1
|
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.
Collapse
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
| | | |
Collapse
|
2
|
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
| |
Collapse
|
3
|
Liu W, Wu J, Zhang N, Chen G, Li J, Shen Y, Li F. Postural deformities in Parkinson's disease: A bibliometric analysis based on web of science. Heliyon 2023; 9:e14251. [PMID: 36938404 PMCID: PMC10015243 DOI: 10.1016/j.heliyon.2023.e14251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/29/2022] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Objective Postural deformities are common debilitating conditions during the progression of Parkinson's disease (PD). However, the underlying pathophysiology and optimal treatment strategy are unclear. In this study, we aimed to identify primary research fields, important achievements and emerging trends in postural deformities in PD. Methods Web of Science Core Collection database was searched to retrieve all literature related to postural deformities in PD over the past 20 years. Data such as annual numbers of publications, countries of origin, publication journals, cooperation between countries, citation index and keywords were retrieved from the selected publications. Bibliometrix Package in R software were used for bibliometric analysis and visualization. Results In total, 211 publications that met the criteria were collected. Analyses had shown that the annual numbers of publications increased gradually with fluctuations. Japan was the most prolific country (n = 59). Italy participated in international cooperation the most frequently. Parkinsonism & related disorders (n = 25) took a prominent lead among all journals, and the most productive institution in this area was University of Verona (n = 27). The most local cited author was Tinazzi Michele. According to the thematic map, "scoliosis", "fusion", and "balance" have rapidly become research hot spots in related fields. Conclusions Articles pertaining to postural deformities in PD are still being published, in which the etiology is a combination of peripheral plus central involvement. Treatment approaches include rehabilitative exercises, oral medication, botulinum toxin injection, deep brain stimulation and spine surgery, which is getting current attention and would be a hot topic of future research.
Collapse
Affiliation(s)
- Wangmi Liu
- Department of Orthopedics, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jiayan Wu
- Department of Neurology, Chongming Branch, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 66 East Xiangyang Road, Chongming, Shanghai, China
| | - Ning Zhang
- Department of Orthopedics, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Gang Chen
- Department of Orthopedics, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Li
- Department of Orthopedics, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yuanqing Shen
- Department of Orthopedics, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fangcai Li
- Department of Orthopedics, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
4
|
Al-Wardat M, Geroin C, Schirinzi T, Etoom M, Tinazzi M, Pisani A, Natoli S. Axial postural abnormalities and pain in Parkinson's disease. J Neural Transm (Vienna) 2023; 130:77-85. [PMID: 36550202 DOI: 10.1007/s00702-022-02576-4] [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: 11/16/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Axial postural abnormalities and pain are two main determinants of poor quality of life in patients with Parkinson's disease (PD). Indeed, a detailed characterization of pain and other non-motor symptoms in patients with PAs has not been provided yet. The aim of this study is to assess the phenomenology of pain and other non-motor symptoms in PD patients with Pisa syndrome and camptocormia compared to PD patients without axial postural abnormality. Forty-five PD participants were equally distributed in three groups: patients with Pisa syndrome (PS), patients with Camptocormia (CC), and patients without postural abnormalities (PD). Pain characteristics were assessed by Kings Parkinson's Pain Scale (KPPS), brief pain inventory (BPI), and numeric pain rating scale (NRS). All participants completed clinical assessments by non-motor symptom scale (NMSS), and movement disorder society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) parts II-III. Patients with and without axial postural abnormalities showed one or more types of pain, being fluctuation, nocturnal, chronic, and musculoskeletal the most frequently reported in Pisa Syndrome and camptocormia. PD group compared with PS and CC groups showed differences in the KPPS, NMSS, BPI pain severity and interference, and NRS total scores. No significant differences were found between PS group compared with CC group with exception of the NMSS total scores. PD patients with Pisa syndrome or camptocormia have a higher burden of musculoskeletal, chronic and fluctuation pain than PD patients without axial postural abnormalities, suggesting different etiologies of pain and possible different treatments.
Collapse
Affiliation(s)
- Mohammad Al-Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Mohammad Etoom
- Physical Therapy Division, Allied Medical Sciences Department, Aqaba University of Technology, Aqaba, Jordan
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Antonio Pisani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Fondazione Mondino, Pavia, Italy
| | - Silvia Natoli
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- IRCCS Maugeri Pavia, Pavia, Italy
| |
Collapse
|
5
|
Lu WJ, Fan JQ, Yan MY, Mukaeda K, Zhuang LX, Wang LL. Effect of electroacupuncture for Pisa syndrome in Parkinson’s disease: A case report. World J Clin Cases 2022; 10:11023-11030. [PMID: 36338234 PMCID: PMC9631139 DOI: 10.12998/wjcc.v10.i30.11023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/15/2022] [Accepted: 09/16/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pisa syndrome (PS) refers to marked lateral flexion of the trunk with a Cobb angle greater than 10°, which is typically mobile and can be resolved by lying down. PS is one of the most common postural deformities secondary to Parkinson’s disease (PD) and can aggravate scoliosis in the advanced stages of PD.
CASE SUMMARY Here, we present the case of a 53-year-old woman who presented with lateral curvature for 6 mo. Full spine X-ray films in the correct position showed that the thoracolumbar spine was bent to the right without any rotation of the vertebrae. The patient was diagnosed with Pisa syndrome. After receiving a month’s treatment with electroacupuncture, the Cobb angle decreased from 18.14° to 13.41°.
CONCLUSION This case demonstrates that electroacupuncture can effectively improve Pisa syndrome secondary to PD with few side effects and a low risk of recurrence. Additionally, early accurate diagnosis and timely intervention are meaningful for the prognosis of PS.
Collapse
Affiliation(s)
- Wei-Jing Lu
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Jing-Qi Fan
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Ming-Yue Yan
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Keiko Mukaeda
- International College, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
| | - Li-Xing Zhuang
- The Parkinson's Clinic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Li-Li Wang
- The Parkinson's Clinic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Standardized Biomechanical Investigation of Posture and Gait in Pisa Syndrome Disease. Symmetry (Basel) 2021. [DOI: 10.3390/sym13122237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Pisa syndrome is one of the possible postural deformities associated with Parkinson’s disease and it is clinically defined as a sustained lateral bending of the trunk. Some previous studies proposed clinical and biomechanical investigation to understand the pathophysiological mechanisms that occur, mainly focusing on EMG patterns and clinics. The current research deals with the assessment of a standardized biomechanical analysis to investigate the Pisa syndrome postural effects. Eight patients participated in the experimental test. Both static posture and gait trials were performed. An optoelectronic system and two force plates were used for data acquisition, while a custom multi-segments kinematic model of the human spine was used to evaluate the 3D angles. All subjects showed an important flexion of the trunk superior segment with respect to the inferior one, with a strong variability among patients (range values between 4.3° and 41.0°). Kinematics, ground reaction forces and spatio-temporal parameters are influenced by the asymmetrical trunk posture. Moreover, different proprioception, compensation and abilities of correction were depicted among subjects. Considering the forces exchanged by the feet with the floor during standing, results highlighted a significant asymmetry (p-value = 0.02) between the omo and contralateral side in a normal static posture, with greater load distribution on the same side of lateral deviation. When asked to self-correct the posture, all patients demonstrated a reduction of asymmetry, but without stressing any statistical significance. All these aspects might be crucial for the definition of a PS patients’ classification and for the assessment of the efficacy of treatments and rehabilitation.
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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]
|
11
|
Yao MS, Zhou LC, Tan YY, Jiang H, Chen ZC, Zhu L, Luo ND, Wu QZ, Kang WY, Liu J. Gait Characteristics and Brain Activity in Parkinson's Disease with Concomitant Postural Abnormalities. Aging Dis 2020; 11:791-800. [PMID: 32765946 PMCID: PMC7390521 DOI: 10.14336/ad.2019.0929] [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: 06/22/2019] [Accepted: 09/29/2019] [Indexed: 11/02/2022] Open
Abstract
To explore the underlying pathogenic mechanism of Parkinson's disease (PD) with concomitant postural abnormalities (PDPA) through the relationship between its gait and brain function characteristics. PD patients from the neurology outpatient clinic at Ruijin Hospital were recruited and grouped according to whether postural abnormalities (including camptocormia and Pisa syndrome) were present. PD-related scale assessments, three-dimensional gait tests and brain resting-state functional magnetic imaging were performed and analyzed. The gait characteristics independently associated with PDPA were decreased pelvic obliquity angle and progressive downward movement of the center of mass during walking. PDPA features included decreased functional connectivity between the left insula and bilateral supplementary motor area, which was significantly correlated with reduced Berg Balance Scale scores. Functional connectivity between the right insula and bilateral middle frontal gyrus was decreased and significantly correlated with a decreased pelvic obliquity angle and poor performance on the Timed Up and Go test. Moreover, through diffusion tensor imaging analysis, the average fractional anisotropy value of the fibers connecting the left insula and left supplementary motor area was shown to be decreased in PDPA. There is decreased functional connectivity among the insula, supplementary motor area and middle frontal gyrus with structural abnormalities between the left insula and the left supplementary motor area; these changes in brain connectivity are probably among the causes of gait dysfunction in PDPA and provide some clues regarding the pathogenic mechanisms of PDPA.
Collapse
Affiliation(s)
- Meng-sha Yao
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Li-che Zhou
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yu-yan Tan
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Hong Jiang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zhi-chun Chen
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Lin Zhu
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ning-di Luo
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Quan-zhou Wu
- State Key Laboratory of ISN, School of Computer Science and Technology, Xidian University, Xi'an, Shanxi Province, China.
| | - Wen-yan Kang
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Department of Neurology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jun Liu
- Department of Neurology & Collaborative Innovation Center for Brain Science, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
12
|
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.
Collapse
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.)
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
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.
Collapse
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.
| |
Collapse
|
15
|
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]
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Management of Pisa syndrome with lateralized subthalamic stimulation. J Neurol 2018; 265:2442-2444. [PMID: 30074081 DOI: 10.1007/s00415-018-8991-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 02/06/2023]
|
18
|
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.
Collapse
|
19
|
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
| |
Collapse
|
20
|
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.
Collapse
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.
| |
Collapse
|
21
|
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
| |
Collapse
|
22
|
Abstract
Parkinson disease (PD) is increasingly prevalent in the aging population. Spine disorders in patients with PD may be degenerative in nature or may arise secondary to motor effects related to the parkinsonian disease process. Physicians providing care for patients with PD and spine pathologies must be aware of several factors that affect treatment, including the patterns of spinal deformity, complex drug interactions, and PD-associated osteoporosis. Following spine surgery, complication rates are higher in patients with PD than in those without the disease. Literature on spine surgery in this patient population is limited by small cohort size, the heterogeneous patient population, and variable treatment protocols. However, most studies emphasize the need for preoperative optimization of motor control with appropriate medications and deep brain stimulation, as well as consultation with a movement disorder specialist. Future studies must control for confounding variables, such as the type of surgery and PD severity, to improve understanding of spinal pathology and treatment options in this patient population.
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
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
| |
Collapse
|
26
|
Volpe D, Giantin MG, Manuela P, Filippetto C, Pelosin E, Abbruzzese G, Antonini A. Water-based vs. non-water-based physiotherapy for rehabilitation of postural deformities in Parkinson’s disease: a randomized controlled pilot study. Clin Rehabil 2016; 31:1107-1115. [DOI: 10.1177/0269215516664122] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To compare the efficacy of two physiotherapy protocols (water-based vs. non-water-based) on postural deformities of patients with Parkinson’s disease. Design: A single blind, randomized controlled pilot study. Setting: Inpatient (Rehabilitative Department). Participants: A total of 30 patients with idiopathic Parkinson’s disease. Interventions: Participants were randomly assigned to one of two eight-week treatment groups: Water-based ( n = 15) or non-water-based physiotherapy exercises ( n = 15). Outcome measures: Changes in the degree of cervical and dorsal flexion and in the angle of lateral inclination of the trunk (evaluated by means of a posturographic system) were used as primary outcomes. Unified Parkinson Disease Rating Scale section III, Time Up and Go Test, Berg Balance Scale, Activities-specific Balance Confidence, Falls Efficacy Scale and the Parkinson’s disease quality of life questionnaire (39 items) were the secondary outcomes. All outcomes were assessed at baseline, at the end of training and eight weeks after treatment. Patients were always tested at the time of their optimal antiparkinsonian medication (‘on’ phase). Results: After the treatment, only Parkinson’s disease subjects randomized to water-based treatment showed a significant improvement of trunk posture with a significant reduction of cervical flexion (water-based group: −65.2°; non-water-based group: +1.7°) and dorsal flexion (water-based group: −22.5°; non-water-based group: −6.5°) and lateral inclination of the trunk (water-based group: −2.3°; non-water-based group: +0.3°). Both groups presented significant improvements in the secondary clinical outcomes without between-group differences. Conclusion: Our results show that water-based physiotherapy was effective for improving postural deformities in patients with Parkinson’s disease.
Collapse
Affiliation(s)
- Daniele Volpe
- Department of Physical Medicine and Rehabilitation, Casa di Cura “Villa Margherita”, Vicenza, Italy
| | - Maria Giulia Giantin
- Department of Physical Medicine and Rehabilitation, Casa di Cura “Villa Margherita”, Vicenza, Italy
| | - Pilleri Manuela
- Department of Physical Medicine and Rehabilitation, Casa di Cura “Villa Margherita”, Vicenza, Italy
| | - Consuelo Filippetto
- Parkinson’s Centre, IRCCS S. Camillo, Lido Alberoni, Venice, Italy
- Department of Physical Medicine and Rehabilitation, Montebelluna, Italy
| | - Elisa Pelosin
- Department of Neuroscience, University of Genova, Genova, Italy
| | | | - Angelo Antonini
- Parkinson’s Centre, IRCCS S. Camillo, Lido Alberoni, Venice, Italy
| |
Collapse
|
27
|
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.
Collapse
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.
| |
Collapse
|
28
|
Schulz-Schaeffer WJ. Camptocormia in Parkinson's Disease: A Muscle Disease Due to Dysregulated Proprioceptive Polysynaptic Reflex Arch. Front Aging Neurosci 2016; 8:128. [PMID: 27445789 PMCID: PMC4914504 DOI: 10.3389/fnagi.2016.00128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 05/17/2016] [Indexed: 12/01/2022] Open
Affiliation(s)
- Walter J Schulz-Schaeffer
- Prion and Dementia Research Unit, Department of Neuropathology, University Medical Center Göttingen Göttingen, Germany
| |
Collapse
|
29
|
Solla P, Grau-Rivera O, Gelpi E, Marrosu F, Martí MJ. Pisa syndrome in a patient with pathologically confirmed Parkinson's disease. Neuropathol Appl Neurobiol 2016; 42:654-658. [DOI: 10.1111/nan.12324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/22/2016] [Accepted: 03/21/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Paolo Solla
- Movement Disorders Center; Department of Neurology; Institute of Neurology; University of Cagliari; Cagliari Italy
| | - Oriol Grau-Rivera
- Neurological Tissue Bank of the Biobanc-Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Ellen Gelpi
- Neurological Tissue Bank of the Biobanc-Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - Francesco Marrosu
- Movement Disorders Center; Department of Neurology; Institute of Neurology; University of Cagliari; Cagliari Italy
| | - Maria José Martí
- Parkinson's Disease and Movement Disorders Unit; Institut Clínic de Neurociències; CIBERNED; Hospital Clinic de Barcelona; Barcelona Spain
| |
Collapse
|
30
|
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.
Collapse
Affiliation(s)
- Sanjay Pandey
- Department of Neurology, GB Pant Hospital, Delhi, India
| | | |
Collapse
|
31
|
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]
|
32
|
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.
Collapse
|
33
|
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.
Collapse
|
34
|
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.
Collapse
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
| | | |
Collapse
|
35
|
|
36
|
Dupeyron A, Viollet E, Coroian F, Gagnard C, Renard D, Castelnovo G. Botulinum Toxin-A for treatment of Pisa syndrome: A new target muscle. Parkinsonism Relat Disord 2015; 21:669-70. [DOI: 10.1016/j.parkreldis.2015.03.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/28/2015] [Accepted: 03/31/2015] [Indexed: 11/16/2022]
|
37
|
Rasagiline and Pisa syndrome in Parkinson’s disease patients. Neurol Sci 2014; 36:485-6. [DOI: 10.1007/s10072-014-2024-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 11/27/2014] [Indexed: 10/24/2022]
|
38
|
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
| | | |
Collapse
|
39
|
Ricciardi L, Piano C, Bentivoglio AR, Fasano A. Long-term effects of pedunculopontine nucleus stimulation for Pisa syndrome. Parkinsonism Relat Disord 2014; 20:1445-6. [DOI: 10.1016/j.parkreldis.2014.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/26/2014] [Accepted: 10/05/2014] [Indexed: 11/25/2022]
|
40
|
Mensikova K, Kaiserova M, Vastik M, Kurcova S, Kanovsky P. Treatment of camptocormia with continuous subcutaneous infusions of apomorphine: 1-year prospective pilot study. J Neural Transm (Vienna) 2014; 122:835-9. [DOI: 10.1007/s00702-014-1297-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/11/2014] [Indexed: 11/28/2022]
|
41
|
Marchione P, Spallone A, Valente M, Giannone C, De Angelis F, Meco G. Reversible Pisa syndrome associated to subdural haematoma: case-report. BMC Neurol 2014; 14:149. [PMID: 25123109 PMCID: PMC4236656 DOI: 10.1186/1471-2377-14-149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/30/2014] [Indexed: 01/19/2023] Open
Abstract
Background Pisa Syndrome or Pleurothotonus is a relatively rare truncal dystonia, characterized by tonic flexion of the trunk and head to one side with slight rotation of the body. Since frequently associated to specific drugs such as antipsychotics and cholinesterase inhibitors or to Parkinson Disease, a pathophysiological role of cholinergic-dopaminergic imbalance has been suggested. We report here the first case of Pisa Syndrome due to an extracerebral pathology as subdural haematoma. Case presentation A hypertensive patient was admitted to Our Department for subacute onset of tonic flexion and slight rotation of the trunk associated to progressive motor deficit in left upper limb after a mild head trauma without loss of consciousness occurred around three month before. No previous or current pharmacological interventions with antidepressant, neuroleptic or anticholinergic drugs were anamnestically retrieved. Familiar and personal history was negative for neurological disorders other than acute cerebrovascular diseases. Acutely performed cerebral MRI with DWI showed a voluminous right subdural haematoma with mild shift of median line. After surgical evacuation, both motor deficit and truncal dystonia were dramatically resolved. At one-year follow up, the patient did not develop any extrapyramidal and cognitive signs or symptoms. Conclusions According to many Authors, the occurrence of truncal dystonia during several pharmacologic treatments and neurodegenerative disorders (such as Alzheimer disease and parkinsonian syndromes) supported the hypothesis that a complex dysregulation of multiple neurotransmitter systems are involved. We suggest a possible role of basal ganglia compression in pathogenesis of truncal dystonia by means of thalamo-cortical trait functional disruption and loss of proprioceptive integration. A further contribution of the subcortical structure displacement that alters motor cortex connectivity to basal ganglia may be postulated.
Collapse
Affiliation(s)
- Pasquale Marchione
- Department of Clinical Neurosciences, Neurological Center of Latium - Institute of Neurosciences, Via Patrica 15, 00178 Rome, Italy.
| | | | | | | | | | | |
Collapse
|
42
|
Castrioto A, Piscicelli C, Pérennou D, Krack P, Debû B. The pathogenesis of Pisa syndrome in Parkinson's disease. Mov Disord 2014; 29:1100-7. [DOI: 10.1002/mds.25925] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 04/17/2014] [Accepted: 04/27/2014] [Indexed: 12/26/2022] Open
Affiliation(s)
- Anna Castrioto
- Grenoble University Hospital; Psychiatry and Neurology Dept.; Grenoble France
- Grenoble Institute of Neuroscience; INSERM-UJF-CEA U836; Grenoble France
| | - Céline Piscicelli
- Grenoble University Hospital; Physical Medicine and Rehabilitation Dept.; Grenoble France
| | - Dominic Pérennou
- Grenoble University Hospital; Physical Medicine and Rehabilitation Dept.; Grenoble France
- Grenoble-Alpes University; Grenoble France
| | - Paul Krack
- Grenoble University Hospital; Psychiatry and Neurology Dept.; Grenoble France
- Grenoble Institute of Neuroscience; INSERM-UJF-CEA U836; Grenoble France
- Grenoble-Alpes University; Grenoble France
| | - Bettina Debû
- Grenoble Institute of Neuroscience; INSERM-UJF-CEA U836; Grenoble France
- Grenoble-Alpes University; Grenoble France
| |
Collapse
|
43
|
Valentino F, Cosentino G, Fierro B, Realmuto S, Mastrilli S, Savettieri G, D’Amelio M. Insidious onset of Pisa syndrome after rasagiline therapy in a patient with Parkinson’s disease. Neurol Sci 2014; 35:1615-7. [DOI: 10.1007/s10072-014-1806-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
|