Painful abdominal contractions in patients with Parkinson disease

Persistent intolerable abdominal pain in patients with Parkinson's disease

OBJECTIVES

In Parkinson's disease (PD), pain is common, increases motor disability, and makes daily life unpleasant. Few patients reportedly have a low prevalence of abdominal pain. The pathophysiology of such abdominal pain has not been confirmed. We clinically studied patients with PD and persistent intolerable abdominal pain to determine the pathophysiology and effective therapy.

MATERIALS AND METHODS

We obtained detailed clinical information from medical records, including the disease course before and after the onset of abdominal pain. The maximal thickness of the rectus muscle at the L4 and L5 corpus vertebral level of the abdomen on axial computed tomography was calculated, and the relative muscle thickness ratio was calculated by dividing the maximal thickness by the distance from the fascia between the bilateral rectus muscles of the abdomen and the dorsal part of the corpus vertebrae.

RESULTS

In six patients with PD (three men, age range 71-85 years), the Hoehn-Yahr stage, disease duration, and daily levodopa equivalent dose were 3.1 ± 0.7, 107 ± 44 months, and 636.7 ± 451.4 mg/day, respectively. The pain occurred daily and often during the night and was not related to the timing of food intake. The pain in two patients was related to wearing-off. One patient showed constant hypertonic activity in the rectus abdominis on surface electromyography. The rectus abdominis showed that the maximal thickness and relative muscle thickness ratio of patients with abdominal pain were significantly higher than those of patients without pain. Therapeutic usefulness of antiparkinsonian medications was short and limited.

CONCLUSIONS

Although intolerable abdominal pain is likely to be infrequent, it alleviates the quality of life of patients with PD. The pathophysiology seems to vary, and our observations found wearing-off of related pain and muscle contraction, suggesting dystonia. Among persistent abdominal pain, organic abnormalities, such as the precursor state of megacolon, may be lurking.

Recent advancements in lateral trunk flexion in Parkinson disease

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.

Gastrointestinal dysfunction in idiopathic Parkinsonism: A narrative review

Currently, gastrointestinal (GI) dysfunctions in Parkinson's disease (PD) are well-recognized problems and are known to be the initial symptoms in the pathological process that eventually results in PD. Many types of PD-associated GI dysfunctions have been identified, including weight loss, nausea, hypersalivation, dysphagia, dyspepsia, abdominal pain, intestinal pseudo-obstruction, constipation, defecatory dysfunction, and small intestinal bacterial overgrowth. These symptoms can influence on other PD symptoms and are the second most significant predictor of the quality of life of these patients. Recognition of GI symptoms requires vigilance on the part of clinicians. Health-care providers should routinely ask direct questions about GI symptoms during office visits so that efforts can be directed at appropriate management of these distressing manifestations. Multiple system atrophy (MSA) and progressive supranuclear palsy are two forms of neurodegenerative Parkinsonism. Symptoms of autonomic dysfunctions such as GI dysfunction are common in patients with parkinsonian disorders. Despite recent progress in the recognition of GI dysfunctions, there are a few reviews on the management of GI dysfunction and GI symptoms in idiopathic Parkinsonism. In this review, the clinical presentation, pathophysiology, and treatment of each GI symptom in PD, MSA, and prostate-specific antigen will be discussed.

The assessment of abdominal and multifidus muscles and their role in physical function in older adults: a systematic review

BACKGROUND

Age-related changes in the trunk (abdominal and lumbar multifidus) muscles and their impact on physical function of older adults are not clearly understood.

OBJECTIVES

To systematically summarise studies of these trunk muscles in older adults.

DATA SOURCES

Cochrane Library, Pubmed, EMBASE and CINAHL were searched using terms for abdominal and MF muscles and measurement methods.

STUDY SELECTION

Two reviewers independently assessed studies and included those reporting measurements of abdominal muscles and/or MF by ultrasound, computed tomography, magnetic resonance imaging or electromyography of adults aged ≥50 years.

DATA SYNTHESIS

A best evidence synthesis was performed.

RESULTS

Best evidence synthesis revealed limited evidence for detrimental effects of ageing or spinal conditions on trunk muscles, and conflicting evidence for decreased physical activity or stroke having detrimental effects on trunk muscles. Thicknesses of rectus abdominis, internal oblique and external oblique muscles were 36% to 48% smaller for older than younger adults. Muscle quality was poorer among people with moderate-extreme low back pain and predicted physical function outcomes.

LIMITATIONS

Study heterogeneity precluded meta-analysis.

CONCLUSION

Overall, the evidence base in older people has significant limitations, so the role of physiotherapy interventions aimed at these muscles remains unclear. The results point to areas in which further research could lead to clinically useful outcomes. These include determining the role of the trunk muscles in the physical function of older adults and disease; developing and testing rehabilitation programmes for older people with spinal conditions and lower back pain; and identifying modifiable factors that could mitigate age-related changes.

Pathophysiological Concepts and Treatment of Camptocormia

Camptocormia is a disabling pathological, non-fixed, forward bending of the trunk. The clinical definition using only the bending angle is insufficient; it should include the subjectively perceived inability to stand upright, occurrence of back pain, typical individual complaints, and need for walking aids and compensatory signs (e.g. back-swept wing sign). Due to the heterogeneous etiologies of camptocormia a broad diagnostic approach is necessary. Camptocormia is most frequently encountered in movement disorders (PD and dystonia) and muscles diseases (myositis and myopathy, mainly facio-scapulo-humeral muscular dystrophy (FSHD)). The main diagnostic aim is to discover the etiology by looking for signs of the underlying disease in the neurological examination, EMG, muscle MRI and possibly biopsy. PD and probably myositic camptocormia can be divided into an acute and a chronic stage according to the duration of camptocormia and the findings in the short time inversion recovery (STIR) and T1 sequences of paravertebral muscle MRI. There is no established treatment of camptocormia resulting from any etiology. Case series suggest that deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) is effective in the acute but not the chronic stage of PD camptocormia. In chronic stages with degenerated muscles, treatment options are limited to orthoses, walking aids, physiotherapy and pain therapy. In acute myositic camptocormia an escalation strategy with different immunosuppressive drugs is recommended. In dystonic camptocormia, as in dystonia in general, case reports have shown botulinum toxin and DBS of the globus pallidus internus (GPi-DBS) to be effective. Camptocormia in connection with primary myopathies should be treated according to the underlying illness.

Camptocormia in Parkinson's disease: definition, epidemiology, pathogenesis and treatment modalities

Camptocormia is an axial postural deformity characterised by abnormal thoracolumbar spinal flexion. The symptom usually presents while standing, walking or exercising and is alleviated while sitting, lying in a recumbent position, standing against a wall or using walking support. There is no consensus on the degree of thoracolumbar flexion to define camptocormia. However, most authors usually use an arbitrary number of at least 45° flexion of the thoracolumbar spine when the individual is standing or walking. Aetiologies of camptocormia are heterogeneous, and Parkinson's disease (PD) is one of its many causes. The prevalence of camptocormia in PD ranges from 3% to 18%. Central and peripheral mechanisms might both contribute to its pathogenesis. Although there is no established consensus for treatment of camptocormia in PD, there are non-pharmacological, pharmacological and surgical approaches that can be used.