. Impact of Trunk Resistance and Stretching Exercise on Fall-Related Factors in Patients with Parkinson's Disease: A Randomized Controlled Pilot Study. SENSORS (BASEL, SWITZERLAND) 2020; 20:s20154106. [PMID: 32717956 PMCID: PMC7435366 DOI: 10.3390/s20154106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/10/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND This study aimed to examine the effect of a 12-week progressive trunk resistance and stretching exercise program on fall-related factors in patients with Parkinson's disease (PD). METHODS A randomized study assessed a progressive trunk resistance and stretching exercise program over a 12-week period. A total of 17 patients with PD participated and wererandomly allocated into an exercise group (n = 10) or a control group (n = 7). Participants in the exercise group completed the exercise program in 60- to 90-min sessions for three days per week. Primary and secondary outcome measures included the trunk mobility scale, functional fitness test, standing balance, and sit-to-walk test. RESULTS The exercise group showed improvements in functional fitness, trunk mobility, standing balance, and dynamic stability compared with the control group (all p < 0.05). The 2.44 m timed up and go test (odds ratio (OR): 0.125) and the 2 min step test (OR: 10.584) of the functional fitness test, and the first-step length (OR: 3.558) and first-toe clearance height (OR: 4.777) of the sit-to-walk test, were different between the groups following the exercise program. CONCLUSION This 12-week exercise program improved fall-related factors in patients with PD and may lead to prevention of fall-related injuries.
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Affiliation(s)
- Changhong Youm
- Department of Health Care and Science, College of Health Sciences, Dong-A University, Saha-gu, Busan 49315, Korea;
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Saha-gu, Busan 49315, Korea; (Y.K.); (M.L.); (J.K.)
| | - Youkyung Kim
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Saha-gu, Busan 49315, Korea; (Y.K.); (M.L.); (J.K.)
| | - Byungjoo Noh
- Department of Health Care and Science, College of Health Sciences, Dong-A University, Saha-gu, Busan 49315, Korea;
| | - Myeounggon Lee
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Saha-gu, Busan 49315, Korea; (Y.K.); (M.L.); (J.K.)
| | - Jinhee Kim
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Saha-gu, Busan 49315, Korea; (Y.K.); (M.L.); (J.K.)
| | - Sang-Myung Cheon
- Department of Neurology, School of Medicine, Dong-A University, Dongdaesin-dong 3-ga, Seo-gu, Busan 49201, Korea;
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Choi JH, Kim JM, Yang HK, Lee HJ, Shin CM, Jeong SJ, Kim WS, Han JW, Yoon IY, Song YS, Bae YJ. Clinical Perspectives of Parkinson's Disease for Ophthalmologists, Otorhinolaryngologists, Cardiologists, Dentists, Gastroenterologists, Urologists, Physiatrists, and Psychiatrists. J Korean Med Sci 2020; 35:e230. [PMID: 32686370 PMCID: PMC7371452 DOI: 10.3346/jkms.2020.35.e230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022] Open
Abstract
Parkinson's disease (PD) is a multisystemic disorder characterized by various non-motor symptoms (NMS) in addition to motor dysfunction. NMS include sleep, ocular, olfactory, throat, cardiovascular, gastrointestinal, genitourinary, or musculoskeletal disorders. A range of NMS, particularly hyposmia, sleep disturbances, constipation, and depression, can even appear prior to the motor symptoms of PD. Because NMS can affect multiple organs and result in major disabilities, the recognition and multidisciplinary and collaborative management of NMS by physicians is essential for patients with PD. Therefore, the aim of this review article is to provide an overview of the organs that are affected by NMS in PD together with a brief review of pathophysiology and treatment options.
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Affiliation(s)
- Ji Hyun Choi
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyo Jung Lee
- Department of Dentistry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Won Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - In Young Yoon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoo Sung Song
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Evaluation of scoliosis in patients with lumbosacral transitional vertebra. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.735849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Muscle echo intensity of abdominal wall in Parkinson's disease and healthy controls: a cross sectional study. Neurol Sci 2020; 41:3201-3207. [PMID: 32372195 DOI: 10.1007/s10072-020-04440-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/18/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of this study was to describe the differences between abdominal wall muscles echo intensity (EI) in PD patients and healthy controls. METHODS Forty-three consecutive PD patients (25 males and 18 females, age 73.7 ± 7.1, and 42 controls without neurological diseases (22 males, 20 females, age 69.8 ± 6.0) participated in this cross-sectional study. The clinical assessment included the following: IPAQ (International Physical Activity Questionnaire), Hoehn Yahr score, plumb line distance from the spinous process of C7, kyphosis apex, and spinous process of L3 and S1. A real-time ultrasound B-scanner (system MyLab40 by Esaote, Genoa, Italy) was used to obtain muscle images of the right and left biceps brachii (BB), external (EO), and internal oblique (IO) and rectus abdomen (RA). Heckmatt scale and measure of EI through ImageJ software were used to assess muscle quality. RESULTS When considering the Heckmatt score, the RA and BB did not significantly differ between PD and control patients, while there was a significant difference for right (p < 0.01) and left (p = 0.02) IO muscles. There was no difference among EI values of the RA, IO, and BB between PD and control patients. CONCLUSIONS Echo intensity of abdominal wall muscles (rectus abdominis, internal oblique) and biceps brachii did not differ between Parkinsonian patients and healthy subjects. We did not found ultrasound useful in disease evolution assessment or in early diagnosis of postural disorders.
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Sin MK, Khemani P. Pain and Musculoskeletal Disorders: Common Nuisances in Parkinson Disease. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Adult Spinal Deformity Surgery in Patients With Movement Disorders: A Propensity-matched Analysis of Outcomes and Cost. Spine (Phila Pa 1976) 2020; 45:E288-E295. [PMID: 32045403 DOI: 10.1097/brs.0000000000003251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This was a retrospective study using national administrative data from the MarketScan database. OBJECTIVE To investigate the complication rates, quality outcomes, and costs in a nationwide cohort of patients with movement disorders (MD) who undergo spinal deformity surgery. SUMMARY OF BACKGROUND DATA Patients with MD often present with spinal deformities, but their tolerance for surgical intervention is unknown. METHODS The MarketScan administrative claims database was queried to identify adult patients with MD who underwent spinal deformity surgery. A propensity-score match was conducted to create two uniform cohorts and mitigate interpopulation confounders. Perioperative complication rates, 90-day postoperative outcomes, and total costs were compared between patients with MD and controls. RESULTS A total of 316 patients with MD (1.7%) were identified from the 18,970 undergoing spinal deformity surgery. The complication rate for MD patients was 44.6% and for the controls 35.6% (P = 0.009). The two most common perioperative complications were more likely to occur in MD patients, acute-posthemorrhagic anemia (26.9% vs. 20.8%, P < 0.05) and deficiency anemia (15.5% vs. 8.5%, P < 0.05). At 90 days, MD patients were more likely to be readmitted (17.4% vs. 13.2%, P < 0.05) and have a higher total cost ($94,672 vs. $85,190, P < 0.05). After propensity-score match, the overall complication rate remained higher in the MD group (44.6% vs. 37.6%, P < 0.05). 90-day readmissions and costs also remained significantly higher in the MD cohort. Multivariate modeling revealed MD was an independent predictor of postoperative complication and inpatient readmission. Subgroup analysis revealed that Parkinson disease was an independent predictor of inpatient readmission, reoperation, and increased length of stay. CONCLUSION Patients with MD who undergo spinal deformity surgery may be at risk of higher rate of perioperative complications and 90-day readmissions compared with patients without these disorders. LEVEL OF EVIDENCE 3.
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Chan AK, Chan AY, Lau D, Durcanova B, Miller CA, Larson PS, Starr PA, Mummaneni PV. Surgical management of camptocormia in Parkinson's disease: systematic review and meta-analysis. J Neurosurg 2019; 131:368-375. [PMID: 30215560 DOI: 10.3171/2018.4.jns173032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/02/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Camptocormia is a potentially debilitating condition in the progression of Parkinson's disease (PD). It is described as an abnormal forward flexion while standing that resolves when lying supine. Although the condition is relatively common, the underlying pathophysiology and optimal treatment strategy are unclear. In this study, the authors systematically reviewed the current surgical management strategies for camptocormia. METHODS PubMed was queried for primary studies involving surgical intervention for camptocormia in PD patients. Studies were excluded if they described nonsurgical interventions, provided only descriptive data, or were case reports. Secondarily, data from studies describing deep brain stimulation (DBS) to the subthalamic nuclei were extracted for potential meta-analysis. Variables showing correlation to improvement in sagittal plane bending angle (i.e., the vertical angle caused by excessive kyphosis) were subjected to formal meta-analysis. RESULTS The query resulted in 9 studies detailing treatment of camptocormia: 1 study described repetitive trans-spinal magnetic stimulation (rTSMS), 7 studies described DBS, and 1 study described deformity surgery. Five studies were included for meta-analysis. The total number of patients was 66. The percentage of patients with over 50% decrease in sagittal plane imbalance with DBS was 36.4%. A duration of camptocormia of 2 years or less was predictive of better outcomes (OR 4.15). CONCLUSIONS Surgical options include transient, external spinal stimulation; DBS targeting the subthalamic nuclei; and spinal deformity surgery. Benefit from DBS stimulation was inconsistent. Spine surgery corrected spinal imbalance but was associated with a high complication rate.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Alvin Y Chan
- 2Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Darryl Lau
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Beata Durcanova
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Catherine A Miller
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Paul S Larson
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Philip A Starr
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
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Soares C, Vilas-Boas MDC, Lopes EM, Choupina H, Soares-Dos-Reis R, Fitas D, Cunha JPS, Monteiro P, Linhares P, Rosas MJ. Automated and objective measures of gait dynamics in camptocormia Parkinson's Disease subthalamic deep brain stimulation. Clin Neurol Neurosurg 2019; 186:105537. [PMID: 31605896 DOI: 10.1016/j.clineuro.2019.105537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Axial motor features are common in Parkinson's disease (PD). These include gait impairment and postural abnormalities, such as camptocormia. The response of these symptoms to deep brain stimulation (DBS) is variable and difficult to assess objectively. For the first time, this study analyzes the treatment outcomes of two PD patients with camptocormia that underwent bilateral subthalamic nucleus (STN)-DBS evaluated with disruptive technologies. PATIENTS AND METHODS Two patients with PD and camptocormia who underwent STN-DBS were included. Gait parameters were quantitatively assessed before and after surgery by using the NeuroKinect system and the camptocormia angle was measured using the camptoapp. RESULTS After surgery, patient 1 improved 29 points in the UPDRS-III. His camptocormia angle was 68° before and 38° after surgery. Arm and knee angular amplitudes (117.32 ± 7.47 vs 134.77 ± 2.70°; 144.51 ± 7.47 vs 169.08 ± 3.27°) and arm swing (3.59 ± 2.66 vs 5.40 ± 1.76 cm) improved when compared with his preoperative measurements. Patient 2 improved 22 points in the UPDRS-III after surgery. Her camptocormia mostly resolved (47° before to 9° after surgery). Gait analysis revealed improvement of stride length (0.29 ± 0.03 vs 0.35 ± 0.03 m), stride width (18.25 ± 1.16 vs 17.9 ± 0.84 cm), step velocity (0.91 ± 0.57 vs 1.33 ± 0.48 m/s), arm swing (4.51 ± 1.01 vs 7.38 ± 2.71 cm) and arm and hip angular amplitudes (131.57 ± 2.45° vs 137.75 ± 3.18; 100.51 ± 1.56 vs 102.18 ± 1.77°) compared with her preoperative results. CONCLUSION The gait parameters and camptocormia of both patients objectively improved after surgery, as assessed by the two quantitative measurement systems. STN-DBS might have a beneficial effect on controlling axial posturing and gait, being a potential surgical treatment for camptocormia in patients with PD. However, further studies are needed to derive adequate selection criteria for this patient population.
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Affiliation(s)
- Carolina Soares
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Portugal.
| | | | | | - Hugo Choupina
- INESC TEC and Faculty of Engineering, University of Porto, Portugal
| | - Ricardo Soares-Dos-Reis
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Portugal; Department of Biomedicine, Faculty of Medicine, University of Porto, Portugal
| | - Diogo Fitas
- Department of Neurology, Hospital de Santa Luzia, Viana do Castelo, Portugal
| | | | - Pedro Monteiro
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Portugal; Department of Neurosurgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Movement Disorders Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paulo Linhares
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Portugal; Department of Neurosurgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Movement Disorders Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria José Rosas
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Neurosurgery, Centro Hospitalar Universitário de São João, Porto, Portugal
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Papalia R, Torre G, Papalia G, Baums MH, Narbona P, Di Lazzaro V, Denaro V. Frozen shoulder or shoulder stiffness from Parkinson disease? Musculoskelet Surg 2019; 103:115-119. [PMID: 30276531 DOI: 10.1007/s12306-018-0567-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/20/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE To understand the role of camptocormia (increased kyphosis) and postural alteration in Parkinson's disease in the development of shoulder pathology, with a special concern for adhesive capsulitis and shoulder stiffness. METHODS A preliminary online search was carried out, with combination of keywords including "Parkinson," "Shoulder stiffness," "Frozen shoulder," "Adhesive capsulitis," "Postural alteration," "Camptocormia". The retrieved papers were screened by title and abstract and those considered relevant to the aim of the review were read in full text and included. Relevant information were extracted and reported into text. RESULTS Due to a severe impairment of posture, patients affected by PD show an increased thoracic kyphosis (camptocormia) and decreased mobility of the trunk that can yield a humeroacromial impingement syndrome and capsulitis, resulting in inflammation of the bursa, shoulder pain and reduction of movement. Furthermore, kinematic of the shoulder is allowed by the combined movement of the humerus, the scapula, the clavicle, the thoracic wall and thoracic spine. The thoracic spine and wall mobility are severely impaired in the parkinsonian patient, thus limiting the shoulder motion. CONCLUSION The postural alteration observed in PD is the primum movens for shoulder pathology, since anterior tilt of the scapula, which occurs with the increment of thoracic kyphosis, yields to a subacromial impingement. A closed loop is then created, as the rigidity of the shoulder causes further alteration in the posture, which worsens the impingement syndrome and so on.
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Affiliation(s)
- R Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - G Torre
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - G Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - M H Baums
- Department of Orthopaedic Surgery, Georg-August-University of Göttingen, Göttingen, Germany
| | - P Narbona
- Departamento de Artroscopía, Sanatorio Allende, Córdoba, Argentina
| | - V Di Lazzaro
- Institute of Neurology, Campus Bio-Medico University of Rome, Rome, Italy
| | - V Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy
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Baizabal‐Carvallo JF, Alonso‐Juarez M, Murillo Ortiz B, Fekete R. Clinical correlations of striatal hand deformities in Parkinson's disease. Acta Neurol Scand 2019; 140:162-166. [PMID: 31087802 DOI: 10.1111/ane.13117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hand deformities have been recognized since the 19th century as part of the postural abnormalities observed in Parkinson's disease (PD). However, their pathogenesis and clinical correlations are poorly understood. METHODS We evaluated 104 hands of 52 consecutive patients with PD by high-resolution photographs taken from the radial aspect of each hand; the degree of flexion of the 2nd metacarpophalangeal (MCP) joint was measured by software. The presence of classical striatal hand deformity (CSHD) was also evaluated, defined as MCP flexion, proximal interphalangeal joint extension, and distal interphalangeal joint flexion. RESULTS Patients with PD had a mean age of 63.3 ± 12.7 years, and 29 (56%) were male. The degree of MCP joint flexion in both hands showed moderate correlation with the MDS-UPDRS-III motor score (r = 0.518, P < 0.001), mainly related to ipsilateral rigidity and ipsilateral bradykinesia scores, and fair correlation with the Hoehn-Yahr stage. A CSHD only correlated with a younger age at onset of PD (P = 0.049). These hand deformities were not markers of dyskinesia, levodopa equivalent dose, or cognitive dysfunction. CONCLUSIONS Metacarpophalangeal joint flexion is the most common hand deformity in PD and correlates with rigidity and bradykinesia. A CSHD was only related to a younger age at onset.
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Marsili L, Bologna M, Kojovic M, Berardelli A, Espay AJ, Colosimo C. Dystonia in atypical parkinsonian disorders. Parkinsonism Relat Disord 2019; 66:25-33. [PMID: 31443953 DOI: 10.1016/j.parkreldis.2019.07.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023]
Abstract
Dystonia is common in the classic atypical parkinsonian disorders such as multiple system atrophy, progressive supranuclear palsy and corticobasal degeneration, and to a lesser extent in dementia with Lewy bodies. Its clinical phenomenology, including body distribution, timing of appearance, severity, and relationship to dopaminergic and other medications may vary considerably within and between atypical parkinsonian disorders. From a pathophysiological standpoint, the coexistence of dystonia with parkinsonism challenges the functional model of the basal ganglia. Clinical recognition of specific dystonic features may assist in the differential diagnosis of atypical parkinsonian disorders and in distinguishing them from Parkinson's disease. The presence of dystonia in atypical parkinsonian disorders informs management decisions. Reduction or withdrawal of levodopa should be considered if there is a close relationship between the onset of dystonia with periods of high dopaminergic tone. Botulinum neurotoxin may be considered in focal presentations. We here provide an updated overview of dystonia arising in the setting of atypical parkinsonian disorders, summarizing relevant clinical and clinicopathological studies, underlying pathophysiological mechanisms, diagnostic clues and potential pitfalls in the diagnosis. Finally, we suggest a tailored therapeutic approach for the management of these patients.
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Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Maja Kojovic
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy.
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Alwardat M, Schirinzi T, Di Lazzaro G, Franco D, Sinibaldi Salimei P, Mercuri NB, Pisani A. The effect of postural deformities on back function and pain in patients with Parkinson’s disease. NeuroRehabilitation 2019; 44:419-424. [DOI: 10.3233/nre-182637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mohammad Alwardat
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Neuroscience PhD School, University of Rome “Tor Vergata”, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Department of Neurosciences, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Giulia Di Lazzaro
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
| | - Donatella Franco
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | | | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Neuroscience PhD School, University of Rome “Tor Vergata”, Rome, Italy
- IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Antonio Pisani
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Neuroscience PhD School, University of Rome “Tor Vergata”, Rome, Italy
- IRCSS Fondazione Santa Lucia, Rome, Italy
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Shetty AS, Bhatia KP, Lang AE. Dystonia and Parkinson's disease: What is the relationship? Neurobiol Dis 2019; 132:104462. [PMID: 31078682 DOI: 10.1016/j.nbd.2019.05.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/15/2019] [Accepted: 05/07/2019] [Indexed: 01/30/2023] Open
Abstract
Dystonia and Parkinson's disease are closely linked disorders sharing many pathophysiological overlaps. Dystonia can be seen in 30% or more of the patients suffering with PD and sometimes can precede the overt parkinsonism. The response of early dystonia to the introduction of dopamine replacement therapy (levodopa, dopamine agonists) is variable; dystonia commonly occurs in PD patients following levodopa initiation. Similarly, parkinsonism is commonly seen in patients with mutations in various DYT genes including those involved in the dopamine synthesis pathway. Pharmacological blockade of dopamine receptors can cause both tardive dystonia and parkinsonism and these movement disorders syndromes can occur in many other neurodegenerative, genetic, toxic and metabolic diseases. Pallidotomy in the past and currently deep brain stimulation largely involving the GPi are effective treatment options for both dystonia and parkinsonism. However, the physiological mechanisms underlying the response of these two different movement disorder syndromes are poorly understood. Interestingly, DBS for PD can cause dystonia such as blepharospasm and bilateral pallidal DBS for dystonia can result in features of parkinsonism. Advances in our understanding of these responses may provide better explanations for the relationship between dystonia and Parkinson's disease.
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Affiliation(s)
- Aakash S Shetty
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Kailash P Bhatia
- Department of Clinical Movement Disorders and Motor Neuroscience, University College London (UCL), Institute of Neurology, Queen Square, London, United Kingdom
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, Canada.
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Subjective Vertical Position Allows Prediction of Postural Deterioration in Patients with Parkinson's Disease. PARKINSON'S DISEASE 2019; 2019:1875435. [PMID: 31061695 PMCID: PMC6466872 DOI: 10.1155/2019/1875435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/27/2019] [Accepted: 03/18/2019] [Indexed: 11/18/2022]
Abstract
Background We believe that, in patients with Parkinson's disease (PD), a forward-directed increase in the subjective vertical position (SV) leads to prolonged worsening of forward flexion of the trunk (FFT) mainly because the body adjusts to the SV. We conducted a study to clarify the relation between the SV angle, FFT angle, and various other clinical measures by comparing baseline values against values obtained 1 year later. Methods A total of 39 PD patients (mean age, 71.9 ± 10.1 years; disease duration, 7.2 ± 5.4 years; modified Hoehn & Yahr (mH&Y) score, 2.6 ± 0.7) were enrolled. The Unified Parkinson's Disease Rating Scale score, Mini-Mental State Examination (MMSE) score, mH&Y score, FFT angle, SV angle, and levodopa-equivalent dose (LED) were assessed at the time of enrollment (baseline evaluation) and 1 year later. Results Eighteen patients (46%) complied with the protocol and completed the study. Significant increases were observed in the 1-year SV angle (p=0.02), MMSE score (p=0.008), and LED (p=0.001) compared to baseline values. Correlation was observed between the baseline SV angle and baseline and 1-year FFT angles (r=0.64, p=0.008 and r=0.58, p=0.012, respectively) and between the 1-year SV angle and 1-year FFT angle (r=0.63, p=0.005). Conclusion Our data suggest that the SV contributes to increased FFT.
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Zhang L, Cao B, Zou Y, Wei QQ, Ou R, Zhao B, Yang J, Wu Y, Shang H. Prevalence of and factors associated with postural deformities in Chinese patients with multiple system atrophy. Parkinsonism Relat Disord 2019; 64:324-327. [PMID: 30987897 DOI: 10.1016/j.parkreldis.2019.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/13/2019] [Accepted: 03/25/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The prevalence of postural deformities in patients with multiple system atrophy (MSA) has varied among previous studies. The objective of our study was to investigate the prevalence of and factors associated with postural deformities in Chinese MSA patients. METHODS A total of 732 MSA patients were consecutively enrolled in the current study. Clinical data including age, sex, age of onset, disease duration, onset symptom and treatment were collected. The Unified Multiple System Atrophy Rating Scale (UMSARS) was used to evaluate the severity of the disease. RESULTS One hundred and fourteen (15.6%) patients presented with camptocormia. Thirty-one (4.2%) patients manifested with Pisa syndrome. Twenty-four (3.3%) patients presented with antecollis. Patients who exhibited postural deformities were more common among the MSA patients with predominant parkinsonism (MSA-P) (P < 0.05). In addition, MSA patients with postural deformities had a longer disease duration compared to those patients without postural deformities (P < 0.001). After adjusting for disease duration, compared with patients without postural deformities, MSA patients with postural deformities presented with higher score of UMSARS-I (P < 0.001), UMSARS-II (P < 0.001), UMSARS-IV (P < 0.001), and total UMSARS (P < 0.001) scores. The binary logistic regression model indicated that the factors associated with postural deformity in MSA patients were the total UMSARS score (OR = 1.076, P < 0.001) and MSA-P subtype (OR = 3.870, P < 0.001). CONCLUSION Postural deformities were common in Chinese MSA patients. Camptocormia was the most common type of postural deformity, followed by Pisa syndrome and antecollis. The factors associated with postural deformity were the severity of the disease and MSA-P subtype.
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Affiliation(s)
- LingYu Zhang
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bei Cao
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yutong Zou
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Qian-Qian Wei
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - RuWei Ou
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bi Zhao
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Wu
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - HuiFang Shang
- Department of Neurology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Kataoka H, Sugie K. Recent advancements in lateral trunk flexion in Parkinson disease. Neurol Clin Pract 2019; 9:74-82. [PMID: 30859010 DOI: 10.1212/cpj.0000000000000574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/13/2018] [Indexed: 11/15/2022]
Abstract
Purpose of review Understanding the pathophysiologic underpinnings of lateral trunk flexion (LTF) in Parkinson disease (PD) has been growing. Adjusting antiparkinsonian medications, botulinum toxin, or surgical intervention has been found efficacious in some patients. Nevertheless, these treatments remain limited, often resulting in inadequate outcomes. We review patients with LTF with PD, including recent advancements in treatment and neuroimaging examination. Recent findings The basal ganglia system is a major contributing factor to LTF, and the therapeutic intervention also targets the basal ganglia system, including dystonic contraction. The perceptions of the postural verticality or spatial cognition of the correct body orientation promote the severity of LTF or result in a chronic condition with irreversible structural deformities. Conclusion The combination of pharmacologic interventions with nonpharmacologic interventions, such as rehabilitation, might be needed to manage LTF, and the initiation of these treatments should be started as early as possible.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Neurology, Nara Medical University, Nara Medical University, Kashihara, Nara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Nara Medical University, Kashihara, Nara, Japan
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Wijemanne S, Jankovic J. Hand, foot, and spine deformities in parkinsonian disorders. J Neural Transm (Vienna) 2019; 126:253-264. [PMID: 30809710 DOI: 10.1007/s00702-019-01986-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/09/2019] [Indexed: 12/31/2022]
Abstract
Hand and foot deformities, known as "striatal deformities", and other musculoskeletal abnormalities such as dropped head, bent spine, camptocormia, scoliosis and Pisa syndrome, are poorly understood and often misdiagnosed features of Parkinson's disease and other parkinsonian syndromes. These deformities share some similarities with known rheumatologic conditions and can be wrongly diagnosed as rheumatoid arthritis, osteoarthritis, psoriatic arthritis, Dupuytren's contracture, trigger finger, or other rheumatologic or orthopedic conditions. Neurologists, rheumatologists, and other physicians must be familiar with these deformities to prevent misdiagnosis and unnecessary diagnostic tests, and to recommend appropriate treatment options.
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Affiliation(s)
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 7200 Cambridge St, Suite #9A, Houston, TX, 77030, USA.
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Alwardat M, Schirinzi T, Di Lazzaro G, Franco D, Imbriani P, Sinibaldi Salimei P, Mercuri NB, Pisani A. The influence of postural deformities on neck function and pain in patients with Parkinson’s disease. NeuroRehabilitation 2019; 44:79-84. [DOI: 10.3233/nre-182505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mohammad Alwardat
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Neuroscience PhD School, University of Rome “Tor Vergata”, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Department of Neurosciences, Bambino Gesu Children Hospital, Rome, Italy
| | - Giulia Di Lazzaro
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
| | - Donatella Franco
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Paola Imbriani
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Neuroscience PhD School, University of Rome “Tor Vergata”, Rome, Italy
| | | | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Neuroscience PhD School, University of Rome “Tor Vergata”, Rome, Italy
- Fondazione Santa Lucia (IRCSS), Rome, Italy
| | - Antonio Pisani
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Neuroscience PhD School, University of Rome “Tor Vergata”, Rome, Italy
- Fondazione Santa Lucia (IRCSS), Rome, Italy
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Roediger J, Artusi CA, Romagnolo A, Boyne P, Zibetti M, Lopiano L, Espay AJ, Fasano A, Merola A. Effect of subthalamic deep brain stimulation on posture in Parkinson's disease: A blind computerized analysis. Parkinsonism Relat Disord 2019; 62:122-127. [PMID: 30638820 DOI: 10.1016/j.parkreldis.2019.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION We sought to assess the effect of subthalamic deep brain stimulation (STN DBS) on Parkinson's disease (PD)-associated postural abnormalities. METHODS A computerized analysis of posture was used to quantify the thoracolumbar, thoracic, and cervical-occipital ventral angles, as well as the thoracolumbar and cervical-occipital lateral angles from the video-repository of three specialized movement disorder centers (n = 158 patients). Data was extracted from frames from video-recordings in the pre-surgical medication-ON (dopaminergic therapy) and post-surgical stimulation-ON/medication-ON states (STN DBS plus dopaminergic therapy). The sum of the five postural angles (global postural angle) was used to compare pre-vs. post-surgical trunk posture alterations. A multivariate analysis was used to examine the association between changes in the postural angles and demographic or clinical variables. RESULTS There was a 6.7% amelioration in the global postural angle between the pre- and post-surgical assessments (p = 0.031). Motor response to and pre-surgical dosage of levodopa, male gender, and shorter PD duration were identified as predictors for posture improvement after STN DBS. Cases meeting criteria for lower (n = 2) or upper (n = 1) camptocormia respectively improved by 48.1% in the ventral thoracolumbar angle (from 36.4 ± 0.0° to 18.9 ± 4.2°) and 13.8% in the ventral thoracic angle (from 49.1° to 42.3°). Cases meeting criteria for Pisa syndrome (n = 2) improved by 67.5% in the lateral thoracolumbar angle (from 16.9 ± 2.0° to 5.5 ± 4.7°). CONCLUSIONS STN DBS has a relatively small but significant effect on PD-associated postural abnormalities, potentially enhancing the effect of dopaminergic medications alone.
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Affiliation(s)
- Jan Roediger
- Department of Neurology, University Hospital of Cologne, Germany
| | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Torino, Italy
| | - Alberto Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Torino, Italy
| | - Pierce Boyne
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Torino, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10124, Torino, Italy
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada.
| | - Aristide Merola
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
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Baizabal-Carvallo JF, Alonso-Juarez M, Fekete R. The frequency and diagnostic accuracy of hand deformities in Parkinson's disease. J Neural Transm (Vienna) 2018; 125:1813-1817. [PMID: 30291445 DOI: 10.1007/s00702-018-1937-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/29/2018] [Indexed: 11/24/2022]
Abstract
Hand deformities are well-known abnormalities observed in patients with Parkinson's disease (PD). We determined the frequency and diagnostic accuracy of hand deformities in PD. We studied 44 consecutive patients with PD, 44 age- and gender-matched normal controls and 22 patients with essential tremor (ET). By means of photographs taken in both hands of all participants, the degree of metacarpophalangeal (MCP) joint flexion was quantified by software and by blinded evaluations using a semiquantitative scale from the radial aspect, we grouped hands into four grades. The presence of classical striatal hand deformity (CSHD), defined as MCP joint flexion, proximal interphalangeal joint extension and distal interphalangeal joint flexion was also evaluated. Patients with PD had a higher frequency of MCP joint flexion and CSHD compared to normal controls and patients with ET. Mean MCP joint flexion was higher in both hands in patients with PD: 20.8° vs. normal controls (3.3°-3.9°) and patients with ET (2.8°-6.3°), P = 0.001. Concordance between evaluators for MCP joint flexion was fair: κ = 0.34 (P < 0.001), but poor for CSHD: κ = 0.142-0.235 (P < 0.05). A right hand MCP joint flexion of 12.5° and left hand of 10.5°, showed similar sensitivity (0.70) and specificity (between 0.75 and 0.80) than any degree of MCP joint flexion for the diagnosis of PD. CSHD had a sensitivity (0.60-0.80) and specificity (0.78-0.98) for the diagnosis of PD. Hand deformities are commonly observed in patients with PD, they may aid in the diagnosis of PD when compared to normal controls and patients with ET.
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Affiliation(s)
- José Fidel Baizabal-Carvallo
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, USA. .,Department of Internal Medicine, University of Guanajuato, 20 de Enero no. 927, C.P. 37320, León, Guanajuato, Mexico.
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48
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Bhidayasiri R, Sringean J, Reich SG, Colosimo C. Red flags phenotyping: A systematic review on clinical features in atypical parkinsonian disorders. Parkinsonism Relat Disord 2018; 59:82-92. [PMID: 30409560 DOI: 10.1016/j.parkreldis.2018.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/28/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022]
Abstract
To establish a clinical diagnosis of a parkinsonian disorder, physicians rely on their ability to identify relevant red flags, in addition to cardinal features, to support or refute their working diagnosis in an individual patient. The term 'red flag', was originally coined in 1989 to define the presence of non-cardinal features that may raise a suspicion of multiple system atrophy (MSA), or at least suggest alternative diagnosis to Parkinson's disease (PD). Since then, the term 'red flag', has been consistently used in the literature to denote the clinical history or signs that may signal to physicians the possibility of an atypical parkinsonian disorder (APD). While most red flags were originally based on expert opinion, many have gained acceptance and are now included in validated clinical diagnostic criteria of PD and APDs. The clinical appreciation of red flags, in conjunction with standard criteria, may result in a more accurate and earlier diagnosis compared to standard criteria alone. However, red flags can be clinical signs that are non-neurological, making the systematic assessment for them a real challenge in clinical practice. Here, we have conducted a systematic review to identify red flags and their clinical evidence in the differential diagnosis of common degenerative parkinsonism, including PD, MSA, progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and dementia with Lewy body (DLB). Increasing awareness and appropriate use of red flags in clinical practice may benefit physicians in the diagnosis and management of their patients with parkinsonism.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand; Department of Neurology, Juntendo University, Tokyo, Japan.
| | - Jirada Sringean
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Stephen G Reich
- Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy
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Galazky I, Caspari C, Heinze HJ, Franke J. The prevalence of chronic low back pain and lumbar deformities in patients with Parkinson’s disease: implications on spinal surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2847-2853. [DOI: 10.1007/s00586-018-5748-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/06/2018] [Accepted: 08/24/2018] [Indexed: 11/28/2022]
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50
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Fietzek UM, Schroeteler FE, Hahn L, Ziegler K, Ceballos-Baumann AO. Body height loss characterizes camptocormia in Parkinson's disease. J Neural Transm (Vienna) 2018; 125:1473-1480. [PMID: 30083816 DOI: 10.1007/s00702-018-1912-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/31/2018] [Indexed: 11/28/2022]
Abstract
Axial deformities such as camptocormia or Pisa syndrome in people with Parkinson's disease (PwP) are poorly understood. The scarcity of information may result from the shortage of reliable and responsive evaluation instruments. We evaluated the body height loss (BHL) as a new measure for PwP with axial deformities. 50 PwP with axial deformity defined by an UPDRS item 28 value of at least 2 were included in this mono-center study. We measured body height while lying supine and after 1 min of standing, providing a percentage value of BHL, and compared this measure to other clinical variables. BHL depended on the Hoehn and Yahr clinical stage and correlated with clinical scales for function and mobility, but not with timely measures of the axial disorder such as age at diagnosis or duration of disease. ANOVA showed that only lumbar flexion explained the variability of BHL (F = 21.0, p < 0.0001), but not kyphosis (F = 0.4, p = 0.74) or lateroflexion (F = 0.6, p = 0.6). Re-test reliability of BHL was good with к = 0.76 (p < 0.0001). BHL resulted from the lumbar spine and the hip joint and not from the thoracic spine or lateroflexion. This observation conforms to the concept of upper-type and lower-type camptocormia with only the latter leading to a BHL. The assessment of the BHL is shown to be a well defined, easy to perform, and reliable measure for the clinical evaluation of lower-type camptocormia.
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Affiliation(s)
- Urban M Fietzek
- Department of Neurology and Clinical Neurophysiology, Centre for Parkinson's Disease and Movement Disorders, Schön Klinik München Schwabing, Parzivalplatz 4, 80804, Munich, Germany.
| | - Frauke E Schroeteler
- Department of Neurology and Clinical Neurophysiology, Centre for Parkinson's Disease and Movement Disorders, Schön Klinik München Schwabing, Parzivalplatz 4, 80804, Munich, Germany
| | - Lisa Hahn
- Department of Neurology and Clinical Neurophysiology, Centre for Parkinson's Disease and Movement Disorders, Schön Klinik München Schwabing, Parzivalplatz 4, 80804, Munich, Germany
| | - Kerstin Ziegler
- Department of Neurology and Clinical Neurophysiology, Centre for Parkinson's Disease and Movement Disorders, Schön Klinik München Schwabing, Parzivalplatz 4, 80804, Munich, Germany
| | - Andres O Ceballos-Baumann
- Department of Neurology and Clinical Neurophysiology, Centre for Parkinson's Disease and Movement Disorders, Schön Klinik München Schwabing, Parzivalplatz 4, 80804, Munich, Germany.,Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
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