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Yoritaka A, Hayashi T, Fusegi K, Nakayama S, Haneda J, Hattori N. Hypoperfusion in Supramarginal and Orbital Gyrus, Position Discrimination Test, and Microsaccades as a Predictor of Pisa Syndrome in Parkinson's Disease. PARKINSON'S DISEASE 2024; 2024:5550362. [PMID: 38846136 PMCID: PMC11156507 DOI: 10.1155/2024/5550362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/27/2024] [Accepted: 05/13/2024] [Indexed: 06/09/2024]
Abstract
Patients with Parkinson's disease (PD) experience significantly reduced quality of life when PD is complicated with Pisa syndrome (PS). PS is a postural abnormality associated with a lateral bending of the trunk, causing the patient to lean to one side. Microsaccades during fixation are transmitted to the visual cortex, and this gaze movement may be impaired in PD. We aimed to detect presymptomatic signs of PS. We enrolled 50 patients with PD without dementia and investigated the visual systems in patients with concurrent PD and PS based on a Romberg ratio of<1.0. Gaze analysis, pupil diameter, stabilization tests, neuropsychological tests, and cerebral perfusion scintigraphy were reviewed and statistically analyzed. Two years later, we divided the patients into three groups as follows: PISA++ (patients who had PS at enrollment), PISA-+ (patients without PS that developed PS during the 2-year period), and PISA-- (patients without PS that did not develop PS during the 2-year period). The PISA-+ group exhibited a significantly higher daily levodopa dose and longer fixations, as well as lower position discrimination, Wechsler Adult Intelligence Scale-Third Edition blocking, and blood flow in the left supramarginal and orbital gyri than that in the PISA-- group. The PISA++ group showed a significantly longer fixation time and lower Mini-Mental State Examination score, Romberg ratio of area, amplitude, velocity of microsaccades, and blood flow in the left precuneus and cuneus than that in the PISA-+ group. Before the onset of PS, hypoperfusion occurred in the correlative visual cortex and the position discrimination test. Patients with PS have reduced saccades and slow microsaccades.
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Affiliation(s)
- Asako Yoritaka
- Department of Neurology, Juntendo University Koshigaya Hospital, Saitama 343-0032, Japan
| | - Tetsuo Hayashi
- Department of Neurology, Juntendo University Koshigaya Hospital, Saitama 343-0032, Japan
| | - Keiko Fusegi
- Department of Neurology, Juntendo University Koshigaya Hospital, Saitama 343-0032, Japan
| | - Sachiko Nakayama
- Department of Neurology, Juntendo University Koshigaya Hospital, Saitama 343-0032, Japan
| | - Jun Haneda
- Department of Radiology, Koshigaya Municipal Hospital, Saitama 343-8577, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
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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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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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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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De Icco R, Putortì A, Allena M, Avenali M, Dagna C, Martinelli D, Cristina S, Grillo V, Fresia M, Bitetto V, Cosentino G, Valentino F, Alfonsi E, Sandrini G, Pisani A, Tassorelli C. Non-Invasive Neuromodulation in the Rehabilitation of Pisa Syndrome in Parkinson's Disease: A Randomized Controlled Trial. Front Neurol 2022; 13:849820. [PMID: 35493824 PMCID: PMC9046718 DOI: 10.3389/fneur.2022.849820] [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: 01/06/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Pisa syndrome (PS) is a frequent postural complication of Parkinson's disease (PD). PS poorly responds to anti-parkinsonian drugs and the improvement achieved with neurorehabilitation tends to fade in 6 months or less. Transcranial direct current stimulation (t-DCS) is a non-invasive neuromodulation technique that showed promising results in improving specific symptoms in different movement disorders. Objectives This study aimed to evaluate the role of bi-hemispheric t-DCS as an add-on to a standardized hospital rehabilitation program in the management of PS in PD. Methods This study included 28 patients with PD and PS (21 men, aged 72.9 ± 5.1 years) who underwent a 4-week intensive neurorehabilitation treatment and were randomized to receive: i) t-DCS (t-DCS group, n = 13) for 5 daily sessions (20 min−2 mA) with bi-hemispheric stimulation over the primary motor cortex (M1), or ii) sham stimulation (sham group, n = 15) with the same duration and cadence. At baseline (T0), end of rehabilitation (T1), and 6 months later (T2) patients were evaluated with both trunk kinematic analysis and clinical scales, including UPDRS-III, Functional Independence Measure (FIM), and Numerical Rating Scale for lumbar pain. Results When compared to the sham group, the t-DCS group achieved a more pronounced improvement in several variables: overall posture (p = 0.014), lateral trunk inclination (p = 0.013) during upright standing position, total range of motion of the trunk (p = 0.012), FIM score (p = 0.048), and lumbar pain intensity (p = 0.017). Conclusions Our data support the use of neuromodulation with t-DCS as an add-on to neurorehabilitation for the treatment of patients affected by PS in PD.
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Affiliation(s)
- Roberto De Icco
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- *Correspondence: Roberto De Icco
| | - Alessia Putortì
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marta Allena
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Micol Avenali
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Carlotta Dagna
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Daniele Martinelli
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Silvano Cristina
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Valentina Grillo
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Mauro Fresia
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Vito Bitetto
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Francesca Valentino
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Enrico Alfonsi
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giorgio Sandrini
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Antonio Pisani
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Huh YE, Seo DW, Kim K, Chung WH, Kim S, Cho JW. Factors Contributing to the Severity and Laterality of Pisa Syndrome in Parkinson's Disease. Front Aging Neurosci 2022; 13:716990. [PMID: 35046790 PMCID: PMC8761952 DOI: 10.3389/fnagi.2021.716990] [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: 05/29/2021] [Accepted: 11/18/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: Pisa syndrome (PS) is a disabling postural deformity in Parkinson’s disease (PD). We aimed to elucidate clinical factors determining the severity and laterality of PS in PD. Methods: In 54 PD patients with PS, we measured the clinical factors that are previously known to contribute to the occurrence of PS as follows: asymmetry of motor symptoms for the evaluation of asymmetric basal ganglia dysfunction, the degree and direction of subjective visual vertical (SVV) tilt for the misperception of body verticality, the canal paresis for unilateral peripheral vestibulopathy, and the tonic electromyographic (EMG) hyperactivity of paraspinal muscles for dystonia. Multivariable linear and logistic regression analyses were conducted to identify the clinical factors associated with the degree of truncal tilt, for the quantification of the severity of PS, and PS tilting to the less affected side, respectively. Results: The multivariable linear regression analyses revealed that the larger degree of SVV tilt (β = 0.29, SE = 0.10, p = 0.005), right-sided SVV tilt (β = 2.32, SE = 0.82, p = 0.007), and higher Hoehn and Yahr (HY) stage (β = 4.01, SE = 1.29, p = 0.003) significantly increased the severity of PS. In the multivariable logistic regression analyses, greater asymmetry of motor symptoms [odds ratio (OR) = 2.01, 95% CI = 1.34–3.49] was significantly associated with PS tilting to the less affected side, while right-sided SVV tilt (OR = 0.02, 95% CI = 0.001–0.21), unilateral canal paresis (OR = 0.06, 95% CI = 0.003–0.79), and higher HY stage (OR = 0.04, 95% CI = 0.002–0.46) were associated with PS tilting to the more affected side. Conclusion: Misperception of verticality, asymmetric basal ganglia dysfunction, unilateral peripheral vestibulopathy, and motor disability are the clinical factors associated with the severity and laterality of PS in patients with PD.
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Affiliation(s)
- Young Eun Huh
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Dae-Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kunhyun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won-Ho Chung
- Department of Otolaryngology, Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seonwoo Kim
- Statistics and Data Center, Samsung Medical Center, Research Institute for Future Medicine, Seoul, South Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Casal MZ, Peyré-Tartaruga LA, Zanardi APJ, Ivaniski-Mello A, Alves LDL, Haas AN, Martinez FG. Postural Adjustments and Biomechanics During Gait Initiation and Obstacle Negotiation: A Comparison Between Akinetic-Rigid and Hyperkinetic Parkinson's Disease. Front Physiol 2021; 12:723628. [PMID: 34803726 PMCID: PMC8600270 DOI: 10.3389/fphys.2021.723628] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Individuals with Parkinson's disease (PD) exhibit different combinations of motor symptoms. The most frequent subtypes are akinetic-rigid (AK-R) and hyperkinetic (HYP). Motor symptoms, such as rigidity and bradykinesia, can directly affect postural adjustments and performance in daily tasks, like gait initiation and obstacles negotiation, increasing the risk of falls and functional dependence. Objective: To compare postural adjustments and biomechanical parameters during the gait initiation and obstacle negotiation of people with AK-R and HYP PD and correlate with functional mobility and risk of falls. Methods: Cross-sectional study. Thirty-three volunteers with PD were divided into two groups according to clinical motor manifestations: AK-R (n = 16) and HYP (n = 17). We assessed the anticipatory (APA), compensatory (CPA) postural adjustments analyzing kinematic, kinetic and, electromyographic parameters during the gait initiation and obstacle negotiation tests. We applied independent T-tests and Pearson correlation tests for comparisons and correlations, respectively (α = 0.05). Results: In the APA phase of the gait initiation test, compared to the functional HYP group, the AK-R group showed shorter time for single support (p = 0.01), longer time for double support (p = 0.01) accompanied by a smaller first step (size, p = 0.05; height, p = 0.04), and reduced muscle activation of obliquus internus (p = 0.02). Similarly, during the first step in the obstacle negotiation test, the AK-R group showed less step height (p = 0.01) and hip excursion (p = 0.02), accompanied by a reduced mediolateral displacement of the center of pressure (p = 0.02) during APA, and activation of the gluteus medius (p = 0.02) and the anterior tibialis (p = 0.04) during CPA in comparison with HYP group. Conclusion: The findings suggest that people with AK-R present impaired postural adjustments during gait initiation and obstacles negotiation compared to hyperkinetic PD. Based on defined motor symptoms, the proposition presented here revealed consistent postural adjustments during complex tasks and, therefore, may offer new insights onto PD motor evaluation and neurorehabilitation.
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Affiliation(s)
- Marcela Zimmermann Casal
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | | | - André Ivaniski-Mello
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lucas de Liz Alves
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Aline Nogueira Haas
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Flávia Gomes Martinez
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Zak M, Sikorski T, Wasik M, Krupnik S, Andrychowski J, Brola W. Pisa syndrome: Pathophysiology, physical rehabilitation and falls risk. NeuroRehabilitation 2021; 49:363-373. [PMID: 34542040 DOI: 10.3233/nre-210167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pisa syndrome (PS) is a postural disorder characterised by lateral flexion of the spine (> 10°), predisposing the affected individuals to falls, and contributing to increased mortality in neurodegenerative diseases. OBJECTIVE An overview of currently applied therapeutic management options, primarily focused on specifically structured rehabilitation exercises, in conjunction with falls-risk assessment in the individuals affected by PS. METHODS A narrative literature review, augmented with the authors' own experience in physical rehabilitation management. RESULTS As individuals affected by PS are evidenced to be intrinsically exposed to higher falls-risk through acquired postural deformities, they often fall victims of traumatic accidents, occasionally also facing relocation into 24-hour nursing facilities due to the injuries sustained/resultant disability, consequently having overall quality of their life appreciably reduced. CONCLUSIONS sA comprehensive approach is postulated in designing optimal therapeutic management, comprised of the exercises controlling postural stability, whilst reducing lower back pain, and the ones also promoting specific skills essential for coping unassisted after an accidental fall effectively. Rehabilitation of individuals affected by PS should be a fully integrated service, eliminating all identified risk factors for falls. As clinical PS symptoms tend to recur after completion of a full course of therapeutic management, all PS patients should continue the pursuit of therapeutic exercises on an individual basis, to effectively retard their recurrence. In view of overall scarcity of clinical studies completed on the large population samples of PS patients, further in-depth research is still required to ensure higher credence to overall efficacy of the presently proposed therapeutic solutions.
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Affiliation(s)
- Marek Zak
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Tomasz Sikorski
- Doctoral School, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Magdalena Wasik
- Doctoral School, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Szymon Krupnik
- Symmetry, Medical Rehabilitation Centre, Sosnowiec, Poland
| | - Jaroslaw Andrychowski
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Waldemar Brola
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
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Piscicelli C, Castrioto A, Jaeger M, Fraix V, Chabardes S, Moro E, Krack P, Debû B, Pérennou D. Contribution of Basal Ganglia to the Sense of Upright: A Double-Blind Within-Person Randomized Trial of Subthalamic Stimulation in Parkinson's Disease with Pisa Syndrome. JOURNAL OF PARKINSONS DISEASE 2021; 11:1393-1408. [PMID: 33896847 DOI: 10.3233/jpd-202388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Verticality perception is frequently altered in Parkinson's disease (PD) with Pisa syndrome (PS). Is it the cause or the consequence of the PS? OBJECTIVE We tested the hypothesis that both scenarios coexist. METHODS We performed a double-blind within-person randomized trial (NCT02704910) in 18 individuals (median age 63.5 years) with PD evolving for a median of 17.5 years and PS for 2.5 years and treated with bilateral stimulation of the subthalamus nuclei (STN-DBS) for 6.5 years. We analyzed whether head and trunk orientations were congruent with the visual (VV) and postural (PV) vertical, and whether switching on one or both sides of the STN-DBS could modulate trunk orientation via verticality representation. RESULTS The tilted verticality perception could explain the PS in 6/18 (33%) patients, overall in three right-handers (17%) who showed net and congruent leftward trunk and PV tilts. Two of the 18 (11%) had an outstanding clinical picture associating leftward: predominant parkinsonian symptoms, whole-body tilt (head -11°, trunk -8°) and transmodal tilt in verticality perception (PV -10°, VV -8.9°). Trunk orientation or VV were not modulated by STN-DBS, whereas PV tilts were attenuated by unilateral or bilateral stimulations if it was applied on the opposite STN. CONCLUSION In most cases of PS, verticality perception is altered by the body deformity. In some cases, PS seems secondary to a biased internal model of verticality, and DBS on the side of the most denervated STN attenuated PV tilts with a quasi-immediate effect. This is an interesting track for further clinical studies.
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Affiliation(s)
- Céline Piscicelli
- Department of NeuroRehabilitation, Grenoble-Alpes University Hospital, Grenoble, France.,Lab Cognitive Neurosciences CNRS-UMR5105 (LPNC), University Grenoble-Alpes, Grenoble, France
| | - Anna Castrioto
- Grenoble Institute Neurosciences (GIN), Grenoble-Alpes University Hospital, University Grenoble-Alpes, Inserm, U1216, Grenoble, France
| | - Marie Jaeger
- Department of NeuroRehabilitation, Grenoble-Alpes University Hospital, Grenoble, France
| | - Valerie Fraix
- Grenoble Institute Neurosciences (GIN), Grenoble-Alpes University Hospital, University Grenoble-Alpes, Inserm, U1216, Grenoble, France
| | - Stephan Chabardes
- Department of Neurosurgery, Grenoble-Alpes University Hospital, Grenoble, France
| | - Elena Moro
- Grenoble Institute Neurosciences (GIN), Grenoble-Alpes University Hospital, University Grenoble-Alpes, Inserm, U1216, Grenoble, France
| | - Paul Krack
- Movement Disorders Center, Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Bettina Debû
- Grenoble Institute Neurosciences (GIN), Grenoble-Alpes University Hospital, University Grenoble-Alpes, Inserm, U1216, Grenoble, France
| | - Dominic Pérennou
- Department of NeuroRehabilitation, Grenoble-Alpes University Hospital, Grenoble, France.,Lab Cognitive Neurosciences CNRS-UMR5105 (LPNC), University Grenoble-Alpes, Grenoble, France
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Hung CJJ, Wang SC, Cheng YY, Chang ST. Brain imaging findings in Parkinson disease with Pisa syndrome: A case report. Medicine (Baltimore) 2021; 100:e24631. [PMID: 33578580 PMCID: PMC7886393 DOI: 10.1097/md.0000000000024631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The Pisa syndrome (PS) is defined as a kind of reversible postural deformity which causes a lateral trunk flexion of 10 degrees or more. A prevalence of approximately 7.4% to 10.3% of patients with Parkinson disease (PD) also have PS. Though unbalanced function of the basal ganglia network and impaired visual-spatial functions including parietal cortices in PS is known, the pathophysiology of PS remains to be unclear. PATIENT CONCERNS A 67-year-old male patient with PD visited our Rehabilitation outpatient department because of his trunk which involuntarily deviated to the left side when he stood up. DIAGNOSES Based on the history, physical examination, X-ray images, Tc-99m brain TRODAT-1 single-photon emission computed tomography (SPECT), and regional cerebral perfusion Tc-99m ethyl cysteinate dimer SPECT, the patient was diagnosed with PD with PS. INTERVENTIONS The patient refused our recommendation of admission for pharmaceutical treatment due to personal reasons and was only willing to accept physical training programs at our outpatient department. OUTCOMES We arranged functional neuroimaging of the brain to survey possible neurologic deficits. The patient's images of ethyl cysteinate dimer SPECT and TRODAT SPECT showed abnormalities, including hypoperfusion and diminished dopamine transporter uptake, in the areas of the basal ganglia network and other brain regions. LESSONS Based on previous literature and the imaging of our patient, we hypothesize that PS results from unbalanced function of the basal ganglia network and impaired visual-spatial functions of bilateral parietal cortices.
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Affiliation(s)
| | - Su-Chen Wang
- Department of Long Term Care and Management, Chung Hwa University of Medical Technology, Tainan
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung
- School of Medicine, National Yang-Ming University
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei
- Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
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11
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Therapeutic interventions for Pisa syndrome in idiopathic Parkinson's disease. A Scoping Systematic Review. Clin Neurol Neurosurg 2020; 198:106242. [DOI: 10.1016/j.clineuro.2020.106242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 12/28/2022]
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12
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Tang H, Chen Y, Cen Z, Ouyang Z, Lou D, Tan Y, Luo W. The link between lateral trunk flexion in Parkinson's disease and vestibular dysfunction: a clinical study. Int J Neurosci 2020; 131:521-526. [PMID: 32942935 DOI: 10.1080/00207454.2020.1825419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Lateral trunk flexion (LTF) is a common postural deformity in Parkinson's disease (PD). Postural control is known to depend on visual, vestibular, and somatosensory information. OBJECTIVES This study aimed to investigate the relationship between vestibular dysfunction and postural abnormalities in PD patients with LTF. METHODS We enrolled a total of 19 PD patients with LTF (PD-LTF+) and 19 age- and sex-matched PD patients without LTF (PD-LTF-). All patients underwent vestibular tests, including spontaneous nystagmus, gaze-evoked nystagmus, ocular movements, optokinetic eye test, fast positioning maneuvers, and the bithermal caloric test. RESULTS Most of the PD-LTF + patients had abnormal vestibular function (11/19), while there were fewer vestibular function injuries in the control group (3/19). In PD-LTF + group, there were 5 patients (5/11, 45.5%) of peripheral vestibular dysfunction, 2 patients (2/11, 18.2%) of central vestibular damage, and 4 patients (4/11, 36.4%) of mixed injuries. The peripheral vestibular deficiencies could be either bilateral (4/9, 44.4%) or unilateral (5/9, 55.6%). The unilateral vestibular dysfunction was ipsilateral to the leaning side in 2 patients and contralateral to the leaning side in the other 3 patients. CONCLUSION Vestibular dysfunction may be an independent risk factor for LTF in PD patients.
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Affiliation(s)
- Haiyan Tang
- Department of Neurology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang, China.,Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - You Chen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhidong Cen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhiyuan Ouyang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Danning Lou
- Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Ying Tan
- Department of Neurology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang, China
| | - Wei Luo
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Diamanti L, Paoletti M, Di Vita U, Muzic SI, Cereda C, Ballante E, Pichiecchio A. MRI study of paraspinal muscles in patients with Amyotrophic Lateral Sclerosis (ALS). J Clin Med 2020; 9:jcm9040934. [PMID: 32231147 PMCID: PMC7230865 DOI: 10.3390/jcm9040934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 01/16/2023] Open
Abstract
Background: the study of paraspinal muscles is pivotal for the diagnosis and staging of Amyotrophic Lateral Sclerosis (ALS), and is usually performed by electromyography. Objective: to evaluate the role of paraspinal muscle MRI as a diagnostic biomarker in ALS. Methods: we evaluated T1-w images of newly diagnosed ALS patients (n = 14), age-matched healthy controls (n = 11), patients affected by inflammatory myopathy (n = 10), and lumbar radiculopathy (n = 19), and compared them semiquantitatively by using the Mercuri Scale. Results: a significant difference in the appearance of the psoas muscle was observed between ALS patients and patients with radiculopathy (p = 0.003); after stratifying ALS patients into spinal and bulbar onsets, we found a significant difference in the appearance of the longissimus dorsi muscle between the spinal onset ALS subgroup and bulbar onset ALS subgroup (p = 0.0245), while no difference was found for multifidus (p = 0.1441), iliocostal (p = 0.0655), and psoas muscles (p = 0.0813) between the cohort subgroups. Conclusions: paraspinal T1-w MRI could help to distinguish spinal ALS patients from healthy and pathological controls. Specifically, the study of longissimus dorsi could play the role of a diagnostic ALS biomarker.
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Affiliation(s)
- Luca Diamanti
- IRCCS Mondino Foundation, 27100 Pavia, Italy; (M.P.); (C.C.); (E.B.); (A.P.)
- Correspondence: ; Tel.: +39-382-3801
| | - Matteo Paoletti
- IRCCS Mondino Foundation, 27100 Pavia, Italy; (M.P.); (C.C.); (E.B.); (A.P.)
| | - Umberto Di Vita
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (U.D.V.); (S.I.M.)
| | - Shaun Ivan Muzic
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (U.D.V.); (S.I.M.)
| | - Cristina Cereda
- IRCCS Mondino Foundation, 27100 Pavia, Italy; (M.P.); (C.C.); (E.B.); (A.P.)
| | - Elena Ballante
- IRCCS Mondino Foundation, 27100 Pavia, Italy; (M.P.); (C.C.); (E.B.); (A.P.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (U.D.V.); (S.I.M.)
| | - Anna Pichiecchio
- IRCCS Mondino Foundation, 27100 Pavia, Italy; (M.P.); (C.C.); (E.B.); (A.P.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (U.D.V.); (S.I.M.)
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14
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Pérennou D, Jaeger M, Debu B, Fraix V, Marquer A, Krack P, Piscicelli C, Castrioto A. Interplay of Pisa syndrome and scoliosis in individuals with Parkinson's disease treated with bilateral stimulation of subthalamic nuclei: IPOLAP study. Ann Phys Rehabil Med 2020; 63:578-580. [PMID: 32061769 DOI: 10.1016/j.rehab.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 12/29/2019] [Accepted: 02/05/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Dominic Pérennou
- Department of neurological rehabilitation, Grenoble-Alpes university hospital, Grenoble, France; Lab Psychology and Neurocognition (LPNC), UMR5105, CNRS, university Grenoble-Alpes, 38000 Grenoble, France.
| | - Marie Jaeger
- Department of neurological rehabilitation, Grenoble-Alpes university hospital, Grenoble, France
| | - Bettina Debu
- Movement disorders unit, neurology department, Grenoble-Alpes university hospital, Grenoble, France; GIN, Grenoble institut des neurosciences, university Grenoble-Alpes, 38000 Grenoble, France
| | - Valérie Fraix
- Movement disorders unit, neurology department, Grenoble-Alpes university hospital, Grenoble, France; GIN, Grenoble institut des neurosciences, university Grenoble-Alpes, 38000 Grenoble, France
| | - Adelaide Marquer
- Department of neurological rehabilitation, Grenoble-Alpes university hospital, Grenoble, France
| | - Paul Krack
- Movement disorder center, university hospital Bern, Bern, Switzerland
| | - Céline Piscicelli
- Department of neurological rehabilitation, Grenoble-Alpes university hospital, Grenoble, France; Lab Psychology and Neurocognition (LPNC), UMR5105, CNRS, university Grenoble-Alpes, 38000 Grenoble, France
| | - Anna Castrioto
- Movement disorders unit, neurology department, Grenoble-Alpes university hospital, Grenoble, France; GIN, Grenoble institut des neurosciences, university Grenoble-Alpes, 38000 Grenoble, France
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15
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Liu K, Ou R, Hou Y, Wei Q, Cao B, Song W, Zhao B, Shang H. Predictors of Pisa syndrome in Chinese patients with Parkinson's disease: A prospective study. Parkinsonism Relat Disord 2019; 69:1-6. [DOI: 10.1016/j.parkreldis.2019.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/25/2022]
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Liu K, Ou R, Wei Q, Cao B, Chen Y, Song W, Wu Y, Shang H. Pisa Syndrome in Chinese Patients With Parkinson's Disease. Front Neurol 2019; 10:651. [PMID: 31281286 PMCID: PMC6596278 DOI: 10.3389/fneur.2019.00651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/04/2019] [Indexed: 02/05/2023] Open
Abstract
Objective: To investigate the prevalence and the clinical factors related to Pisa syndrome (PS) in Chinese Parkinson's disease (PD) patients. Methods: A total of 2,167 PD patients were continuously included in this observational study. Patients with PS were identified as presented with a lateral trunk flexion of at least 10° that can be completely alleviated by passive mobilization or supine positioning. The data of the motor and non-motor symptoms including depression, anxiety and cognitive dysfunction was collected and analyzed. Results: We found seventy-seven (3.6%) PD patients presenting with PS. The following variables including age, disease duration, levodopa equivalent daily doses (LEDD), the proportion of males, the proportion of participants using levodopa, dopaminergic agonist, amantadine and entacapone, the proportion of motor fluctuations, scores of Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Unified PD Rating Scale (UPDRS) part III, and Hoehn and Yahr (H&Y) stage were significantly higher in patients with PS compared with patients without PS (P < 0.05). Scores of the Frontal Assessment Battery (FAB) and the Montreal Cognitive Assessment (MoCA) were not different between the two groups. The binary logistic regression model indicated that the presence of PS was associated with older age (OR = 1.027, P = 0.030), higher LEDD (OR = 1.002, P < 0.001) and a higher UPDRS III score (OR = 1.060, P < 0.001), but had no relationship with HAMD and HAMA scores. Conclusion: PS is relatively rare (3.6%) in Chinese PD patients. It is likely associated with older age, higher LEDD and more severe motor disabilities. However, non-motor symptoms such as depression, anxiety, and cognitive dysfunction have no association with PS in PD. These findings provided important complementary information for identifying the underlying mechanisms of PS.
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Affiliation(s)
- Kuncheng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ruwei Ou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qianqian Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Bei Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yongping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Song
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Todisco M, Pozzi NG, Zangaglia R, Minafra B, Servello D, Ceravolo R, Alfonsi E, Fasano A, Pacchetti C. Pisa syndrome in Idiopathic Normal Pressure Hydrocephalus. Parkinsonism Relat Disord 2019; 66:40-44. [PMID: 31300263 DOI: 10.1016/j.parkreldis.2019.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Idiopathic Normal Pressure Hydrocephalus (iNPH) is a complex syndrome of ventriculomegaly that can include parkinsonian-like features besides the classical triad of cognitive decline, urinary incontinence, and gait/balance disturbances. Pisa syndrome (PS) is a postural abnormality often associated with parkinsonism and defined as lateral trunk flexion greater than 10° while standing that resolves in the supine position. We reported a case series of classical "fixed" PS and one case of "Metronome" recurrent side-alternating PS in iNPH, displaying opposite electromyographic patterns of paraspinal muscles. METHODS Eighty-five iNPH patients were followed longitudinally for at least one year through scheduled clinical and neuropsychological visits. RESULTS Five (5.9%) subjects revealed PS. None of them had nigrostriatal dopaminergic involvement detected by [123I]FP-CIT SPECT. Among these patients, four had "fixed" PS, whereas one showed a recurrent side-alternating PS which repeatedly improved after ventriculo-peritoneal shunt and following adjustments of the valve-opening pressure of the shunt system. DISCUSSION This is the first case series of PS in iNPH and the first report of "Metronome" PS in iNPH. The prompt response of the abnormal trunk postures through cerebrospinal fluid (CSF) shunt surgery suggests a causative role of an altered CSF dynamics. PS and gait disorders in iNPH could be explained by a direct involvement of cortico-subcortical pathways and subsequent secondary brainstem involvement, with also a possible direct functional damage of the basal ganglia at the postsynaptic level, due to enlargement of the ventricular system and impaired CSF dynamics. The early detection of these cases supports a proper surgical management.
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Affiliation(s)
- Massimiliano Todisco
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Nicolò Gabriele Pozzi
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Neurology, University Hospital Würzburg and Julius-Maximilians-University, Würzburg, Germany
| | - Roberta Zangaglia
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Brigida Minafra
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Domenico Servello
- Unit of Functional Neurosurgery, Department of Neurology and Neurosurgery, IRCCS Galeazzi Institute, Milan, Italy
| | - Roberto Ceravolo
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enrico Alfonsi
- Department of Neurophysiopathology, IRCCS Mondino Foundation, Pavia, Italy
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada
| | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy.
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Artusi CA, Bortolani S, Merola A, Zibetti M, Busso M, De Mercanti S, Arnoffi P, Martinetto S, Gaidolfi E, Veltri A, Barbero P, Lopiano L. Botulinum toxin for Pisa syndrome: An MRI-, ultrasound- and electromyography-guided pilot study. Parkinsonism Relat Disord 2019; 62:231-235. [DOI: 10.1016/j.parkreldis.2018.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/03/2018] [Accepted: 11/04/2018] [Indexed: 01/05/2023]
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19
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Clinical correlates of repetitive speech disorders in Parkinson's disease. J Neurol Sci 2019; 401:67-71. [PMID: 31029883 DOI: 10.1016/j.jns.2019.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study aimed to explore clinical correlates of repetitive speech disorders in patients with Parkinson's disease (PD). METHODS This study investigated speech function (Assessment of Motor Speech for Dysarthria and Stuttering Severity Instrument-3), motor function (Unified Parkinson's Disease Rating Scale III [UPDRS-III] and UPDRS-IV), cognitive function (Mini-Mental State Examination [MMSE], Montreal Cognitive Assessment [MoCA], Stroop color-word test, verbal fluency, digit span tests, and line orientation), and activities of daily living of 113 PD patients. Comparison between groups (independent t-tests, Mann-Whitney U tests, or χ2 test) and linear regression analyses were performed to determine clinical correlates of repetitive speech disorders. RESULTS Totally, 65 patients (57.5%) had repetitive speech disorders. Patients with repetitive speech disorders had significantly worse UPDRS-III (P = .049), MoCA (P = .030), and speech function and higher levodopa equivalent daily dose (LEDD; P = .031) than those without repetitive speech disorders. Males were significantly predominant in patients with repetitive speech disorders (64.6%) compared to those without repetitive speech disorders (18.7%; P < .001). The univariate and subsequent multiple linear regression analyses revealed that the severity of repetitive speech disorders significantly correlated with gender (P < .001), MoCA (P = .006), and speech variables (abnormal rate, P = .007; imprecise consonants, P = .043), independent from disease duration, UPDRS III, and LEDD. CONCLUSIONS PD patients with repetitive speech disorders had worse motor, cognitive, and speech functions than those without repetitive speech disorders. The most influential factor for repetitive speech disorders might be male gender.
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Formaggio E, Masiero S, Volpe D, Demertzis E, Gallo L, Del Felice A. Lack of inter-muscular coherence of axial muscles in Pisa syndrome. Neurol Sci 2019; 40:1465-1468. [DOI: 10.1007/s10072-019-03821-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
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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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22
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Geroin C, Squintani G, Morini A, Donato F, Smania N, Gandolfi MG, Tamburin S, Fasano A, Tinazzi M. Pisa syndrome in Parkinson's disease: electromyographic quantification of paraspinal and non-paraspinal muscle activity. FUNCTIONAL NEUROLOGY 2018; 32:143-151. [PMID: 29042003 DOI: 10.11138/fneur/2017.32.3.143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with Parkinson's disease (PD) and Pisa syndrome (PS) may present tonic dystonic or compensatory (i.e. acting against gravity) hyperactivity in the paraspinal and non-paraspinal muscles. Electromyographic (EMG) activity was measured in nine patients with PD and PS, three with PD without PS, and five healthy controls. Fine-wire intramuscular electrodes were inserted bilaterally into the iliocostalis lumborum (ICL), iliocostalis thoracis (ICT), gluteus medius (GM), and external oblique (EO) muscles. The root mean square (RMS) of the EMG signal was calculated and normalized for each muscle. In stance condition, side-to-side muscle activity comparisons showed a higher RMS only for the contralateral ICL in PD patients with PS (p=0.028). Moreover, with increasing degrees of lateral flexion, the activity of the EO and the ICL muscles progressively increased and decreased, respectively. The present data suggest that contralateral paraspinal muscle activity plays a crucial compensatory role and can be dysfunctional in PD patients with PS.
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23
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Ruttiman R, Eltorai AEM, Daniels AH. Etiology and Management of Spinal Deformity in Patients With Parkinson's Disease. Int J Spine Surg 2018; 12:15-21. [PMID: 30280078 DOI: 10.14444/5003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Patients with Parkinson's disease (PD) commonly develop severe spinal deformity, including scoliosis, antecollis, camptocormia, and Pisa syndrome. The etiology of PD-associated spinal deformity is not completely understood and in most cases is likely due to multiple interrelated factors, including central dystonia and focal myopathy. Once spinal deformity has occurred, surgery is often the only modality that can correct the condition, although control of the movement disorder through medication and deep brain stimulation may slow progression. Advances in spinal instrumentation and deformity correction techniques have improved the outcomes of PD spinal deformity patients, though complications and revision surgery rates remain high. Surgical intervention is reserved for individuals who are physiologically healthy and whose condition is refractory to nonoperative management and follows similar treatment principles as other causes of neuromuscular scoliosis/kyphosis. Spinal deformity patients with PD are optimally treated by spinal deformity surgeons who are familiar with the unique needs of PD patients, with vigilant preoperative and postoperative treatment of their movement disorder and bone density.
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Affiliation(s)
- Roy Ruttiman
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adam E M Eltorai
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alan H Daniels
- Division of Spine Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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24
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Xiang X, Wu L, Mao L, Liu Y. Anti‑oxidative and anti‑apoptotic neuroprotective effects of Azadirachta indica in Parkinson‑induced functional damage. Mol Med Rep 2018; 17:7959-7965. [PMID: 29620282 DOI: 10.3892/mmr.2018.8815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 05/03/2017] [Indexed: 11/06/2022] Open
Abstract
Azadirachta indica has previously been demonstrated to act as a multi‑functional medicinal plant for >2,000 years in India, and its neighboring countries. Currently, it is considered a natural resource with great value used in industrial product development and as a medicine for various types of diseases. The present study investigated the neuroprotective effects of Azadirachta indica which improved functional recovery in the 6‑hydroxydopamine induced rat Parkinson's disease (PD) model. Catalase, glutathione‑peroxidase, tumor necrosis factor‑α, interleukin (IL)‑1β, IL‑6, nuclear factor (NF)‑κB p65, inducible nitric oxide synthase (iNOS) and AChE activity levels were analyzed via ELISA. Western blotting was used to analyze B cell lymphoma‑2 associated X protein (Bax), cytochrome c and p53 protein expression. Treatment with Azadirachta indica significantly decreased the PD‑induced rotational behavior in rats. PD‑induced catalase, glutathione‑peroxidase, iNOS activity and iNOS protein expression were significantly suppressed by treatment with Azadirachta indica. Inflammatory factors, acetylcholinesterase activity and cyclo‑oxygenase‑2 protein expression levels were additionally significantly suppressed by treatment with Azadirachta indica. The protein expression levels of Bax, cytochrome c and p53 were decreased and caspase‑3 and caspase‑9 activities diminished, with treatment with Azadirachta indica. Therefore, Azadirachta indica was demonstrated to exhibit neuroprotective antioxidative and anti‑apoptotic effects in Parkinson's disease.
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Affiliation(s)
- Xin Xiang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Lin Wu
- Department of Neurology, Rizhao City People's Hospital, Rizhao, Shandong 1250832, P.R. China
| | - Lining Mao
- Department of Traditional Chinese Medicine, Dongying Bonesetting Hospital, Dongying, Shandong 257000, P.R. China
| | - Yiming Liu
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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25
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Alwardat M, Di Lazzaro G, Schirinzi T, Sinibaldi Salime P, Mercuri NB, Pisani A. Does Pisa syndrome affect upper limb function in patients with Parkinson’s disease? An observational cross-sectional study. NeuroRehabilitation 2018; 42:143-148. [DOI: 10.3233/nre-172274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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
| | - Giulia Di Lazzaro
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma “Tor Vergata”, Rome, Italy
- Department of Neurosciences, Bambino Gesú Children Hospital, 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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26
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Huh YE, Kim K, Chung WH, Youn J, Kim S, Cho JW. Pisa Syndrome in Parkinson's Disease: Pathogenic Roles of Verticality Perception Deficits. Sci Rep 2018; 8:1804. [PMID: 29379091 PMCID: PMC5788854 DOI: 10.1038/s41598-018-20129-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/11/2018] [Indexed: 11/09/2022] Open
Abstract
We elucidated whether verticality misperception is associated with the generation of Pisa syndrome (PS) in patients with Parkinson's disease (PD). To examine the heterogenous influence of verticality perception, we also identified the characteristics distinguishing between PD patients with PS who tilted toward the deviation of perceived verticality and those who did not. Subjective visual vertical (SVV) testing was performed in 54 PD patients with PS and 36 without PS to measure verticality perception. Other potential risk factors for PS were evaluated by assessing the asymmetry of motor symptoms, EMG activities of paraspinal muscles, bithermal caloric tests, back pain history, and Berg Balance Scale. Abnormal SVV (odds ratio (OR) 18.40, p = 0.006), postural imbalance (OR 0.71, p = 0.046), and unilateral EMG hyperactivity of paraspinal muscles (OR 39.62, p = 0.027) were independent contributors to PS. In subgroup analysis, EMG hyperactivity of paraspinal muscles contralateral to the leaning side and postural imbalance were associated with PD patients with PS who tilted toward the SVV deviation, whereas back pain was more frequent in those who did not. Verticality misperception is a potent risk factor for PS in PD and contributes differentially to PS depending on the congruence between its direction and PS direction, indicating distinct pathogenic roles.
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Affiliation(s)
- Young Eun Huh
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, 13496, Korea
| | - Kunhyun Kim
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, 06351, Korea
| | - Won-Ho Chung
- Department of Otolaryngology, Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, 06351, Korea
| | - Jinyoung Youn
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, 06351, Korea
| | - Seonwoo Kim
- Statistics and Data Center, Samsung Medical Center, Seoul, 06351, Korea
| | - Jin Whan Cho
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, 06351, Korea.
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27
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Lena F, Iezzi E, Etoom M, Santilli M, Centonze D, Foti C, Grillea G, Modugno N. Effects of postural exercises in patients with Parkinson’s disease and Pisa syndrome: A pilot study. NeuroRehabilitation 2017; 41:423-428. [DOI: 10.3233/nre-162033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Francesco Lena
- Department of Neurorehabilitation, INM, Neuromed, Pozzilli (IS), Italy
| | - Ennio Iezzi
- Department of Neurology, INM, Neuromed, Pozzilli (IS), Italy
| | - Mohammad Etoom
- Advance Sciences and Technologies in Medical Rehabilitation, Tor Vergata University, Rome, Italy
| | - Marco Santilli
- Department of Neurorehabilitation, INM, Neuromed, Pozzilli (IS), Italy
| | - Diego Centonze
- Department of Neurorehabilitation, INM, Neuromed, Pozzilli (IS), Italy
| | - Calogero Foti
- Advance Sciences and Technologies in Medical Rehabilitation, Tor Vergata University, Rome, Italy
| | - Giovanni Grillea
- Department of Neuro-Radiology, INM, Neuromed, Pozzilli (IS), Italy
| | - Nicola Modugno
- Department of Neurology, INM, Neuromed, Pozzilli (IS), Italy
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28
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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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29
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Ye X, Lou D, Ding X, Xie C, Gao J, Lou Y, Cen Z, Xiao Y, Miao Q, Xie F, Zheng X, Wu J, Li F, Luo W. A clinical study of the coronal plane deformity in Parkinson disease. 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 2017; 26:1862-1870. [PMID: 28281005 DOI: 10.1007/s00586-017-5018-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 02/12/2017] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Postural deformities in the coronal plane were frequent and disabling complications of PD, which reduces the quality of life of patients. This study aimed to garner greater attention to the Parkinson disease (PD)-related postural trunk deviations in the coronal plane by exploring a method for diagnosis because of the lack of any uniform diagnostic criteria and epidemiological studies. It also aimed to provide correlation data in the Chinese PD patients. METHODS In this cross-sectional study, 503 consecutive outpatients with PD were enrolled who underwent standardized clinical evaluation. The study recruited 83 PD patients diagnosed with Pisa syndrome (PS). Scoliosis and coronal imbalance were diagnosed accurately by radiographic data. The PD patients were compared based on the Cobb angle and coronal balance for several demographic and clinical variables. RESULTS PD patients with PS had a prevalence of 16.5%. The prevalence of coronal imbalance and scoliosis was 10.34 and 7.75%, respectively. PD patients with PS were older and had a more severe disease, significantly longer disease duration and treatment duration, and reduced quality of life. The most important finding was that the different morphology of the spinal level had an effect on the severity of coronal balance or Cobb angle. CONCLUSIONS The present study indicated that the postural deformities in the coronal plane were related to the morphology of the spinal level, especially the position of the Cobb angle. To benefit the PD patients with PS, the full-length standing spine radiographs should be performed as early as possible.
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Affiliation(s)
- Xiaoyun Ye
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Danning Lou
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Xueping Ding
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Neurology, Haining People's Hospital, Jiaxing, China
| | - Chaoyan Xie
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Neurology, Beilun People's Hospital, Ningbo, China
| | - Jixiang Gao
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Yuting Lou
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Pediatrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhidong Cen
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Pediatrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuxiang Xiao
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Qianzhuang Miao
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Pharmacy, Fenghua Hospital, Fenghua, Ningbo, China
| | - Fei Xie
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaosheng Zheng
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Jianxin Wu
- Department of Neurology, No. 117 Hospital of People's Liberation Army, Hangzhou, China
| | - Fangcai Li
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
| | - Wei Luo
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
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31
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Tsou CC, Huang SY. Olanzapine as a possible replacement choice for paliperidone-induced Pisa syndrome: a case report. Australas Psychiatry 2016; 24:545-547. [PMID: 27590078 DOI: 10.1177/1039856216665285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this paper is to present a case of paliperidone-induced Pisa syndrome and provide treatment experience. METHOD The case report is combined with a review of the literature. RESULTS A 37-year-old man had been diagnosed with paranoid-type schizophrenia for about 10 years. He received three-month treatment of paliperidone extended release (ER) at 6 mg per day, but showed a progressively Pisa-like physical position. We initially added an anticholinergic drug, but saw no improvement. The paliperidone ER was replaced by olanzapine at 10 mg per day, and the Pisa-like symptom improved after 1 month of the drug replacement. CONCLUSIONS We propose olanzapine as a possible replacement choice for patients with paliperidone-related Pisa syndrome.
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Affiliation(s)
- Chang-Chih Tsou
- Resident, Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - San-Yuan Huang
- Attending Physician, Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, and; Professor, Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
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32
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Pandey S, Kumar H. Assessment of striatal & postural deformities in patients with Parkinson's disease. Indian J Med Res 2016; 144:682-688. [PMID: 28361820 PMCID: PMC5393078 DOI: 10.4103/ijmr.ijmr_502_15] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND & OBJECTIVES Though striatal and postural deformities are known to occur commonly in atypical Parkinsonism patients, these may also be seen in patients with Parkinson's disease (PD). These are frequently misdiagnosed as joint or orthopaedic pathology leading to unnecessary investigations. This study was conducted to observe the various striatal and postural deformities among patients with PD in India. METHODS This study was conducted at a tertiary care teaching institute in north# India. Seventy consecutive patients with PD diagnosed as per the modified UK Brain Bank criteria were included. Various striatal (hand & foot) and postural (antecollis, camptocormia, scoliosis & Pisa syndrome) deformities and their relation with the duration of disease, severity [measured by the Unified Parkinson's Disease Rating Scale (UPDRS)] and levodopa intake were analyzed. RESULTS Of the 70 patients with PD, 34 (48.57%) had either striatal or postural deformities. Striatal foot was the most common deformity observed (25.71%). Camptocormia was the second most common deformity (20%). Striatal and postural deformities were seen in more advanced PD as suggested by significantly higher UPDRS and Hoehn and Yahr scale (P<0.001). Striatal deformities were more ipsilateral to PD symptom onset side (agreement 94.44%). Pisa and scoliosis concavity were more on contralateral side to PD symptoms onset side (66.67%). INTERPRETATION & CONCLUSIONS Our results showed that striatal and postural deformities were common and present in about half of the patients with PD. These deformities we more common in patients with advanced stage of PD.
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Affiliation(s)
- Sanjay Pandey
- Department of Neurology, GB Pant Hospital, New Delhi, India
| | - Hitesh Kumar
- Department of Neurology, GB Pant Hospital, New Delhi, India
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33
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Tinazzi M, Geroin C, Gandolfi M, Smania N, Tamburin S, Morgante F, Fasano A. Pisa syndrome in Parkinson's disease: An integrated approach from pathophysiology to management. Mov Disord 2016; 31:1785-1795. [PMID: 27779784 DOI: 10.1002/mds.26829] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/09/2016] [Accepted: 09/11/2016] [Indexed: 12/26/2022] Open
Abstract
Pisa syndrome was first described in 1972 in patients treated with neuroleptics. Since 2003, when it was first reported in patients with Parkinson's disease (PD), Pisa syndrome has progressively drawn the attention of clinicians and researchers. Although emerging evidence has partially clarified its prevalence and pathophysiology, the current debate revolves around diagnostic criteria and assessment and the effectiveness of pharmacological, surgical, and rehabilitative approaches. Contrary to initial thought, Pisa syndrome is common among PD patients, with an estimated prevalence of 8.8% according to a large survey. Furthermore, it is associated with the following specific patient features: more severe motor phenotype, ongoing combined pharmacological treatment with levodopa and dopamine agonists, gait disorders, and such comorbidities as osteoporosis and arthrosis. The present literature on treatment outcomes is scant, and the uneven effectiveness of specific treatments has produced conflicting results. This might be because of the limited knowledge of Pisa syndrome pathophysiology and its variable clinical presentation, which further complicates designing randomized clinical trials on this condition. However, because some forms of Pisa syndrome are potentially reversible, there is growing consensus on the importance of its early recognition and the importance of pharmacological adjustment and rehabilitation. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Christian Geroin
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Morgante
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
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34
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Stocchi F, Torti M, Fossati C. Advances in dopamine receptor agonists for the treatment of Parkinson's disease. Expert Opin Pharmacother 2016; 17:1889-902. [PMID: 27561098 DOI: 10.1080/14656566.2016.1219337] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Dopamine agonists (DA) are a class of agents which directly stimulate dopamine receptors mimicking the endogenous neurotransmitter dopamine. At first used as adjunctive therapy in the advanced phases of the disease, over the years a significant role was found for DA monotherapy as a first approach in the initial stage of Parkinson's disease (PD). Several reviews have already reported efficacy and safety of DA in PD and differences between DA and levodopa. Therefore the objective of this review is to gather recent updates in DA therapy. A thorough knowledge of recent literature evidences, would help clinician in the management of treatment with DA. AREAS COVERED Our review investigates recent updates on DA therapy, the role of these compounds in controlling non-motor symptoms (NMS) as well as new formulations under clinical evaluation and newly emerged post-marketing safety considerations. A literature search has been performed using Medline and reviewing the bibliographies of selected articles. EXPERT OPINION DA represents a very important option in the treatment of PD, even though there are still some criticisms and unmet needs. A better knowledge of dopamine receptors could lead to identification of new compounds able to better balance clinical efficacy and side effects.
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Affiliation(s)
- Fabrizio Stocchi
- a Department of Neurology, Institute for research and medical care , IRCCS San Raffaele Roma , Roma , Italy
| | - Margherita Torti
- a Department of Neurology, Institute for research and medical care , IRCCS San Raffaele Roma , Roma , Italy
| | - Chiara Fossati
- a Department of Neurology, Institute for research and medical care , IRCCS San Raffaele Roma , Roma , Italy
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35
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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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36
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Barone P, Santangelo G, Amboni M, Pellecchia MT, Vitale C. Pisa syndrome in Parkinson's disease and parkinsonism: clinical features, pathophysiology, and treatment. Lancet Neurol 2016; 15:1063-74. [PMID: 27571158 DOI: 10.1016/s1474-4422(16)30173-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/26/2016] [Accepted: 06/27/2016] [Indexed: 12/21/2022]
Abstract
Pisa syndrome is defined as a reversible lateral bending of the trunk with a tendency to lean to one side. It is a frequent and often disabling complication of Parkinson's disease, and has also been described in several atypical forms of parkinsonism and in neurodegenerative and psychiatric disorders after drug exposure and surgical procedures. Although no consistent diagnostic criteria for Pisa syndrome are available, most investigations have adopted an arbitrary cutoff of at least 10° of lateral flexion for the diagnosis of the syndrome. Pathophysiological mechanisms underlying Pisa syndrome have not been fully explained. One hypothesis emphasises central mechanisms, whereby Pisa syndrome is thought to be caused by alterations in sensory-motor integration pathways; by contrast, a peripheral hypothesis emphasises the role of anatomical changes in the musculoskeletal system. Furthermore, several drugs are reported to induce Pisa syndrome, including antiparkinsonian drugs. As Pisa syndrome might be reversible, clinicians need to be able to recognise this condition early to enable prompt management. Nevertheless, further research is needed to determine optimum treatment strategies.
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Affiliation(s)
- Paolo Barone
- Neurodegenerative Diseases Centre, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Gabriella Santangelo
- Department of Psychology, Second University of Naples, Caserta, Italy; IDC-Hermitage-Capodimonte, Naples, Italy
| | - Marianna Amboni
- Neurodegenerative Diseases Centre, Department of Medicine and Surgery, University of Salerno, Salerno, Italy; IDC-Hermitage-Capodimonte, Naples, Italy
| | - Maria Teresa Pellecchia
- Neurodegenerative Diseases Centre, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Carmine Vitale
- IDC-Hermitage-Capodimonte, Naples, Italy; Department of Motor Sciences and Wellness, University Parthenope, Naples, Italy.
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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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Abstract
Parkinson's disease (PD) is the most common neurodegenerative disease and is characterized by tremor, rigidity and akinesia. Diagnosis is clinical in the majority of the patients. Patients with PD may have stooped posture but some of them develop different types of postural and striatal deformities. Usually these deformities are more common in atypical parkinsonian disorders such as progressive supranuclear palsy and multisystem atrophy. But in many studies it has been highlighted that these may also be present in approximately one third of PD patients leading to severe disability. These include antecollis or dropped head, camptocormia, Pisa syndrome, scoliosis, striatal hands and striatal toes. The pathogenesis of these deformities is a complex combination of central and peripheral influences such as rigidity, dystonia and degenerative skeletal changes. Duration of parkinsonism symptoms is an important risk factor and in majority of the patients these deformities are seen in advanced statge of the disease. The patients with such symptoms may initially respond to dopaminergic medications but if not intervened they may become fixed and difficult to treat. Pain and restriction of movement are most common clinical manifestations and these may mimick symptoms of musculoskeletal disorders like rheumatoid arthritis. Early diagnosis is important as the patients may respond to adjustment in dopaminergic medications. Recent advances such as deep brain stimulation (DBS) and ultrasound guided botulinum toxin injection are helpful in management of these deformities in patients with PD.
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Affiliation(s)
- Sanjay Pandey
- Department of Neurology, GB Pant Hospital, Delhi, India
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Cervantes-Arriaga A, Rodríguez-Violante M, Morales-Briceño H, Neri-Nani G, Millán-Cepeda R, Velázquez-Osuna S. Frequency and clinical correlates of postural and striatal deformities in Parkinson’s disease. Clin Neurol Neurosurg 2016; 142:140-144. [DOI: 10.1016/j.clineuro.2016.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 09/04/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
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Pisa Syndrome in Parkinson's Disease: Electromyographic Aspects and Implications for Rehabilitation. PARKINSONS DISEASE 2015; 2015:437190. [PMID: 26682083 PMCID: PMC4670865 DOI: 10.1155/2015/437190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 11/09/2015] [Indexed: 11/18/2022]
Abstract
Pisa Syndrome (PS) is a real clinical enigma, and its management remains a challenge. In order to improve the knowledge about resting state and during maximal voluntary muscle contraction (MVMC) of the axial muscles, we described the electromyography results of paraspinal muscles, rectus abdominis, external oblique, and quadratus lumborum of both sides of 60 patients. Electromyography was assessed at rest, during MVMC while bending in the opposite direction of the PS and during MVMC while bending in the direction of the PS. The MVMC gave information about the interferential pattern (INT) or subinterferential pattern (sub-INT). We defined asymmetrical activation (AA) when a sub-INT was detected on the muscle on the side opposite to the PS bending and an INT of same muscle in the direction of PS bending. We observed significant AA during MVMC only in the external oblique muscles in 78% of the subjects. Our results of asymmetric ability to generate maximal voluntary force of the external oblique muscles support a central dissynchronisation of axial muscles as a significant contributor for the bending of the spine in erect position. These results could have important implication to physiotherapy and the use of botulinum toxin in the treatment of PS.
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Identification of a new target muscle for treatment in patients with Parkinson's disease who have lateral trunk flexion? J Neurol Sci 2015; 358:435-9. [PMID: 26375624 DOI: 10.1016/j.jns.2015.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 09/04/2015] [Accepted: 09/04/2015] [Indexed: 11/22/2022]
Abstract
Parkinson's disease (PD) can present with lateral trunk flexion (LTF). Abnormal posture associated with PD has been treated, but the effectiveness of these treatments is limited, resulting in unsatisfactory outcomes. Unilateral hypertrophy and unilateral hyperactivity may be useful for deciding targets for injection of botulinum toxin or physical rehabilitation. However, such findings may be limited such as the obliquus abdominis muscle or thoracic paraspinal muscles, and several other muscles may have a causative role in LTF. We investigated 8 patients whether other muscles show unilateral hypertrophy by analyzing computed tomographic scans. Cobb's angle was 11° to 34°. The area of the paravertebral muscles was large contralateral to the bending side and this trend intensified from L4 to Th10. The lumbar quadrate muscle and psoas major muscle showed unilateral enlargement. These larger muscles were prominent contralateral to the bending side in five patients and ipsilateral to the bending side in two patients. This unilateral muscle change was mildly seen in the internal and external abdominal oblique muscles. The lumbar quadrate muscle or psoas major muscle showed two hypertrophic patterns, and these muscles might be new therapeutic targets for treatments such as botulinum toxin.
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Tinazzi M, Fasano A, Geroin C, Morgante F, Ceravolo R, Rossi S, Thomas A, Fabbrini G, Bentivoglio A, Tamma F, Cossu G, Modugno N, Zappia M, Volontè MA, Dallocchio C, Abbruzzese G, Pacchetti C, Marconi R, Defazio G, Canesi M, Cannas A, Pisani A, Mirandola R, Barone P, Vitale C. Pisa syndrome in Parkinson disease: An observational multicenter Italian study. Neurology 2015; 85:1769-79. [PMID: 26491088 DOI: 10.1212/wnl.0000000000002122] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 07/21/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of Pisa syndrome (PS) in patients with Parkinson disease (PD) and to assess the association between PS and demographic and clinical variables. METHODS In this multicenter cross-sectional study, consecutive outpatients with PD attending 21 movement disorders Italian tertiary centers were enrolled and underwent standardized clinical evaluation. PS was defined as trunk lateral deviation ≥10°. Patients with PD were compared according to the presence of PS for several demographic and clinical variables. RESULTS Among 1,631 enrolled patients with PD, PS was detected in 143 patients (8.8%, 95% confidence interval 7.4%-10.3%). Patients with PS were older, had lower body mass index, longer disease duration, higher disease stages, and poorer quality of life. Falls were more frequent in the PS group as well as occurrence of "veering gait" (i.e., the progressive deviation toward one side when patient walked forward and backward with eyes closed). Patients with PS received higher daily levodopa equivalent daily dose and were more likely to be treated with combination of levodopa and dopamine agonists. Osteoporosis and arthrosis were significantly the most frequent associated medical conditions in patients with PS. Multiple explanatory variable logistic regression models confirmed the association of PS with the following variables: Hoehn and Yahr stage, ongoing combined treatment with levodopa and dopamine agonist, associated medical conditions, and presence of veering gait. CONCLUSIONS Our results suggest that PS is a relatively frequent and often disabling complication in PD, especially in the advanced disease stages. The association is dependent on a number of potentially relevant demographic and clinical variables.
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Affiliation(s)
- Michele Tinazzi
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Alfonso Fasano
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Christian Geroin
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Francesca Morgante
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Roberto Ceravolo
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Simone Rossi
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Astrid Thomas
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Giovanni Fabbrini
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Annarita Bentivoglio
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Filippo Tamma
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Giovanni Cossu
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Nicola Modugno
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Mario Zappia
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Maria Antonietta Volontè
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Carlo Dallocchio
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Giovanni Abbruzzese
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Claudio Pacchetti
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Roberto Marconi
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Giovanni Defazio
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Margherita Canesi
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Antonino Cannas
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Antonio Pisani
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Rina Mirandola
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Paolo Barone
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
| | - Carmine Vitale
- From the Department of Neurological and Movement Sciences (M.T., C.G.) and Neuromotor and Cognitive Rehabilitation Research Centre (C.G.), University of Verona, Italy; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease (A.F.), Toronto Western Hospital and Division of Neurology, University of Toronto, Canada; Department of Clinical and Experimental Medicine (F.M.), University of Messina; Neurology Unit (R.C.), Department of Clinical and Experimental Medicine, University of Pisa; Department of Neurological and Neurosensorial Sciences (S.R.), Neurology and Neurophysiology Unit, University of Siena; Department of Neuroscience and Imaging (A.T.), University of Chieti-Pescara; Aging Research Center Ce.S.I. University Foundation (A.T.), Chieti Behavioural Neurology and Movement Disorders Unit; Department of Neurology and Psychiatry (G.F.), University of Rome Sapienza; IRCSS Neuromed Institute (G.F., N.M.), Pozzilli-Isernia; Department of Geriatrics, Neuroscience and Orthopedics (A.B.), Università Cattolica del Sacro Cuore, University Hospital Agostino Gemelli, Rome; Department of Neurology (F.T.), F. Miulli General Hospital, Acquaviva delle Fonti (BA); Department of Neurology (G.C.), AOB Brotzu, Cagliari; Department G.F. Ingrassia (M.Z.), Area of Neurosciences, University of Catania; Neurological Department and INSPE-Institute of Experimental Neurology (M.A.V.), University Hospital San Raffaele, Milan; Division of Neurology (C.D.), Civil Hospital Voghera (PV); Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (G.A.), University of Genova; U.O.C. Parkinson e Disordini del Movimento (C.P.), IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia; Neurology Unit (R. Marconi), Ospedale Misericordia, Grosseto; Department of Basic Medical Sciences (G.D.), Neuroscience and Sense Organs, University of Bari Aldo Moro; Parkinson Institute (M.C.), Istituti Clinici di Perfe
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Therapy-resistant symptoms in Parkinson’s disease. J Neural Transm (Vienna) 2015; 123:19-30. [DOI: 10.1007/s00702-015-1463-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/15/2015] [Indexed: 12/25/2022]
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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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Geroin C, Smania N, Schena F, Dimitrova E, Verzini E, Bombieri F, Nardello F, Tinazzi M, Gandolfi M. Does the Pisa syndrome affect postural control, balance, and gait in patients with Parkinson's disease? An observational cross-sectional study. Parkinsonism Relat Disord 2015; 21:736-41. [PMID: 25940999 DOI: 10.1016/j.parkreldis.2015.04.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/16/2015] [Accepted: 04/19/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION An altered sense of verticality, associated with impaired proprioception and somatosensory integration deficits, has been reported in patients with Parkinson's disease (PD) but it has not been characterized in patients with Pisa syndrome (PS). Therefore, we investigated postural control, balance, and gait disturbances in patients with PD and PS, patients with PD but without PS, and aged-matched normal controls. METHODS This observational cross-sectional study involved patients with PD and PS (n = 10, Hoehn & Yahr score <4), patients with PD but without PS (n = 10), and age-matched healthy controls (n = 10). The primary outcome measure was the velocity of CoP displacement (VEL_MED_AP/ML) assessed by static stabilometry in eyes open (EO) and eyes closed (EC) conditions. The secondary outcomes were other stabilometric parameters, the Sensory Organization Balance Test (SOT), and gait analysis (GA). RESULTS There were no significant differences in demographic and clinical data and Berg Balance Scale scores between the groups. There was a significant main effect in the VEL_MED_AP/ML between the groups and eye conditions (p = .016). A significant main effect was found in the EO (p = .01) and EC (p = .04) conditions. Post-hoc comparisons showed a significant increase in VEL_CoP in both the EO and EC conditions only in the patients with PD and PS. No significant main effects on SOT and GA were found. CONCLUSION Patients with PD and PS had more difficulty achieving good postural alignment with gravity and greater velocity of body sway than the other groups. Rehabilitation programs for patients with PD and PS should include spine alignment and dynamic postural training.
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Affiliation(s)
- Christian Geroin
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurological and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy.
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurological and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy; Neurological Rehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, P.le Scuro 10, 37134 Verona, Italy.
| | - Federico Schena
- School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Via Casorati 43, 37137 Verona, Italy.
| | - Eleonora Dimitrova
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurological and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy.
| | - Elisabetta Verzini
- School of Specialization in Physical Medicine and Rehabilitation, Department of Neurological and Movement Sciences, University of Verona, Italy.
| | - Federica Bombieri
- School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Via Casorati 43, 37137 Verona, Italy.
| | - Francesca Nardello
- School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Via Casorati 43, 37137 Verona, Italy.
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurological and Movement Sciences, University of Verona, P.le Scuro 10, 37134 Verona, Italy.
| | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurological and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy.
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Vasconcellos LF, Pedroso JL, Barsottini OGP. Machado-Joseph Disease Progressing to Truncal Dystonia. Mov Disord Clin Pract 2014; 1:364-365. [PMID: 30363908 DOI: 10.1002/mdc3.12052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 04/23/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Luiz Felipe Vasconcellos
- Instituto de Neurologia Universidade Federal do Rio de Janeiro and Hospital Federal dos Servidores do Estado Rio de Janeiro Brazil
| | - José Luiz Pedroso
- Ataxia Unit Department of Neurology Universidade Federal de São Paulo São Paulo Brazil
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Tassorelli C, De Icco R, Alfonsi E, Bartolo M, Serrao M, Avenali M, De Paoli I, Conte C, Pozzi N, Bramanti P, Nappi G, Sandrini G. Botulinum toxin type A potentiates the effect of neuromotor rehabilitation of Pisa syndrome in Parkinson disease: A placebo controlled study. Parkinsonism Relat Disord 2014; 20:1140-4. [DOI: 10.1016/j.parkreldis.2014.07.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/18/2014] [Accepted: 07/31/2014] [Indexed: 01/21/2023]
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Subjective visual vertical in Pisa syndrome. Parkinsonism Relat Disord 2014; 20:878-83. [DOI: 10.1016/j.parkreldis.2014.04.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 04/21/2014] [Accepted: 04/28/2014] [Indexed: 11/18/2022]
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