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Jost WH, Berberovic E. Therapy with botulinum neurotoxin for Parkinson's disease. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02805-y. [PMID: 39052120 DOI: 10.1007/s00702-024-02805-y] [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: 06/14/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
Botulinum neurotoxin (BoNT) has been in use since the 1970's. Its effect is reached mainly by inhibiting the release of acetylcholine in the synaptic gap of motor neurons or at the motor end plate and the parasympathetic ganglia. In the case of Parkinson's disease, it is used to treat several motor and non-motor symptoms. Within recent years increasingly numerous possible fields of application of BoNT have been found for the treatment of Parkinson's disease, and for some specific symptoms it has in fact become the therapy of choice, while for others it is but one of the therapeutic options that come into consideration when others are not sufficiently effective. In the following, we intend to outline the indications, the possible side effects and also the approvals for therapies with botulinum toxin in the primary and secondary symptoms of Parkinson's disease.
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Affiliation(s)
- Wolfgang H Jost
- Parkinson-Klinik Ortenau, Kreuzbergstraße 12-16, 77709, Wolfach, Germany.
| | - Emir Berberovic
- Parkinson-Klinik Ortenau, Kreuzbergstraße 12-16, 77709, Wolfach, Germany
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2
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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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Anandan C, Jankovic J. Use of botulinum toxin in the management of dystonia in Parkinson's disease. Front Neurosci 2024; 18:1371601. [PMID: 38650620 PMCID: PMC11033361 DOI: 10.3389/fnins.2024.1371601] [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: 01/16/2024] [Accepted: 03/19/2024] [Indexed: 04/25/2024] Open
Abstract
Botulinum toxin is one of the most potent neurotoxins, but when injected into an overactive muscle, it can transiently alleviate an involuntary movement, such as dystonia. The primary aim of this article is to provide a comprehensive review of the various forms of dystonia observed in patients with Parkinson's disease who can benefit from a therapeutic trial of botulinum toxin. Although most of these indications are not supported by randomized controlled clinical trials and, therefore, not approved by the Food and Drug Administration, there are many open-label trials supporting a large body of empirical experience testifying to the benefits of botulinum toxin treatment in these conditions.
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Affiliation(s)
- Charenya Anandan
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, United States
- Neurology Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, United States
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Gandolfi M, Geroin C, Imbalzano G, Camozzi S, Menaspà Z, Tinazzi M, Alberto Artusi C. Treatment of axial postural abnormalities in parkinsonism disorders: A systematic review of pharmacological, rehabilitative and surgical interventions. Clin Park Relat Disord 2024; 10:100240. [PMID: 38596537 PMCID: PMC11002662 DOI: 10.1016/j.prdoa.2024.100240] [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: 07/03/2023] [Revised: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 04/11/2024] Open
Abstract
Axial postural abnormalities (PA) are frequent, highly disabling, and drug-refractory motor complications affecting patients with Parkinson's disease (PD) or atypical parkinsonism. Over the past few years, advances have been reached across diagnosis, assessment, and pathophysiological mechanisms of PA. Nonetheless, their management remains a challenge, and these disturbances are generally overlooked by healthcare professionals, potentially resulting in their worsening and impact on patients' disabilities. From shared consensus-based assessment and diagnostic criteria, PA calls for interdisciplinary management based on the complexity and multifactorial pathogenesis. In this context, we conducted a systematic literature review to analyze the available pharmacological and non-pharmacological treatment options for PA in PD according to the new expert-based classification of axial PA in Parkinsonism. Different multidisciplinary approaches, including dopaminergic therapy adjustment, physiotherapy, botulinum toxin injection, and deep brain stimulation, can improve PA depending on its type and severity. An early, interdisciplinary approach is recommended in PD patients to manage PA.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Italy
- Neurorehabilitation Unit, AOUI Verona, Italy
| | - Christian Geroin
- Department of Surgery, Dentistry, Paediatric and Gynaecology, University of Verona, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Serena Camozzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Zoe Menaspà
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
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Somma T, Fellico F, De Rosa A, Bocchino A, Corvino S, Milone A, Cappabianca P, Esposito F. Impact of deep brain stimulation therapy on the vertebral sagittal balance in Parkinson's disease patients. Neurosurg Rev 2023; 47:7. [PMID: 38063935 DOI: 10.1007/s10143-023-02243-6] [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: 08/08/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023]
Abstract
Parkinson's disease (PD) is characterized by cardinal motor signs: 4-6 Hz resting tremor, rigidity, and bradykinesia. In addition, 3-18% of PD patients have camptocormia, an abnormal forward flexion of the thoracolumbar spine, which may have a negative impact on patients' quality of life. Different possible treatments have been suggested for such a condition, but no one is resolutive. This study aims to define the possible impact of DBS, with selective targeting on the dorsal-lateral region of the STN, on the sagittal balance of patients affected by PD. Among all patients that have undergone DBS procedures in our institution, we selected eight subjects, four females and four males, with selective targeting on the dorsal-lateral region of the subthalamic nucleus (STN) because of camptocormia and other severe postural changes. Radiological assessments of spinal balance parameters before surgery and at 6 and 12 months postoperatively were carried out. Comparison of preoperative and postoperative spine X-ray data showed a statistically significant improvement in dorsal kyphosis angle (D-Cobb) 12 months after the operation. Deep brain stimulation with selective targeting of the dorsal lateral part of the STN may induce changes of the posture in patients with Parkinson's disease 12 months after the operation, which appears to improve in this small sample size, but larger observational and controlled trials would be required to confirm this observation.
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Affiliation(s)
- Teresa Somma
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Fabrizio Fellico
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Andrea De Rosa
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Andrea Bocchino
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Sergio Corvino
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Antonio Milone
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Paolo Cappabianca
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Felice Esposito
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy.
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Muacevic A, Adler JR. Camptocormia, a Rare Complication of Hemorrhagic Stroke: A Case Report. Cureus 2022; 14:e32450. [PMID: 36644098 PMCID: PMC9833955 DOI: 10.7759/cureus.32450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Camptocormia (bent spine syndrome) is a rare complication after hemorrhagic stroke. It is a disabling, acquired postural abnormality that has a significant impact on a patient's physical function and quality of life and is more often seen in patients with Parkinson's disease. Treatment strategies pertaining to this condition can be broadly divided into invasive which involved deep brain stimulation and spinal fixation operation versus non-invasive approaches like physiotherapy, orthosis and drugs. However, most of the treatments described in the past are mainly for Parkinson's patients with camptocormia, and none are for camptocormia from hemorrhagic stroke. We report a rare case of camptocormia in a posthemorrhagic stroke patient whose rehabilitation progress was greatly impeded by this axial postural deformity and who responded well to Madopar treatment with an improvement in total camptocormia angle from 90 degrees to about 30 degrees, which translated to an improvement in physical function and reduction in care burden.
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Antidepressant-Like Properties of Intrastriatal Botulinum Neurotoxin-A Injection in a Unilateral 6-OHDA Rat Model of Parkinson's Disease. Toxins (Basel) 2021; 13:toxins13070505. [PMID: 34357977 PMCID: PMC8310221 DOI: 10.3390/toxins13070505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
Parkinson’s patients often suffer from depression and anxiety, for which there are no optimal treatments. Hemiparkinsonian (hemi-PD) rats were used to test whether intrastriatal Botulinum neurotoxin-A (BoNT-A) application could also have antidepressant-like properties in addition to the known improvement of motor performance. To quantify depression- and anxiety-like behavior, the forced swim test, tail suspension test, open field test, and elevated plus maze test were applied to hemi-PD rats injected with BoNT-A or vehicle. Furthermore, we correlated the results in the forced swim test, open field test, and elevated plus maze test with the rotational behavior induced by apomorphine and amphetamine. Hemi-PD rats did not show significant anxiety-like behavior as compared with Sham 6-OHDA- + Sham BoNT-A-injected as well as with non-injected rats. However, hemi-PD rats demonstrated increased depression-like behaviors compared with Sham- or non-injected rats; this was seen by increased struggling frequency and increased immobility frequency. Hemi-PD rats intrastriatally injected with BoNT-A exhibited reduced depression-like behavior compared with the respective vehicle-receiving hemi-PD animals. The significant effects of intrastriatally applied BoNT-A seen in the forced swim test are reminiscent of those found after various antidepressant drug therapies. Our data correspond with the efficacy of BoNT-A treatment of glabellar frown lines in treating patients with major depression and suggest that also intrastriatal injected BoNT-A may have some antidepressant-like effect on hemi-PD.
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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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Anandan C, Jankovic J. Botulinum Toxin in Movement Disorders: An Update. Toxins (Basel) 2021; 13:42. [PMID: 33430071 PMCID: PMC7827923 DOI: 10.3390/toxins13010042] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/17/2022] Open
Abstract
Since its initial approval in 1989 by the US Food and Drug Administration for the treatment of blepharospasm and other facial spasms, botulinum toxin (BoNT) has evolved into a therapeutic modality for a variety of neurological and non-neurological disorders. With respect to neurologic movement disorders, BoNT has been reported to be effective for the treatment of dystonia, bruxism, tremors, tics, myoclonus, restless legs syndrome, tardive dyskinesia, and a variety of symptoms associated with Parkinson's disease. More recently, research with BoNT has expanded beyond its use as a powerful muscle relaxant and a peripherally active drug to its potential central nervous system applications in the treatment of neurodegenerative disorders. Although BoNT is the most potent biologic toxin, when it is administered by knowledgeable and experienced clinicians, it is one of the safest therapeutic agents in clinical use. The primary aim of this article is to provide an update on recent advances in BoNT research with a focus on novel applications in the treatment of movement disorders. This comprehensive review of the literature provides a critical review of evidence-based clinical trials and highlights recent innovative pilot studies.
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Affiliation(s)
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA;
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Mehta S, Ray S, Chakravarty K, Lal V. Spectrum of Truncal Dystonia and Response to Treatment: A Retrospective Analysis. Ann Indian Acad Neurol 2020; 23:644-648. [PMID: 33623265 PMCID: PMC7887471 DOI: 10.4103/aian.aian_542_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Presence of truncal dystonia usually points to a secondary cause of dystonia like exposure to dopamine receptor blockers or neurodegenerative illness. Rarely, it can occur as an idiopathic focal or segmental dystonia. Methods: Retrospective review of medical records and videos of patients of truncal dystonia presenting in the Botulinum Toxin Clinic of Department of Neurology at Post Graduate Institute of Medical Education and Research, Chandigarh between May 2016 and February 2019. Results: A total of 16 patients with predominant truncal dystonia were recruited. There were ten males and six females with mean age of 49.1 ± 15.1 years (range 22–70). Extensor truncal dystonia was the most common (12/16) followed by camptocormia (4/16). Various etiologies included Idiopathic Parkinson’s disease (4/16), Tardive dystonia (5/16), Neurodegeneration with brain iron accumulation (genetically confirmed) (2/16) and idiopathic (5/16). All patients were refractory to a combination of oral medications tried over a period of 1.82 ± 1.93 years. All patients received electromyographic-guided botulinum toxin in paraspinals or rectus abdominis muscles depending upon the type of dystonia. The mean dose of abobotulinum toxin used was 286.7 ± 108.6 units (range 200–500 units) for paraspinals and 297.5 ± 68.5 (range 200–350) for rectus abdominis muscles per session. Average subjective response after botulinum toxin injection session was 31.2 ± 21.5% (range 0–70). No adverse effects were reported. Conclusion: Botulinum toxin is an acceptable alternative to patients presenting with medically refractory truncal dystonia and may offer modest benefit.
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Affiliation(s)
- Sahil Mehta
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sucharita Ray
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamalesh Chakravarty
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Comparison between Conventional Blind Injections and Ultrasound-Guided Injections of Botulinum Toxin Type A into the Masseter: A Clinical Trial. Toxins (Basel) 2020; 12:toxins12090588. [PMID: 32932891 PMCID: PMC7551286 DOI: 10.3390/toxins12090588] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/28/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022] Open
Abstract
The aim of the study was to propose a more efficient and safer botulinum toxin type A (BoNT-A) injection method for the masseter by comparing the conventional blind injection and a novel ultrasonography (US)-guided injection technique in a clinical trial. The 40 masseters from 20 healthy young Korean volunteers (10 males and 10 females with a mean age of 25.6 years) were included in this prospective clinical trial. The BoNT-A (24 U) was injected into the masseter of each volunteer using the conventional blind and US-guided injection techniques on the left and right sides, respectively, and analyzed by US and three-dimensional (3D) facial scanning. One case of PMB (paradoxical masseteric bulging) was observed on the side where a conventional blind injection was performed, which disappeared after the compensational injection. The reduction in the thickness of the masseter in the resting state differed significantly at 1 month after the injection between the conventional blind injection group and the US-guided injection group by 12.38 ± 7.59% and 17.98 ± 9.65%, respectively (t(19) = 3.059, p = 0.007). The reduction in the facial contour also differed significantly at 1 month after the injection between the conventional blind injection group and the US-guided injection group by 1.95 ± 0.74 mm and 2.22 ± 0.84 mm, respectively (t(19) = 2.908, p = 0.009). The results of the study showed that the US-guided injection method that considers the deep inferior tendon by visualizing the masseter can prevent the PMB that can occur during a blind injection, and is also more effective.
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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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Magrinelli F, Geroin C, Squintani G, Gandolfi M, Rizzo G, Barillari M, Vattemi G, Morgante F, Tinazzi M. Upper camptocormia in Parkinson's disease: Neurophysiological and imaging findings of both central and peripheral pathophysiological mechanisms. Parkinsonism Relat Disord 2020; 71:28-34. [PMID: 31981996 DOI: 10.1016/j.parkreldis.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Camptocormia is a disabling complication of Parkinson's disease (PD), but its pathophysiology is poorly elucidated. Depending on the fulcrum of forward trunk flexion, two subtypes have been defined, upper (UCC) and lower camptocormia, the former being much more frequent. The aim of the study was to explore possible pathophysiological mechanisms of PD-related UCC. METHODS Ten PD patients with UCC (UCC-PD) and ten PD patients without camptocormia (NoUCC-PD) underwent simultaneous electromyography (EMG) of thoracic paraspinal (TPS), obliquus externus abdominis (OEA), rectus abdominis (RA), and iliopsoas (IP) muscles during relaxed standing (both groups) and trunk realignment (UCC-PD group). Quantitative EMG and magnetic resonance imaging (MRI) of TPS muscles were also performed. RESULTS UCC-PD patients showed hyperactivity of TPS and OEA muscles in quiet stance. During voluntary trunk extension, hyperactivity of OEA muscles persisted, thus revealing a co-contraction of flexor and extensor trunk muscles. Motor unit potentials (MUP) of TPS muscles showed shorter duration (p = 0.005) and lower amplitude (p = 0.004) in UCC-PD than in NoUCC-PD patients. MRI did not detect significant between-group differences in the cross-sectional area and fat fraction of TPS muscles, although the latter was higher in the UCC-PD than in the NoUCC-PD group at all thoracic levels. CONCLUSION Our findings suggest that hyperactivity of OEA might sustain UCC in PD. Concurrent mild myopathic changes in TPS muscles in PD with UCC may be secondary to muscle disuse but nevertheless may contribute to abnormal trunk posture.
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Affiliation(s)
- Francesca Magrinelli
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Christian Geroin
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | | | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Giulio Rizzo
- Radiology BR Unit, University Hospital of Verona, Verona, Italy.
| | - Marco Barillari
- Radiology BR Unit, University Hospital of Verona, Verona, Italy.
| | - Gaetano Vattemi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy.
| | - Michele Tinazzi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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14
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Camargo CHF, Teive HAG. Use of botulinum toxin for movement disorders. Drugs Context 2019; 8:212586. [PMID: 31258617 PMCID: PMC6586173 DOI: 10.7573/dic.212586] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 01/04/2023] Open
Abstract
The term movement disorders encompasses all disorders hypokinetic and hyperkinetic, which were previously known as extrapyramidal syndromes. With the definition of movement disorders and their diagnostic criteria and classifications, new studies for therapeutics could be performed. New drugs were launched, functional neurosurgery was developed, and the introduction of botulinum toxin (BoNT) for hyperkinesias was introduced. BoNT is an important therapy for dystonia, tics, myoclonus, and tremors. The aim of this review is to present the new and well-established uses of BoNT for movement disorders.
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Affiliation(s)
- Carlos Henrique Ferreira Camargo
- Neurological Diseases Group, Graduate Program of Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Hélio Afonso Ghizoni Teive
- Neurological Diseases Group, Graduate Program of Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil.,Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
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15
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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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16
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Wearable Sensor Based Stooped Posture Estimation in Simulated Parkinson's Disease Gaits. SENSORS 2019; 19:s19020223. [PMID: 30634462 PMCID: PMC6359041 DOI: 10.3390/s19020223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/03/2019] [Accepted: 01/05/2019] [Indexed: 02/07/2023]
Abstract
Stooping is a posture which is described as an involuntary forward bending of the thoracolumbar spine. Conventionally, the stooped posture (SP) in Parkinson’s disease patients is measured in static or limited movement conditions using a radiological or optoelectronic system. In the dynamic condition with long movement distance, there was no effective method in preference to the empirical assessment from doctors. In this research, we proposed a practical method for estimating the SP with a high accuracy where accelerometers can be mounted on the neck or upper back as a wearable sensor. The experiments with simulated subjects showed a high correlation of 0.96 and 0.99 between the estimated SP angle and the reference angles for neck and back sensor position, respectively. The maximum absolute error (0.9 and 1.5 degrees) indicated that the system can be used, not only in clinical assessment as a measurement, but also in daily life as a corrector.
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17
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Jocson A, Lew M. Use of botulinum toxin in Parkinson's disease. Parkinsonism Relat Disord 2018; 59:57-64. [PMID: 30579818 DOI: 10.1016/j.parkreldis.2018.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/02/2018] [Accepted: 12/07/2018] [Indexed: 01/28/2023]
Abstract
Botulinum toxin has emerged as an important therapeutic intervention within the realm of movement disorders, especially for focal and generalized dystonias. Botulinum toxin has additionally been used for a variety of symptoms associated with parkinsonism. In this review, we will specifically evaluate use of botulinum toxin in idiopathic Parkinson's disease. We will discuss symptoms including sialorrhea, limb, dystonia, tremor, dyskinesias, freezing of gait, camptocormia, pisa syndrome, urinary dysfunction, constipation, dysphagia, eyelid opening apraxia, and blepharospasm.
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Affiliation(s)
- Angeline Jocson
- Division of Movement Disorders, Department of Neurology, Keck/University of Southern California School of Medicine, Los Angeles, CA, USA.
| | - Mark Lew
- Division of Movement Disorders, Department of Neurology, Keck/University of Southern California School of Medicine, Los Angeles, CA, USA
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18
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Nonnekes J, Giladi N, Guha A, Fietzek UM, Bloem BR, Růžička E. Gait festination in parkinsonism: introduction of two phenotypes. J Neurol 2018; 266:426-430. [PMID: 30536108 PMCID: PMC6373367 DOI: 10.1007/s00415-018-9146-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/13/2018] [Accepted: 11/29/2018] [Indexed: 02/02/2023]
Abstract
Gait festination is one of the most characteristic gait disturbances in patients with Parkinson’s disease or atypical parkinsonism. Although festination is common and disabling, it has received little attention in the literature, and different definitions exist. Here, we argue that there are actually two phenotypes of festination. The first phenotype entails a primary locomotion disturbance, due to the so-called sequence effect: a progressive shortening of step length, accompanied by a compensatory increase in cadence. This phenotype strongly relates to freezing of gait with alternating trembling of the leg. The second phenotype results from a postural control problem (forward leaning of the trunk) combined with a balance control deficit (inappropriately small balance-correcting steps). In this viewpoint, we elaborate on the possible pathophysiological substrate of these two phenotypes of festination and discuss their management in daily clinical practice.
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Affiliation(s)
- Jorik Nonnekes
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, The Netherlands.
| | - Nir Giladi
- Movement Disorders Unit, Sackler School of Medicine, Sagol School for Neuroscience, Tel-Aviv Medical Centre, Neurological Institute, Tel-Aviv University, Tel Aviv, Israel
| | - Anasuya Guha
- Department of Otorhinolaryngology and Head and Neck Surgery, 3rd Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.,Department of Neurology, Centre of Clinical Neuroscience, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Urban M Fietzek
- Department of Neurology and Clinical Neurophysiology, Schön Klinik München Schwabing, Munich, Germany
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Evžen Růžička
- Department of Neurology, Centre of Clinical Neuroscience, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic
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19
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Kawami Y, Marumoto K, Shiomi Y, Okinishi M, Kozuki T, Oyabu H, Yokoyama K, Nikaido Y, Akisue T. The effect of comprehensive physiotherapy-based rehabilitation on stooped posture in Parkinson's disease. J Phys Ther Sci 2018; 30:1440-1445. [PMID: 30568331 PMCID: PMC6279693 DOI: 10.1589/jpts.30.1440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 09/12/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The effect of physiotherapy on stooped posture in Parkinson's disease patients remains to be clarified. Therefore, the purpose of this study was to investigate whether comprehensive physiotherapy-based rehabilitation can improve stooped posture in Parkinson's disease patients. [Participants and Methods] The participants were Parkinson's disease patients with stooped posture. Outpatients were assigned to the control group and inpatients to the postural rehabilitation group. The outcomes measured were trunk bending angle, lumbar lordosis, and thoracic kyphosis. Each group was assessed at baseline and 1 month later. [Results] Of 22 participants identified, 20 were included, with 10 participants in the postural rehabilitation group and 10 in the control group. The age in the postural rehabilitation group was significantly greater than that in the control group, while other parameters were comparable in both groups. After the month-long intervention, the trunk bending angle and lumbar lordosis were significantly improved in the postural rehabilitation group compared to the control group. [Conclusion] The results showed improvement in stooped posture in the postural rehabilitation group as compared to the control group. Furthermore, improvement of lumbar lordosis accompanied improvement of stooped posture. These findings suggest that comprehensive physiotherapy-based rehabilitation may improve stooped posture in Parkinson's disease patients.
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Affiliation(s)
- Yuki Kawami
- Department of Physical Therapy, Faculty of Rehabilitation,
Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima: 1-7-1 Kouto, Shingu-cho,
Tatsuno, Hyogo 679-5165, Japan
- Department of Rehabilitation Science, Kobe University
Graduate School of Health Sciences, Japan
| | - Kohei Marumoto
- Department of Physical Medicine and Rehabilitation, Hyogo
Prefectural Rehabilitation Hospital at Nishi-Harima, Japan
| | - Yukina Shiomi
- Department of Physical Therapy, Faculty of Rehabilitation,
Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima: 1-7-1 Kouto, Shingu-cho,
Tatsuno, Hyogo 679-5165, Japan
| | - Masakado Okinishi
- Department of Physical Therapy, Faculty of Rehabilitation,
Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima: 1-7-1 Kouto, Shingu-cho,
Tatsuno, Hyogo 679-5165, Japan
| | - Tsuyoshi Kozuki
- Department of Physical Therapy, Faculty of Rehabilitation,
Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima: 1-7-1 Kouto, Shingu-cho,
Tatsuno, Hyogo 679-5165, Japan
| | - Hiroko Oyabu
- Department of Physical Therapy, Faculty of Rehabilitation,
Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima: 1-7-1 Kouto, Shingu-cho,
Tatsuno, Hyogo 679-5165, Japan
| | - Kazumasa Yokoyama
- Department of Neurology, Hyogo Prefectural Rehabilitation
Hospital at Nishi-Harima, Japan
| | - Yasutaka Nikaido
- Department of Rehabilitation Science, Kobe University
Graduate School of Health Sciences, Japan
- Clinical Department of Rehabilitation, Osaka Medical
College Hospital, Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Kobe University
Graduate School of Health Sciences, Japan
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20
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Todo H, Yamasaki H, Ogawa G, Nishida K, Futamura N, Funakawa I. Injection of Onabotulinum Toxin A into the Bilateral External Oblique Muscle Attenuated Camptocormia: A Prospective Open-Label Study in Six Patients with Parkinson's Disease. Neurol Ther 2018; 7:365-371. [PMID: 30094699 PMCID: PMC6283798 DOI: 10.1007/s40120-018-0108-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Camptocormia (severe bending of the spine) is a debilitating complication of Parkinson's disease (PD) without established treatment. Botulinum toxin (BT) may be beneficial, but data is scarce regarding the efficacy of administration of BT into the bilateral external oblique (EO) muscle for treatment of camptocormia in PD. METHODS Six patients with PD and camptocormia, with flexion of the thoracic spine, were enrolled in the study. BT (75 or 90 units, onabotulinum toxin A) were injected into each EO bilaterally under sonographic guidance. Camptocormia angle (CA) was defined as the angle between the acromion-greater trochanter line and a vertical line. CA and disabling symptoms were evaluated during the treatment course. RESULTS Two weeks after the injection of BT, the mean CA showed significant attenuation [median (interquartile range); 38° (23.5°) vs. 18° (21°), p = 0.028]. Subjective relief was present in cases 1-3 and 6, and absent in cases 4 and 5. Cases 1-3 received repeated injections to maintain the amelioration; in cases 1 and 2, this was for 1 year or longer, while falls of case 3 limited the amelioration. CONCLUSION Botulinum therapy into bilateral EO attenuated the angle of thoracic-level camptocormia in six patients with PD over the observation period of 2 weeks. The reproducibility of the results, long-term efficacy, and subjective relief of symptoms require further examination.
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Affiliation(s)
- Hiroyuki Todo
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan.
| | - Hiroshi Yamasaki
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan
| | - Go Ogawa
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan
| | - Katsuya Nishida
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan
| | - Naonobu Futamura
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan
| | - Itaru Funakawa
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, 669-1592, Japan
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21
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Debû B, De Oliveira Godeiro C, Lino JC, Moro E. Managing Gait, Balance, and Posture in Parkinson's Disease. Curr Neurol Neurosci Rep 2018; 18:23. [PMID: 29623455 DOI: 10.1007/s11910-018-0828-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Postural instability and gait difficulties inexorably worsen with Parkinson's disease (PD) progression and become treatment resistant, with a severe impact on autonomy and quality of life. We review the main characteristics of balance instability, gait disabilities, and static postural alterations in advanced PD, and the available treatment strategies. RECENT FINDINGS It remains very difficult to satisfactorily alleviate gait and postural disturbances in advanced PD. Medical and surgical interventions often fail to provide satisfactory or durable alleviation of these axial symptoms, that may actually call for differential treatments. Exercise and adapted physical activity programs can contribute to improving the patients' condition. Gait, balance, and postural disabilities are often lumped together under the Postural Instability and Gait Difficulties umbrella term. This may lead to sub-optimal patients' management as data suggest that postural, balance, and gait problems might depend on distinct underlying mechanisms. We advocate for a multidisciplinary approach from the day of diagnosis.
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Affiliation(s)
- Bettina Debû
- University Grenoble Alpes, Grenoble, France.
- INSERM U1216, Grenoble, France.
| | - Clecio De Oliveira Godeiro
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
- Division of Neurology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Jarbas Correa Lino
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
- Division of Neurology, CHU Amiens, Amiens, France
| | - Elena Moro
- University Grenoble Alpes, Grenoble, France
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
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22
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Jankovic J. An update on new and unique uses of botulinum toxin in movement disorders. Toxicon 2017; 147:84-88. [PMID: 28888928 DOI: 10.1016/j.toxicon.2017.09.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 02/01/2023]
Abstract
The therapeutic applications of botulinum toxin (BoNT) have grown manifold since its initial approval in 1989 by the US Food and Drug Administration (FDA) for the treatment of strabismus, blepharospasm, and other facial spasms. Although it is the most potent biologic toxin known to man, long-term studies have established its safety in the treatment of a variety of neurologic and non-neurologic disorders. This review focuses on some novel and uncommon uses of BoNT in the treatment of movement disorders, such as oromandibular dystonia, including bruxism, anterocollis, camptocormia, tremor, tics, tardive and levodopa-induced dyskinesia, and restless legs syndrome. Despite a paucity of randomized controlled trials and lack of FDA approval for these movement disorders, there is growing body of evidence that BoNT provides benefit to patients with these hyperkinetic movement disorders and that BoNT is a safe treatment when used by clinicians skilled in the administration of the drug for these conditions.
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Affiliation(s)
- Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States. http://www.jankovic.org
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23
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Lee KH, Kim JM, Kim HS. Back Extensor Strengthening Exercise and Backpack Wearing Treatment for Camptocormia in Parkinson's Disease: A Retrospective Pilot Study. Ann Rehabil Med 2017; 41:677-685. [PMID: 28971053 PMCID: PMC5608676 DOI: 10.5535/arm.2017.41.4.677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/04/2016] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the effect of a conservative treatment regime in Parkinson's disease patients with camptocormia. Methods Nine patients with Parkinson's disease were included in a retrospective pilot study of the value of back extensor strengthening exercise. Six inpatients received a 30-minute treatment, twice daily for 5 weeks, being treated on average for 34 days; while three outpatients visited the clinic and were educated for home exercise and backpack wearing treatment. Outpatients should be scheduled to visit the outpatient department to check physical status every 2–4 weeks for an average of 3 months. Results All patients except one showed statistically significant improvements in activities of daily living (ADL) and motor symptoms, as measured by flexion angle at standing posture, Unified Parkinson's Disease Rating Scale (UPDRS) II and III, and modified Hoehn-Yahr staging. Conclusion Conservative treatment is effective in postural correction of camptocormia in Parkinson's disease, as well as improvement in ADL and motor symptoms.
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Affiliation(s)
- Kun Hee Lee
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jong Moon Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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24
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Cardoso F. Botulinum toxin in parkinsonism: The when, how, and which for botulinum toxin injections. Toxicon 2017; 147:107-110. [PMID: 28837826 DOI: 10.1016/j.toxicon.2017.08.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/15/2017] [Accepted: 08/20/2017] [Indexed: 02/07/2023]
Abstract
The aim of this article is to provide a review of the use of injections of botulinum toxin in the management of selected symptoms and signs of Parkinson's disease and other forms of parkinsonism. Sialorrhea is defined as inability to control oral secretions, resulting in excessive saliva in the oropharynx. There is a high level of evidence for the treatment of sialorrhea in parkinsonism with injections of different forms of botulinum toxin type A as well as botulinum toxin type B. Tremor can be improved by the use of botulinum toxin injections but improved tremor control often leads to concomitant motor weakness, limiting its use. Levodopa induced dyskinesias are difficult to treat with botulinum toxin injections because of their variable frequency and direction. Apraxia of eyelid opening, a sign more commonly seen in progressive supranuclear palsy and other tauopathies, often improves after botulinum toxin injections. Recent data suggest that regardless of the underlying mechanism, pain in parkinsonism can be alleviated by botulinum toxin injections. Finally, freezing of gait, camptocormia and Pisa syndrome in parkinsonism almost invariably fail to respond to botulinum toxin injections.
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Affiliation(s)
- Francisco Cardoso
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, The Federal University of Minas Gerais, Brazil.
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25
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Di Martino S, Unti E, Tramonti C, Mazzucchi S, Bonuccelli U, Rossi B, Ceravolo R, Chisari C. Efficacy of a combined therapeutic approach in the management of Pisa Syndrome. NeuroRehabilitation 2017; 41:249-253. [PMID: 28505999 DOI: 10.3233/nre-171478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pisa syndrome (PS) represents an important source of disability in Parkinson's disease (PD). Currently no consensus has been reached on its definition or diagnostic criteria, and therapeutic approaches are unspecific and often futile. Recently the role of abdominal muscles, and in particular of the external oblique (EO), in the pathogenesis of PS was hypothesized. OBJECTIVES To evaluate the role of EO and propose a combined therapeutic approach in the management of PS. METHODS Ten PD patients with PS underwent a combined protocol based on repeated lidocaine injection in EO and rehabilitation program. RESULTS Our data confirm the primary role of EO muscles in PS pathogenesis and showed an improvement in truncal flexion and balance with a positive impact on patients' quality of life after treatment. CONCLUSIONS These data highlight the need for accurate characterization of PS focusing on the role of abdominal muscles and the need for a specific rehabilitation protocol for PS management.
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Affiliation(s)
- Siria Di Martino
- Department of Neuroscience, Unit of Neurorehabilitation, University Hospital of Pisa, Pisa, Italy
| | - Elisa Unti
- Department of Clinical and Experimental Medicine, Unit of Neurology, University Hospital of Pisa, Pisa, Italy
| | - Caterina Tramonti
- Department of Neuroscience, Unit of Neurorehabilitation, University Hospital of Pisa, Pisa, Italy
| | - Sonia Mazzucchi
- Department of Clinical and Experimental Medicine, Unit of Neurology, University Hospital of Pisa, Pisa, Italy
| | - Ubaldo Bonuccelli
- Department of Clinical and Experimental Medicine, Unit of Neurology, University Hospital of Pisa, Pisa, Italy
| | - Bruno Rossi
- Department of Neuroscience, Unit of Neurorehabilitation, University Hospital of Pisa, Pisa, Italy
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, Unit of Neurology, University Hospital of Pisa, Pisa, Italy
| | - Carmelo Chisari
- Department of Neuroscience, Unit of Neurorehabilitation, University Hospital of Pisa, Pisa, Italy
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26
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Abstract
A wide range of neuromuscular diseases, including Parkinson disease, cerebral palsy, multiple sclerosis, and myopathy, are associated with spinal deformities. The most common postural deformities include anterocollis, Pisa syndrome (pleurothotonus), scoliosis, and camptocormia. Nonsurgical management of spinal deformity in patients with neuromuscular disease centers on maximizing the medical management of the underlying neurodegenerative pathology before surgical intervention is contemplated. Surgical management can include decompression alone, or decompression and fusion with short or long fusion constructs. Patients with neuromuscular disease are susceptible to postoperative medical complications, such as delirium, epidural hematomas, pulmonary emboli, and cardiac events. Compared with outcomes in the typical patient with spinal deformity, postoperative outcomes in patients with neuromuscular disease have higher rates of surgical complications, such as instrumentation failure, proximal junctional kyphosis, loss of correction, and the need for revision surgery, regardless of the magnitude of surgical treatment.
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Kataoka H, Ueno S. Hypotrophic muscle ipsilateral to the bending side is not a therapeutic target in recurrent and alternating lateral trunk flexion in Parkinson disease: Case report. Ann Phys Rehabil Med 2016; 59:346-348. [PMID: 27562923 DOI: 10.1016/j.rehab.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/02/2016] [Accepted: 07/09/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Hiroshi Kataoka
- Department of Neurology, Nara Medical University, Kashihara, Nara, Japan.
| | - Satoshi Ueno
- Department of Neurology, Nara Medical University, Kashihara, Nara, Japan
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Abstract
AbstractBackground: Parkinson’s disease (PD) and other parkinsonian syndromes are chronic, progressive neurodegenerative diseases. With advancing disease, both motor and non-motor symptoms represent a considerable burden and symptom relief and quality of life improvement become the main goal of treatment. Botulinum toxins (BTX) are an effective treatment modality for many neurological conditions. Methods: To understand the potential usefulness of BTX in this population, we performed a retrospective chart review of all patients with a clinical diagnosis of idiopathic PD and atypical parkinsonism who received treatment with BTX injections in our center from 1995 to 2014 for a variety of symptoms. Response to BTX was assessed using a subjective Clinical Global Impression. Results: Records of 160 patients were reviewed. Probable idiopathic PD was the diagnosis in 117 patients (73.1%). The main indication for BTX treatment was pain (50.6% of cases). Other indications were the treatment of functional impairment resulting from dystonia (26.25%), sialorrhea (18.75%), freezing of gait, and camptocormia. Considering pain as indication, 81% of all patients with PD reported benefits after the first BTX injections. This benefit was maintained after the last recorded visit without significant difference in outcome compared with the first injection (p=0.067). Similar results were observed in patients with atypical parkinsonism. Conclusions: Our results confirm the safety and efficacy of different uses of BTX in the symptomatic treatment of patients with parkinsonism even in advanced stages of the disease, and suggest BTX treatment could have a safe and useful role in the treatment of pain in this population.
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Rabin ML, Earnhardt MC, Patel A, Ganihong I, Kurlan R. Postural, Bone, and Joint Disorders in Parkinson's Disease. Mov Disord Clin Pract 2016; 3:538-547. [PMID: 30363567 DOI: 10.1002/mdc3.12386] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 12/20/2022] Open
Abstract
Background Stooped posture was mentioned in the original description of the characteristic features of Parkinson's disease (PD). Since then, a variety of postural, bone, and joint problems have become recognized as common aspects of the illness and deserve attention. Methods A Medline literature search for the period from 1970 to 2016 was performed to identify articles relevant to this topic. Keywords for the search included posture, spine, bone disorders, fractures, joint disorders, kyphosis, scoliosis, stooping, camptocormia, Pisa syndrome, frozen shoulder, anterocollis, dropped head syndrome, and pain in combination with PD. The articles were then reviewed to summarize clinical features, frequency, impact, pathophysiology, and treatment options for these conditions. Results Postural disorders (kyphoscoliosis, camptocormia, Pisa syndrome, dropped head syndrome), bone mineralization disorders (osteoporosis, bone fractures), and joint disorders (frozen shoulder, dystonia involving joints, joint pain) are often seen in association with PD. Treatment options for these conditions are varied and may include medications, physical therapy, or surgical interventions. Conclusions Posture, bone, and joint disorders are common in patients with PD; they often produce added disability, and they may be treatable.
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Affiliation(s)
- Marcie L Rabin
- Atlantic Neuroscience Institute Overlook Medical Center Summit New Jersey USA
| | | | - Anvi Patel
- Atlantic Neuroscience Institute Overlook Medical Center Summit New Jersey USA
| | - Ivana Ganihong
- Atlantic Neuroscience Institute Overlook Medical Center Summit New Jersey USA
| | - Roger Kurlan
- Atlantic Neuroscience Institute Overlook Medical Center Summit New Jersey USA
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Margraf N, Wrede A, Deuschl G, Schulz-Schaeffer W. Pathophysiological Concepts and Treatment of Camptocormia. JOURNAL OF PARKINSON'S DISEASE 2016; 6:485-501. [PMID: 27314757 PMCID: PMC5008234 DOI: 10.3233/jpd-160836] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 12/12/2022]
Abstract
Camptocormia is a disabling pathological, non-fixed, forward bending of the trunk. The clinical definition using only the bending angle is insufficient; it should include the subjectively perceived inability to stand upright, occurrence of back pain, typical individual complaints, and need for walking aids and compensatory signs (e.g. back-swept wing sign). Due to the heterogeneous etiologies of camptocormia a broad diagnostic approach is necessary. Camptocormia is most frequently encountered in movement disorders (PD and dystonia) and muscles diseases (myositis and myopathy, mainly facio-scapulo-humeral muscular dystrophy (FSHD)). The main diagnostic aim is to discover the etiology by looking for signs of the underlying disease in the neurological examination, EMG, muscle MRI and possibly biopsy. PD and probably myositic camptocormia can be divided into an acute and a chronic stage according to the duration of camptocormia and the findings in the short time inversion recovery (STIR) and T1 sequences of paravertebral muscle MRI. There is no established treatment of camptocormia resulting from any etiology. Case series suggest that deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) is effective in the acute but not the chronic stage of PD camptocormia. In chronic stages with degenerated muscles, treatment options are limited to orthoses, walking aids, physiotherapy and pain therapy. In acute myositic camptocormia an escalation strategy with different immunosuppressive drugs is recommended. In dystonic camptocormia, as in dystonia in general, case reports have shown botulinum toxin and DBS of the globus pallidus internus (GPi-DBS) to be effective. Camptocormia in connection with primary myopathies should be treated according to the underlying illness.
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Affiliation(s)
- N.G. Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - A. Wrede
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - G. Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Srivanitchapoom P, Hallett M. Camptocormia in Parkinson's disease: definition, epidemiology, pathogenesis and treatment modalities. J Neurol Neurosurg Psychiatry 2016; 87:75-85. [PMID: 25896683 PMCID: PMC5582594 DOI: 10.1136/jnnp-2014-310049] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/30/2015] [Indexed: 12/22/2022]
Abstract
Camptocormia is an axial postural deformity characterised by abnormal thoracolumbar spinal flexion. The symptom usually presents while standing, walking or exercising and is alleviated while sitting, lying in a recumbent position, standing against a wall or using walking support. There is no consensus on the degree of thoracolumbar flexion to define camptocormia. However, most authors usually use an arbitrary number of at least 45° flexion of the thoracolumbar spine when the individual is standing or walking. Aetiologies of camptocormia are heterogeneous, and Parkinson's disease (PD) is one of its many causes. The prevalence of camptocormia in PD ranges from 3% to 18%. Central and peripheral mechanisms might both contribute to its pathogenesis. Although there is no established consensus for treatment of camptocormia in PD, there are non-pharmacological, pharmacological and surgical approaches that can be used.
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Affiliation(s)
- Prachaya Srivanitchapoom
- Faculty of Medicine, Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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Bertram KL, Stirpe P, Colosimo C. Treatment of camptocormia with botulinum toxin. Toxicon 2015; 107:148-53. [DOI: 10.1016/j.toxicon.2015.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/11/2015] [Indexed: 12/19/2022]
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Chieng LO, Madhavan K, Wang MY. Deep brain stimulation as a treatment for Parkinson’s disease related camptocormia. J Clin Neurosci 2015; 22:1555-61. [DOI: 10.1016/j.jocn.2015.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/17/2015] [Indexed: 12/11/2022]
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Mechanism of camptocormia in Parkinson's disease analyzed by tilt table-EMG recording. Parkinsonism Relat Disord 2015; 21:765-70. [PMID: 25976984 DOI: 10.1016/j.parkreldis.2015.02.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 02/12/2015] [Accepted: 02/19/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND We previously classified camptocormia of Parkinson's disease (PD) into upper and lower types based on the inflection point, and reported improvement of upper camptocormia after lidocaine injection into the external oblique. However, the exact pathophysiology of this phenomenon remains obscure. METHODS Surface electromyography (sEMG) was recorded in 11 PD patients with upper camptocormia, 11 PD patients with lower camptocormia, and 10 age-matched PD patients without postural deformity. Electrodes were positioned above the external oblique, hip flexors and paraspinal muscles at Th11 level bilaterally. Recording commenced with the patient in supine position on a tilt table, and continued when the table was tilted up to vertical position. Lidocaine was injected into the external oblique in patients with upper camptocormia and the psoas major in patients with lower camptocormia. RESULTS All patients with upper and lower camptocormia developed the corresponding camptocormic posture during tilt up. The onset of camptocormic posture was preceded by the appearance of sEMG activity in the external oblique in 10 out of 11 patients with upper camptocormia, but less frequently in patients with lower camptocormia and the controls. Hip flexors sEMG activity was recorded in almost all patients. Posture was improved in 8 out of 9 patients with upper camptocormia, and 9 out of 11 patients with lower camptocormia following injections of lidocaine. CONCLUSIONS The results suggest the external oblique is involved, at least in part, in the development of upper camptocormia. Although EMG findings cannot differentiate pathogenicity, the psoas major is probably involved in lower camptocormia.
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Wijemanne S, Jimenez-Shahed J. Improvement in dystonic camptocormia following botulinum toxin injection to the external oblique muscle. Parkinsonism Relat Disord 2014; 20:1106-7. [DOI: 10.1016/j.parkreldis.2014.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/23/2014] [Accepted: 06/02/2014] [Indexed: 01/09/2023]
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Dadgar S, Ramjan Z, Floriano WB. Paclitaxel is an inhibitor and its boron dipyrromethene derivative is a fluorescent recognition agent for botulinum neurotoxin subtype A. J Med Chem 2013; 56:2791-803. [PMID: 23484537 DOI: 10.1021/jm301829h] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We have successfully identified one new inhibitor and one new fluorescent recognition agent for the botulinum neurotoxin subtype A (BoNT/A) using the virtual screening protocol "protein scanning with virtual ligand screening" (PSVLS). Hit selection used an in-house developed holistic binding scoring method. Selected hits were tested experimentally for inhibitory activity using fluorescence resonance energy transfer (FRET) assays against the light chain (catalytic domain) of BoNT/A. Ligand binding was determined against the light and heavy chain BoNT/A complex through either radiolabeled ligand binding assays (nonfluorescent ligands) or fluorescence intensity assays (fluorescent ligands). These experimental assays have confirmed one compound (paclitaxel) to inhibit BoNT/A's proteolytic activity experimentally with an IC50 of 5.2 μM. A fluorescent derivative was also confirmed to bind to the toxin and therefore is a suitable candidate for the rational design of new detection agents and for the development of fluorescence-based multiprobe detection assays.
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Affiliation(s)
- Saedeh Dadgar
- Department of Chemistry, Lakehead University and Thunder Bay Regional Research Institute, Thunder Bay, Ontario P7B 5E1, Canada
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Kashihara K. Postural disorders in Parkinson’s disease: clinical characteristics, frequency, pathophysiology and management. Neurodegener Dis Manag 2012. [DOI: 10.2217/nmt.12.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Postural disorders are frequently observed in Parkinson’s disease patients and significantly affect patients’ quality of life. They may develop because of increased muscle tonus, which results in shortened muscle fibers and induces contracted postures and subsequent changes in muscles, connective tissue, bones and peripheral nerves. Enhanced muscle tonus may induce forward and/or lateral flexion of the spine. Abnormal postures usually occur in the middle or later stages of the disease, and are often reversible in the supine position. Forward flexion, lateral flexion and, less frequently, antecollis are the common axial postural disorders in Parkinson’s disease patients. While antiparkinsonian drugs may improve these symptoms, they may also induce or worsen them. As postural disorders become irreversible after the development of secondary changes, such as muscle atrophy and bone fracture, physicians should recognize postural disorders at early stages.
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Affiliation(s)
- Kenichi Kashihara
- Department of Neurology, Okayama Kyokuto Hospital, 567-1 Kurata, Naka-ku, Okayama 703-8265, Japan
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Fietzek UM, Schroeder AS, Wissel J, Heinen F, Berweck S. Split-screen video demonstration of sonography-guided muscle identification and injection of botulinum toxin. Mov Disord 2010; 25:2225-8. [DOI: 10.1002/mds.23113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Upadhyaya CD, Starr PA, Mummaneni PV. Spinal deformity and Parkinson disease: a treatment algorithm. Neurosurg Focus 2010; 28:E5. [PMID: 20196652 DOI: 10.3171/2010.1.focus09288] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors review the literature on the treatment of spinal deformity in patients with Parkinson disease (PD) and formulate a treatment algorithm. METHODS The authors provide representative cases of patients with PD and spinal deformity who underwent deep brain stimulation (DBS) or spinal surgery. RESULTS In patients with PD and spinal deformity who undergo spinal surgery there is a high rate of acute and delayed complications. Patients who undergo DBS, while having significantly fewer complications, often do not regain sagittal balance. CONCLUSIONS Cases involving PD and camptocormia have a high rate of complications when spinal surgery is performed. The authors prefer to offer spinal surgery only to patients with coexisting spinal stenosis causing radiculopathy or myelopathy. Patients with PD and camptocormia without spinal stenosis may be considered for DBS, but the results are mixed.
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Affiliation(s)
- Cheerag D Upadhyaya
- Department of Neurological Surgery, University of California, San Francisco, California 94143, USA
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Lenoir T, Guedj N, Boulu P, Guigui P, Benoist M. Camptocormia: the bent spine syndrome, an update. 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 2010; 19:1229-37. [PMID: 20300781 DOI: 10.1007/s00586-010-1370-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 02/15/2010] [Accepted: 03/04/2010] [Indexed: 12/22/2022]
Abstract
Camptocormia, also referred to as bent spine syndrome (BSS) is defined as an abnormal flexion of the trunk, appearing in standing position, increasing during walking and abating in supine position. BSS was initially considered, especially in wartime, as a psychogenic disorder. It is now recognized that in addition to psychiatric syndromes, many cases of reducible BSS have a somatic origin related to a number of musculo-skeletal or neurological disorders. The majority of BSS of muscular origin is related to a primary idiopathic axial myopathy of late onset, appearing progressively in elderly patients. Diagnosis of axial myopathy first described by Laroche et al. is based upon CT/MRI examination demonstrating massive fatty infiltration of paravertebral muscles. The non-specific histological aspect includes an extensive endomysial fibrosis and fat tissue with irregular degenerated fibers. Weakness of the paravertebral muscles can be secondary to a wide variety of diseases generating diffuse pathologic changes in the muscular tissue. BSS can be the predominant and sometimes revealing symptom of a more generalized muscular disorder. Causes of secondary BSS are numerous. They must be carefully assessed and ruled out before considering the diagnosis of primary axial myopathy. The principal etiologies include on the one hand inflammatory myopathies, muscular dystrophies of late onset, myotonic myopathies, endocrine and metabolic myopathies, and on the other hand neurological disorders, principally Parkinson's disease. Camptocormia in Parkinsonism is caused by axial dystonia, which is the hallmark of Parkinson's disease. There is no specific pharmacologic treatment for primary axial myopathy. General activity, walking with a cane, physiotherapy, and exercises should be encouraged. Treatment of secondary forms of BSS is dependent upon the variety of the disorder generating the muscular pathology. Pharmacologic and general management of camptocormia in Parkinson's disease merge with that of Parkinsonism. Levodopa treatment, usually active on tumor rigidity and akinesia, has poor or negative effect on BSS.
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Affiliation(s)
- Thibaut Lenoir
- Department of Orthopaedic Surgery, Hôpital Beaujon, Clichy, France
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Neurorééducation des syndromes parkinsoniens. Rev Neurol (Paris) 2010; 166:196-212. [DOI: 10.1016/j.neurol.2009.10.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 10/28/2009] [Indexed: 11/19/2022]
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Fietzek UM, Schroeteler FE, Ceballos-Baumann AO. Goal attainment after treatment of parkinsonian camptocormia with botulinum toxin. Mov Disord 2010; 24:2027-8. [PMID: 19645067 DOI: 10.1002/mds.22676] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol 2010; 14:45-66. [PMID: 19914110 DOI: 10.1016/j.ejpn.2009.09.005] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/15/2009] [Accepted: 09/17/2009] [Indexed: 12/20/2022]
Abstract
An interdisciplinary European group of clinical experts in the field of movement disorders and experienced Botulinum toxin users has updated the consensus for the use of Botulinum toxin in the treatment of children with cerebral palsy (CP). A problem-orientated approach was used focussing on both published and practice-based evidence. In part I of the consensus the authors have tabulated the supporting evidence to produce a concise but comprehensive information base, pooling data and experience from 36 institutions in 9 European countries which involves more than 10,000 patients and over 45,000 treatment sessions during a period of more than 280 treatment years. In part II of the consensus the Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System (GMFCS) based Motor Development Curves have been expanded to provide a graphical framework on how to treat the motor disorders in children with CP. This graph is named "CP(Graph) Treatment Modalities - Gross Motor Function" and is intended to facilitate communication between parents, therapists and medical doctors concerning (1) achievable motor function, (2) realistic goal-setting and (3) treatment perspectives for children with CP. The updated European consensus 2009 summarises the current understanding regarding an integrated, multidisciplinary treatment approach using Botulinum toxin for the treatment of children with CP.
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Jankovic J. Disease-oriented approach to botulinum toxin use. Toxicon 2009; 54:614-23. [DOI: 10.1016/j.toxicon.2008.11.013] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 11/28/2008] [Indexed: 11/26/2022]
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Colosimo C, Salvatori FM. Injection of the iliopsoas muscle with botulinum toxin in camptocormia. Mov Disord 2009; 24:316-7. [PMID: 18973251 DOI: 10.1002/mds.22249] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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