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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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St George RJ, Gurfinkel VS, Kraakevik J, Nutt JG, Horak FB. Case Studies in Neuroscience: A dissociation of balance and posture demonstrated by camptocormia. J Neurophysiol 2018; 119:33-38. [PMID: 28978769 DOI: 10.1152/jn.00582.2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Upright stance in humans requires an intricate exchange between the neural mechanisms that control balance and those that control posture; however, the distinction between these control systems is hard to discern in healthy subjects. By studying balance and postural control of a participant with camptocormia - an involuntary flexion of the trunk during standing that resolves when supine - a divergence between balance and postural control was revealed. A kinematic and kinetic investigation of standing and walking showed a stereotyped flexion of the upper body by almost 80° over a few minutes, and yet the participant's ability to control center of mass within the base of support and to compensate for external perturbations remained intact. This unique case also revealed the involvement of automatic, tonic control of the paraspinal muscles during standing and the effects of attention. Although strength was reduced and MRI showed a reduction in muscle mass, there was sufficient strength to maintain an upright posture under voluntary control and when using geste antagoniste maneuvers or "sensory tricks" from visual, auditory, and haptic biofeedback. Dual tasks that either increased or decreased the attention given to postural alignment would decrease or increase the postural flexion, respectively. The custom-made "twister" device that measured axial resistance to slow passive rotation revealed abnormalities in axial muscle tone distribution during standing. The results suggest that the disorder in this case was due to a disruption in the automatic, tonic drive to the postural muscles and that myogenic changes were secondary. NEW & NOTEWORTHY By studying an idiopathic camptocormia case with a detailed biomechanical and sensorimotor approach, we have demonstrated unique insights into the neural control of human bipedalism 1) balance and postural control cannot be considered the same neural process, as there is a stereotyped abnormal flexed posture, without balance deficits, associated with camptocormia, and 2) posture during standing is controlled by automatic axial tone but "sensory tricks" involving sensory biofeedback to direct voluntary attention to postural alignment can override, when required.
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Affiliation(s)
- R J St George
- Sensorimotor Neuroscience and Ageing, School of Medicine, University of Tasmania , Australia
| | - V S Gurfinkel
- Department of Neurology, Oregon Health & Science University , Portland, Oregon
| | - J Kraakevik
- Department of Neurology, Oregon Health & Science University , Portland, Oregon
| | - J G Nutt
- Department of Neurology, Oregon Health & Science University , Portland, Oregon
| | - F B Horak
- Department of Neurology, Oregon Health & Science University , Portland, Oregon.,VA Health Care System, Portland, Oregon
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Margraf N, Wrede A, Deuschl G, Schulz-Schaeffer W. Pathophysiological Concepts and Treatment of Camptocormia. JOURNAL OF PARKINSON'S DISEASE 2016; 6:485-501. [PMID: 27314757 PMCID: PMC5008234 DOI: 10.3233/jpd-160836] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 12/12/2022]
Abstract
Camptocormia is a disabling pathological, non-fixed, forward bending of the trunk. The clinical definition using only the bending angle is insufficient; it should include the subjectively perceived inability to stand upright, occurrence of back pain, typical individual complaints, and need for walking aids and compensatory signs (e.g. back-swept wing sign). Due to the heterogeneous etiologies of camptocormia a broad diagnostic approach is necessary. Camptocormia is most frequently encountered in movement disorders (PD and dystonia) and muscles diseases (myositis and myopathy, mainly facio-scapulo-humeral muscular dystrophy (FSHD)). The main diagnostic aim is to discover the etiology by looking for signs of the underlying disease in the neurological examination, EMG, muscle MRI and possibly biopsy. PD and probably myositic camptocormia can be divided into an acute and a chronic stage according to the duration of camptocormia and the findings in the short time inversion recovery (STIR) and T1 sequences of paravertebral muscle MRI. There is no established treatment of camptocormia resulting from any etiology. Case series suggest that deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) is effective in the acute but not the chronic stage of PD camptocormia. In chronic stages with degenerated muscles, treatment options are limited to orthoses, walking aids, physiotherapy and pain therapy. In acute myositic camptocormia an escalation strategy with different immunosuppressive drugs is recommended. In dystonic camptocormia, as in dystonia in general, case reports have shown botulinum toxin and DBS of the globus pallidus internus (GPi-DBS) to be effective. Camptocormia in connection with primary myopathies should be treated according to the underlying illness.
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Affiliation(s)
- N.G. Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - A. Wrede
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - G. Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Reese R, Knudsen K, Falk D, Mehdorn HM, Deuschl G, Volkmann J. Motor outcome of dystonic camptocormia treated with pallidal neurostimulation. Parkinsonism Relat Disord 2013; 20:176-9. [PMID: 24268100 DOI: 10.1016/j.parkreldis.2013.10.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/20/2013] [Accepted: 10/23/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Deep brain stimulation of the internal pallidum (GPi-DBS) is effective for various types of drug-refractory primary dystonias. Rare clinical forms as dystonic camptocormia may profit but available data are scarce. METHODS We here report on a retrospective clinical assessment of three patients with primary dystonic camptocormia treated with GPi-DBS. RESULTS All three patients showed marked response to bilateral GPi-DBS within days to weeks after surgery which was preserved in the long-term (38-45 months after implantation: mean improvement 82% as rated on the Burke Fahn Marsden Dystonia Rating Scale, 89% in the subitem "trunk"). Two patients developed mild stimulation induced speech problems (stuttering or dysarthria) which resolved with reprogramming or were acceptable in return for the control of dystonic symptoms. CONCLUSIONS The diagnosis and treatment of camptocormia will continue to require expert knowledge in movement and neuromuscular disorders, but DBS may expand treatment options in this difficult patient population.
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Affiliation(s)
- René Reese
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany; Department of Neurology, Julius-Maximilians-University, Würzburg, Germany
| | - Karina Knudsen
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Daniela Falk
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - H Maximilian Mehdorn
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
| | - Jens Volkmann
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany; Department of Neurology, Julius-Maximilians-University, Würzburg, Germany
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Abstract
In this society with an ever increasing number of the elderly there is an increasing number of causes of a bent spine syndrome (camptocormia/dropped head syndrome). The causes include neurological, neuro-orthopedic, rheumatological and psychiatric disorders. Parkinson's disease, dystonia and neuromuscular diseases (motor neuron disease, myositis and muscular dystrophy) with weakness of the axial muscles may result in bent spine syndrome and is often combined with a dropped head. Disc herniation, hypertrophic spondylosis or pseudospondylolisthesis with spinal narrowing may lead to an abnormal flexion of the trunk. Ankylosing spondylitis can produce a disabling bent spine syndrome. Camptocormia may also be mimicked by osteoporotic fractures of the vertebral bones with wedge-shaped vertebrae. In some cases camptocormia is related to a psychogenic disorder.
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Affiliation(s)
- F X Glocker
- Neurologische Universitätsklinik Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland.
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6
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Hagenacker T, Gerwig M, Gasser T, Miller D, Kastrup O, Jokisch D, Sure U, Frings M. Pallidal deep brain stimulation relieves camptocormia in primary dystonia. J Neurol 2013; 260:1833-7. [PMID: 23483215 DOI: 10.1007/s00415-013-6885-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/15/2013] [Accepted: 02/25/2013] [Indexed: 11/30/2022]
Abstract
Camptocormia, characterised by a forward flexion of the thoracolumbar spine may occur in various movement disorders, mainly in Parkinson's disease or in primary dystonia. In severe cases, patients with camptocormia are unable to walk. While treatment options are limited, deep brain stimulation (DBS) with bilateral stimulation of the subthalamic nucleus or globus pallidus internus (GPi) has been proposed as a therapeutic option in refractory cases of Parkinson's disease. Here we present two patients with severe camptocormia as an isolated form of dystonia and as part of generalised dystonia, respectively, which were both treated with bilateral stimulation of the GPi. Symptoms of dystonia were assessed using the Burke-Fahn-Marsden dystonia rating scale (BFM) before and during deep brain stimulation. In both patients there was a significant functional improvement following long-term bilateral GPi stimulation and both patients gained ability to walk. In the first patient with an isolated dystonic camptocormia the BFM motor subscore for the truncal flexion improved by 75 %. The total BFM motor score in the second patient with a camptocormia in generalised dystonia improved by 45 %, while the BFM score for truncal flexion improved by 87 %. In both patients the effect of the bilateral GPi stimulation on camptocormia was substantial, independent of generalisation of dystonia. Therefore, GPi DBS is a possible treatment option for this rare disease.
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Affiliation(s)
- Tim Hagenacker
- Department of Neurology, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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7
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Thani NB, Bala A, Kimber TE, Lind CRP. High-frequency pallidal stimulation for camptocormia in Parkinson disease: case report. Neurosurgery 2012; 68:E1501-5. [PMID: 21307785 DOI: 10.1227/neu.0b013e318210c859] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Camptocormia is characterized by abnormal flexion of the thoracolumbar spine that increases during upright posture and abates in the recumbent position and has been reported to occur in patients with Parkinson disease. Camptocormia causes significant spinal and abdominal pain, impairment of balance, and social stigma. CLINICAL PRESENTATION A 57-year-old woman with Parkinson disease developed severe camptocormia, which did not improve with trials of antiparkinsonian and muscle relaxant medications. The patient was successfully treated with bilateral globus pallidus interna deep brain stimulation surgery under general anesthesia. High-frequency neuromodulation afforded relief of camptocormia and improvement in Parkinson disease symptoms. CONCLUSION Camptocormia in Parkinson disease may represent a form of dystonia and can be treated effectively with chronic pallidal neuromodulation.
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Affiliation(s)
- Nova B Thani
- West Australian Neurosurgical Service, Sir Charles Gairdner Hospital, Perth, Australia
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8
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Ponfick M, Gdynia HJ, Ludolph AC, Kassubek J. Camptocormia in Parkinson’s Disease: A Review of the Literature. NEURODEGENER DIS 2011; 8:283-8. [DOI: 10.1159/000324372] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 01/13/2011] [Indexed: 12/16/2022] Open
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9
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Lenoir T, Guedj N, Boulu P, Guigui P, Benoist M. Camptocormia: the bent spine syndrome, an update. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:1229-37. [PMID: 20300781 DOI: 10.1007/s00586-010-1370-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 02/15/2010] [Accepted: 03/04/2010] [Indexed: 12/22/2022]
Abstract
Camptocormia, also referred to as bent spine syndrome (BSS) is defined as an abnormal flexion of the trunk, appearing in standing position, increasing during walking and abating in supine position. BSS was initially considered, especially in wartime, as a psychogenic disorder. It is now recognized that in addition to psychiatric syndromes, many cases of reducible BSS have a somatic origin related to a number of musculo-skeletal or neurological disorders. The majority of BSS of muscular origin is related to a primary idiopathic axial myopathy of late onset, appearing progressively in elderly patients. Diagnosis of axial myopathy first described by Laroche et al. is based upon CT/MRI examination demonstrating massive fatty infiltration of paravertebral muscles. The non-specific histological aspect includes an extensive endomysial fibrosis and fat tissue with irregular degenerated fibers. Weakness of the paravertebral muscles can be secondary to a wide variety of diseases generating diffuse pathologic changes in the muscular tissue. BSS can be the predominant and sometimes revealing symptom of a more generalized muscular disorder. Causes of secondary BSS are numerous. They must be carefully assessed and ruled out before considering the diagnosis of primary axial myopathy. The principal etiologies include on the one hand inflammatory myopathies, muscular dystrophies of late onset, myotonic myopathies, endocrine and metabolic myopathies, and on the other hand neurological disorders, principally Parkinson's disease. Camptocormia in Parkinsonism is caused by axial dystonia, which is the hallmark of Parkinson's disease. There is no specific pharmacologic treatment for primary axial myopathy. General activity, walking with a cane, physiotherapy, and exercises should be encouraged. Treatment of secondary forms of BSS is dependent upon the variety of the disorder generating the muscular pathology. Pharmacologic and general management of camptocormia in Parkinson's disease merge with that of Parkinsonism. Levodopa treatment, usually active on tumor rigidity and akinesia, has poor or negative effect on BSS.
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Affiliation(s)
- Thibaut Lenoir
- Department of Orthopaedic Surgery, Hôpital Beaujon, Clichy, France
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10
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von Coelln R, Raible A, Gasser T, Asmus F. Ultrasound-guided injection of the iliopsoas muscle with botulinum toxin in camptocormia. Mov Disord 2008; 23:889-92. [PMID: 18307265 DOI: 10.1002/mds.21967] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Camptocormia is characterized by an abnormal posture of the trunk with pronounced flexion of the thoraco-lumbar spine during standing and walking, which abates in a supine position. Treatment options for camptocormia are limited and mostly futile. Here, we report on the ultrasound-guided ventral injection of botulinum toxin A (BTX) into deep portions of the iliopsoas muscle in four parkinsonian patients with camptocormia as chief complaint. Using this novel and safe application technique, all patients received 500-1,500 MU of BTX per side in 4-6 month intervals. Treatment was generally well tolerated. At the highest dose, all patients complained of mild weakness of hip flexion. Standardized physical exam at follow-up visits, as well as self-assessment of patients, failed to show a relevant and lasting improvement of posture. In conclusion, injection of BTX into the iliopsoas does not appear to be a promising approach for the treatment of parkinsonism-associated camptocormia.
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Affiliation(s)
- Rainer von Coelln
- Department for Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
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Affiliation(s)
- Samuel Katsuyuki Shinjo
- Serviço de Reumatologia, Faculdade de Medicina da Universidade de São Paulo – São Paulo. Brazil.
| | | | - Ari Stiel Radu
- Serviço de Reumatologia, Faculdade de Medicina da Universidade de São Paulo – São Paulo. Brazil.
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12
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Abstract
Camptocormia describes a severe forward-flexion at the waist. Originally used in reference to a conversion disorder seen in military personel (Souques and Rosanoff-Saloff, Rev Neurol 1915, 22, 937; Rosen and Frymoyer, Spine 1985, 10, 325; Miller and Forbes, Br J Psychiatry 1990, 157, 765; Perez-Sales, Arch Phys Med Rehabil 1990, 71, 1078; Sinel and Eisenberg, Rev Rhum Mal Osteoartic 1992, 59, 169; Miller and Forbes, Mil Med 1990, 155, 561; Belgrano and Giordano, Rev Neurol 1947, 79, 25-35), the term has been adapted to describe severely flexed postures observed in Parkinson disease (Djaldetti et al., Mov Disord 1999, 14, 443), other basal ganglia disorders (Nieves et al., Mov Disord 2001, 16, 177; Reichel et al., Nervenarzt 2001, 72, 281), and muscular disease (Delcey et al., Rev Med Intern 2002, 23, 144; Van Gerpen, Mov Disord 2001, 16, 358). Although rare, psychogenic camptocormia is seen in civilian populations, presenting diagnostic challenges. We describe a patient whose initial history and examination suggested a psychogenic etiology for his camptocormic posture. A multidisciplinary approach elucidated the patient's motivations and emotional state, and has been helpful in management of this patient.
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Affiliation(s)
- Frank Skidmore
- Department of Neurology, University of Florida, Gainesville, Florida 32605, USA.
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Bonneville F, Bloch F, Kurys E, du Montcel ST, Welter ML, Bonnet AM, Agid Y, Dormont D, Houeto JL. Camptocormia and Parkinson's disease: MR imaging. Eur Radiol 2008; 18:1710-9. [PMID: 18351343 DOI: 10.1007/s00330-008-0927-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Revised: 01/08/2008] [Accepted: 02/16/2008] [Indexed: 11/26/2022]
Abstract
Camptocormia is characterized by an excessive anterior flexion of the spine that appears only when standing or walking. The origin of this symptom remains unknown, but recent clinical reports of camptocormia associated with Parkinson's disease (PD) suggest cerebral involvement in the pathogenesis of camptocormia. This study was undertaken to investigate the hypothesis that camptocormia in PD has a central origin. Seventeen PD patients with camptocormia were prospectively enrolled and were compared to 10 matched PD patients without camptocormia and 12 normal controls. The normalized volumes of the brain, striatal nuclei, and the cross-sectional areas of the midbrain and pons were measured on three-dimensional magnetic resonance imaging. Data were correlated with the severity of the symptoms. The normalized axial surface of the midbrain was statistically smaller in PD patients with camptocormia than in normal controls (P = 0.01). The normalized volumetric data were not statistically different in PD patients with camptocormia. There was a significant negative correlation between the severity of camptocormia and the normalized brain volume (P < 0.009; R = -0.649) and sagittal pons area (P < 0.01; R = -0.642). The results suggest that PD with camptocormia may represent a selective form of PD in which a specific neuronal dysfunction possibly occurs within the brainstem.
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Affiliation(s)
- Fabrice Bonneville
- Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
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Ozer F, Ozturk O, Meral H, Serdaroglu P, Yayla V. Camptocormia in a Patient with Parkinson Disease and a Myopathy with Nemaline Rods. Am J Phys Med Rehabil 2007; 86:3-6. [PMID: 17304682 DOI: 10.1097/phm.0b013e31802b8bde] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Camptocormia, also referred to as bent spine, is a gait disorder characterized by hyperflexion of the thoracolumbar spine that develops in recumbent position while walking and that disappears in supine position. Myopathy is one of the frequent causes of camptocormia. A 77-yr-old male patient who was followed up with the diagnosis of rheumatoid arthritis for 2 yrs was admitted with progressive gait deterioration. Hyperflexion of trunk, disappearing in supine position, was detected and diagnosed as camptocormia. He also exhibited the signs of parkinsonism. A paraspinal muscle biopsy showed myopathy with rods in many muscle fibers. Camptocormia in this patient may be attributable to the myopathic weakness of thoracolumbar paraspinal muscles. The normal biceps brachii muscle biopsy refers to the isolated affection of paraspinal muscles in this patient. A camptocormia (bent spine) case of myopathy with nemaline rods associated with Parkinson disease is presented.
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Affiliation(s)
- Feriha Ozer
- Department of Neurology, Haseki Educational and Research Hospital, Istanbul, Turkey
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Bouzgarou E, Dupeyron A, Castelnovo G, Boudousq V, Collombier L, Labauge P, Pélissier J. [Camptocormia disclosing Parkinson's disease]. ACTA ACUST UNITED AC 2006; 50:55-9. [PMID: 17027115 DOI: 10.1016/j.annrmp.2006.07.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 07/26/2006] [Indexed: 11/25/2022]
Abstract
Camptocormia is characterised as an extreme bent-forward posture of the trunk that disappears in the recumbent position. On X-ray, trunk flexion appears without vertebral rotation as in scoliosis. The condition is a well-known complication of Parkinson's disease (PD) at the late stage. The authors present the case of a 77-year-old woman affected by severe camptocormia, which appeared and worsened in less than 6 months and hindered gait. Despite no signs of PD, neuro-imaging (DAT-Scan) showed an L-Dopa transducer decrease in putamens. A few weeks later, bradykinesia appeared and the clinical diagnosis of PD became more obvious. L-Dopa improved bradykinesia but did not change the bent-spine posture. A 1-year follow-up showed no other signs of PD other than bradykinesia, but the camptocormia was unchanged.
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Affiliation(s)
- E Bouzgarou
- Département de MPR, groupe hospitalier Carémeau, 30029 Nîmes cedex 04, France
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Diederich NJ, Goebel HH, Dooms G, Bumb A, Huber F, Kompoliti K, Meinck HMM. Camptocormia associated with focal myositis in multiple-system atrophy. Mov Disord 2006; 21:390-4. [PMID: 16211611 DOI: 10.1002/mds.20686] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Camptocormia (CC) or pronounced forward flexion of the trunk is a common symptom of Parkinson's disease. We describe 2 patients with probable, respectively possible multiple-system atrophy and CC. Magnetic resonance imaging of the erector trunci showed focal patchy hyperintensities with gadolinium enhancement and muscle biopsy was indicative of variably pronounced focal myositis. CC was progressive and the major handicap for both patients after 1 and 1.5 years of follow-up, respectively. The therapeutic response was poor. Similarities with the dropped-head syndrome suggest that the muscle pathology may be either the primary cause of CC, a focal reaction to the CC posture, or a coincident syndrome of old age.
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Affiliation(s)
- Nico J Diederich
- Department of Neuroscience, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
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Yamada K, Goto S, Matsuzaki K, Tamura T, Murase N, Shimazu H, Nagahiro S, Kuratsu JI, Kaji R. Alleviation of camptocormia by bilateral subthalamic nucleus stimulation in a patient with Parkinson's disease. Parkinsonism Relat Disord 2006; 12:372-5. [PMID: 16731023 DOI: 10.1016/j.parkreldis.2006.02.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Revised: 02/08/2006] [Accepted: 02/08/2006] [Indexed: 11/25/2022]
Abstract
Camptocormia, known also as "bent spine syndrome", is characterized by involuntary truncal flexion of the thoraco-lumbar spine that appears in the sitting or standing position. Although Parkinson's disease (PD) is the most frequent etiologic factor, this postural disorder responds poorly to levodopa or other medications. We report a PD patient in whom chronic bilateral subthalamic nucleus stimulation produced a striking alleviation of camptocormia.
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Affiliation(s)
- Kazumichi Yamada
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto 860-8556, Japan.
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Haig AJ, Tong HC, Kendall R. The bent spine syndrome: myopathy + biomechanics = symptoms. Spine J 2006; 6:190-4. [PMID: 16517392 DOI: 10.1016/j.spinee.2005.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Revised: 06/07/2005] [Accepted: 08/06/2005] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The bent spine syndrome, which mimics spinal stenosis, is thought to be a focal paraspinal myopathy, but because paraspinal fatigue with ambulation is not a feature of more severe myopathies, the cause of symptoms is not clear. PURPOSE To evaluate electromyographic and biomechanical aspects of the bent spine syndrome. STUDY DESIGN/SETTING University spine clinic. METHODS A patient with severe disability from the bent spine syndrome was compared with a fortuitously discovered asymptomatic research subject with the syndrome, in terms of physical examination, magnetic resonance imaging, and electrodiagnostic testing. RESULTS Both subjects had fatty paraspinal replacement on magnetic resonance imaging and electromyography. More detailed electromyography of the patient showed abnormalities medially and caudally, but changes including apparent myopathic motor units up to the high thoracic region. The research subject had no hip flexion contracture, whereas the patient had severe contracture. Correction of contracture increased ambulation from 20 to 300 meters. CONCLUSIONS Bent spine syndrome is likely a paraspinal myopathy, but symptoms do not occur unless there is also a hip flexion contracture.
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Affiliation(s)
- Andrew J Haig
- The Spine Program, The University of Michigan, 325 E. Eisenhower, Ann Arbor, 48108, USA.
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Micheli F, Cersósimo MG, Piedimonte F. Camptocormia in a patient with Parkinson disease: beneficial effects of pallidal deep brain stimulation. Case report. J Neurosurg 2006; 103:1081-3. [PMID: 16381196 DOI: 10.3171/jns.2005.103.6.1081] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Camptocormia is a well-known feature in cases of Parkinson disease (PD), and is usually unresponsive to dopaminergic therapy. A 62-year old man with a long history of PD and severe progressive camptocormia underwent bilateral pallidal stimulation. During the next 6 months a sustained improvement in trunk flexion was observed. After 14 months of follow up, the patient's trunk flexion is almost normal.
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Affiliation(s)
- Federico Micheli
- Parkinson's Disease and Movement Disorders Unit, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina.
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Charpentier P, Dauphin A, Stojkovic T, Cotten A, Hurtevent JF, Maurage CA, Thévenon A, Destée A, Defebvre L. [Parkinson's disease, progressive lumbar kyphosis and focal paraspinal myositis]. Rev Neurol (Paris) 2005; 161:459-63. [PMID: 15924083 DOI: 10.1016/s0035-3787(05)85077-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The camptocormia (bent spine) is characterized by a severe forward flexion of the thoracolumbar spine which disappears in the supine position. Clinical case. We describe a typical case observed in a parkinsonian patient. The MRI, electromyogram and biopsy of the paraspinal muscles revealed a typical myositis pattern. DISCUSSION This case, the sixth published to our knowledge, confirms that focal myositis is associated with the camptocormia in Parkinson's disease. Typically it is observed in male subjects, appearing 4 to 6 years after the onset of Parkinson's disease, in fluctuating patients treated by an association of L-Dopa and agonist. It appears quickly and becomes the most important symptom. Antiparkinsonian drugs are useless. CONCLUSION This exceptional picture raises original pathophysiological and therapeutic questions. Systematic studies should be performed in order to detail the pathophysiological link between these 3 entities: Parkinson's disease, focal myositis and camptocormia.
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Affiliation(s)
- P Charpentier
- Clinique Neurologique, Centre Hospitalier Régional et Universitaire, Lille
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Sławek J, Derejko M, Lass P, Dubaniewicz M. Camptocormia or Pisa syndrome in multiple system atrophy. Clin Neurol Neurosurg 2005; 108:699-704. [PMID: 16112411 DOI: 10.1016/j.clineuro.2005.07.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Accepted: 07/08/2005] [Indexed: 11/30/2022]
Abstract
Although a mild stooped posture is a hallmark of parkinsonism, extreme trunk forward flexion is not common. This phenomenon was described in different etiological entities and called camptocormia. Other similar presentations called Pisa syndrome and antecollis were described mainly in extrapyramidal disorders. Authors present two cases of probable multiple system atrophy (MSA) with predominant parkinsonism and Pisa syndrome (or camptocormia). Both of them were previously misdiagnosed as idiopathic Parkinson's disease (PD) and one was reported 1 year earlier. The typical clinical presentation fulfilling the diagnostic criteria for multiple system atrophy, rapid progression with lack of responsiveness to L-DOPA and apomorphine and typical MRI putaminal pathology observed in both cases allowed us to make a diagnosis. Accuracy of clinical diagnosis in multiple system atrophy is still very poor. Therefore, unusual or rare clinical presentations may support the final diagnosis. The camptocormia, Pisa syndrome and antecollis may represent the continuum of the same motor phenomenon and most of the authors refer them to unusual form of axial dystonia. According to many clinical presentations on different forms of camptocormia/Pisa syndrome authors conclude that not etiology, but the localization of specific lesion, probably within putamen is responsible for that form of dystonia. In cases of parkinsonism and severe forward flexion of trunk multiple system atrophy, diagnosis should be considered.
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Affiliation(s)
- Jarosław Sławek
- Department of Neurosurgery, Division of Functional Neurosurgery and Movement Disorders, Medical University, ul. Debinki 7, 80-211 Gdańsk, Poland.
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Skidmore F, Mikolenko I, Weiss H, Weiner W. Camptocormia in a patient with multiple system atrophy. Mov Disord 2005; 20:1063-4. [PMID: 15986475 DOI: 10.1002/mds.20521] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The term "camptocormia" describes a severe forward-flexed posture. Although initially used to describe a conversion disorder, early authors also recognized organic camptocormia occurring in old age, or "camptocormie senile," as well as traumatic and arthritic camptocormia. More recently, camptocormia has been described in patients with Parkinson's disease and in an individual with parkinsonism. We describe a case of progressive camptocormia as part of the initial presentation of a patient with multiple system atrophy.
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Affiliation(s)
- Frank Skidmore
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Nandi D, Parkin S, Scott R, Winter JL, Joint C, Gregory R, Stein J, Aziz TZ. Camptocormia treated with bilateral pallidal stimulation. J Neurosurg 2002; 97:461-6. [PMID: 12186477 DOI: 10.3171/jns.2002.97.2.0461] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report the neurological, neurophysiological, and neuropsychological effects of using long-term bilateral pallidal high-frequency deep brain stimulation (DBS) in a case of disabling camptocormia. Deep brain stimulation electrodes were implanted stereotactically to target the globus pallidus internus (GPi) bilaterally. Local field potentials (FPs) were recorded using the DBS electrodes and concurrent abdominal flexor electromyography (EMG) potentials during camptocormic episodes. Videotaped assessments of the movement disorder and neuropsychological evaluations of the patient before implantation and 6 months after initiation of pallidal stimulation were recorded. There was significant functional improvement following long-term pallidal stimulation, and some improvement was noted in neuropsychological scores. A temporal correlation between the GPi FPs and EMG-recorded rectus abdominis potentials was evident. There were no treatment-related adverse effects. The authors have found that long-term pallidal stimulation was safe and offered functional benefit to a patient with this severely disabling condition. The physiological studies may help further the understanding of the pathophysiology of this rare entity.
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Affiliation(s)
- Dipankar Nandi
- University Laboratory of Physiology, University of Oxford, United Kingdom
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Nandi D, Parkin S, Scott R, Winter JL, Joint C, Gregory R, Stein J, Aziz TZ. Camptocormia treated with bilateral pallidal stimulation. Neurosurg Focus 2002; 12:ECP2. [PMID: 16212321 DOI: 10.3171/foc.2002.12.2.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report the neurological, neurophysiological, and neuropsychological effects of using chronic bilateral pallidal high-frequency deep brain stimulation (DBS) in a case of disabling camptocormia.
Deep brain stimulation electrodes were implanted stereotactically to target the globus pallidus internus (GPi) bilaterally. Local field potentials (FPs) were recorded using the DBS electrodes and concurrent abdominal flexor elec-tromyography (EMG) potentials during camptocormic episodes. Videotaped assessments of the movement disorder and neuropsychological evaluation before implantation and at 6 months after initiation of pallidal stimulation were recorded.
There was significant functional improvement following chronic pallidal stimulation, and some improvement was noted in neuropsychological scores. The GPi FPs showed temporal correlation with EMG-recorded rectus abdominis potentials. There were no treatment-related adverse effects.
The authors have found that chronic pallidal stimulation was safe and offered functional benefit in this severely disabling condition. The physiological studies may help further the understanding of the pathophysiology of this rare entity.
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Affiliation(s)
- Dipankar Nandi
- Laboratory of Physiology, University of Oxford, Oxford, United Kingdom
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