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Bissolotti L, Rota M, Calza S, Romero-Morales C, Alonso-Pérez JL, López-Bueno R, Villafañe JH. Gender-Specific Differences in Spinal Alignment and Muscle Power in Patients with Parkinson's Disease. Diagnostics (Basel) 2024; 14:1143. [PMID: 38893669 PMCID: PMC11171582 DOI: 10.3390/diagnostics14111143] [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: 05/08/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is an advancing neurodegenerative disorder characterized by spinal anomalies and muscular weakness, which may restrict daily functional capacities. A gender-focused examination of these effects could provide valuable insights into customized rehabilitation strategies for both sexes. PURPOSE This study investigates the influence of spinal alignment on lower-limb function during the sit-to-stand (STS) movement in patients with Parkinson's disease compared to healthy individuals. METHODS A cross-sectional study was conducted with 43 consecutive patients with PD (25 males and 18 females; average age 73.7 ± 7.1 years) and 42 healthy controls (22 males and 20 females; average age 69.8 ± 6.0 years). Assessments included the International Physical Activity Questionnaire (IPAQ), Hoehn and Yahr staging, and measurements of vertical deviations from several spinal landmarks. Lower-limb muscle power during the STS task was evaluated using the Muscle Quality Index (MQI). RESULTS Both absolute (Watts) and relative (Watts/Kg) muscle power in the lower limbs were notably decreased in the PD group compared to the control group. Within the PD cohort, muscle power showed a negative relationship with age and a positive association with the degree of lumbar lordosis (PL-L3). Importantly, gender-specific analysis revealed that male patients with PD had significantly higher lower-limb muscle power compared to female patients with PD, highlighting the need for gender-tailored therapeutic approaches. CONCLUSIONS The findings suggest that preserving lumbar lordosis is crucial for maintaining effective lower-limb muscle biomechanics in individuals with Parkinson's disease.
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Affiliation(s)
- Luciano Bissolotti
- Fondazione Teresa Camplani Casa di Cura Domus Salutis, 25123 Brescia, Italy;
| | - Matteo Rota
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (M.R.); (S.C.)
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (M.R.); (S.C.)
| | - Carlos Romero-Morales
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
| | - José Luís Alonso-Pérez
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, C/Inocencio García 1, 38300 La Orotava, Canary Islands, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Onelife Center, Multidisciplinary Pain Treatment Center, 28925 Alcorcón, Spain
| | - Rubén López-Bueno
- Department of Physical Medicine and Nursing, University of Zaragoza, 50009 Zaragoza, Spain;
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46100 Valencia, Spain
| | - Jorge Hugo Villafañe
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
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Ronconi G, Gatto DM, Ariani M, Codazza S, Ingravalle F, Ferriero G, Coraci D, Ferrara PE. Is there any relationship between scoliosis, cervical pain and postural imbalance in Parkinson's disease? A cross-sectional pilot study. Eur J Transl Myol 2024; 34. [PMID: 38634751 DOI: 10.4081/ejtm.2024.12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
Parkinson's disease (PD) is defined by progressive worsening of gait, posture, and balance, as well as disability in daily life activities, and improvement in chronic musculoskeletal pain, particularly neck pain associated with worsening of balance. The study's goal is to look into the relationship between scoliosis, balance, and cervical pain in Parkinson's disease patients. Cross-sectional, pilot study. The study included 16 Parkinson's patients. Neck cervical pain was measured using the pain visual analogue scale and the short form McGill pain questionnaire, while dynamic balance was assessed using static balance, Tinetti, Berg Balance, and the Short Physical Performance Battery scales (SPPB). Cobb angles are measured on a whole-spine standard X-ray to assess spinal scoliosis.An observational statistical analysis was performed with patients subdivided into two groups: non-scoliosis (NS) and true scoliosis (TS) based on whether they presented a Cobb's angle below or ≥10°. Neck pain was reported by 37% (n=3) of participants in the NS group versus 50% (n=4) in the TS group. Neck pain was more prevalent in patients with a disease duration of less than 48 months (n=6; 75.0% vs n=1; 12.5%; p-value < 0.05). Scoliosis, cervical pain, and postural imbalance are all significant but often overlooked Parkinson's disease complaints.
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Affiliation(s)
| | - Dario Mattia Gatto
- Department of Neurosciences, Sense Organs and Thorax, Catholic University of the Sacred Heart, Rome.
| | - Mariantonietta Ariani
- Department of Neurosciences, Sense Organs and Thorax, Catholic University of the Sacred Heart, Rome.
| | - Sefora Codazza
- University Polyclinic Foundation A. Gemelli IRCCS, Rome.
| | - Fabio Ingravalle
- Hospital Health Management Area, Local Health Authority "Roma 6", Albano Laziale.
| | - Giorgio Ferriero
- Unit of Physical and Rehabilitation Medicine, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Varese, Italy; Department of Biotechnology and Life Sciences, University of Insubria, Varese, Como.
| | - Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua.
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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.
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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
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Cao S, Cui Y, Jin J, Li F, Liu X, Feng T. Prevalence of axial postural abnormalities and their subtypes in Parkinson's disease: a systematic review and meta-analysis. J Neurol 2023; 270:139-151. [PMID: 36098837 DOI: 10.1007/s00415-022-11354-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Axial postural abnormalities, mainly involving the spinal deformities, are disabling symptoms of Parkinson's disease (PD). However, the prevalence of axial postural abnormalities in PD and their clinical correlates remain unclear. The present study aimed to conduct a systematic review and meta-analysis of the prevalence of overall and subtypes of axial postural abnormalities in PD. METHODS PubMed, Embase, Web of Science and Cochrane databases were searched up to 31st March, 2022. We identified studies that reported the prevalence of axial postural abnormalities in PD. The pooled estimate of prevalence was calculated using a random effect model. Subgroup analysis and meta-regression were performed. RESULTS There were 19 studies met the inclusion criteria. The overall prevalence of axial postural abnormalities in PD was 22.1% (95% CI 19.7-24.5%). The prevalence of each subtype of axial postural abnormalities was 19.6% for scoliosis (95% CI 10.6-28.7%), 10.2% for camptocormia (95% CI 7.7-12.7%), 8% for Pisa syndrome (95% CI 4.7-11.4%), and 7.9% for antecollis (95% CI 3.9-11.9%). Subgroup analysis showed that the measuring method of axial postural abnormalities exerted significant effects on prevalence estimates. Axial postural abnormalities in PD were associated with older age, longer disease duration, higher H-Y stage, greater levodopa equivalent daily dose, more severe motor symptoms, motor fluctuations, and akinetic-rigid subtype. CONCLUSIONS Axial postural abnormalities, which include scoliosis, camptocormia, Pisa syndrome, and antecollis, are not uncommon in patients with PD. Future research on axial postural abnormalities should be based on uniform diagnostic criteria and measuring methods.
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Affiliation(s)
- Shuangshuang Cao
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurology, Yidu Central Hospital of Weifang, Shandong, China
| | - Yusha Cui
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianing Jin
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Fangfei Li
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xin Liu
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Tao Feng
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
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Postoperative Complication Rates After One-Level Cervical Spine Surgery in Patients with Parkinson Disease: A Database Study. World Neurosurg 2022; 165:e479-e487. [PMID: 35752419 DOI: 10.1016/j.wneu.2022.06.081] [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: 05/05/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Parkinson disease (PD) is a risk factor for worse surgical outcomes. The degree to which PD affects outcomes in cervical spine surgery is not well understood. Therefore, we characterize rates of postoperative complications among patients with PD who undergo cervical spine surgery. METHODS Using the PearlDiver database, we identified patients who underwent 1-level anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), or discectomy/decompression with concomitant PD between 2011 and 2019. Patients with PD who underwent surgery and had 1 year follow-up were included. Complications 30, 60, and 90 days after surgery were identified and aggregated into body systems (e.g., respiratory and gastrointestinal). Comparison controls without concomitant PD who received cervical spine (C-spine) surgery were matched for age, sex, and comorbidities. RESULTS A total of 259,443 ACDFs, 30,929 PCFs, and 29,563 decompressions were identified. Of these procedures, 1117 were performed on patients with PD (0.35%). The highest 90-day complications rates in patients with PD were pulmonary and gastrointestinal related (6.05%) in those who received ACDF, neuro related (8.51%) in those who received PCF, and genitourinary related (8.76%) in those who received a decompression. Compared with patients without PD, postoperative complications rates were similar and not significantly different. CONCLUSIONS Patients with PD who receive ACDF have higher rates of pulmonary (6.05%), neurologic (5.24%), and psychiatric (3.23%) complications at 90 days. The differences did not reach statistical significance. This finding suggests that patients with PD do not experience higher rates of acute postoperative complications when undergoing 1-level cervical spine surgery.
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Bissolotti L, Rota M, Calza S, Sanchez Romero EA, Battaglino A, Villafañe JH. Relationship between Lower Limbs Performance and Spinal Alignment in Parkinson’s Disease Patients: An Observational Study with Cross Sectional Design. J Clin Med 2022; 11:jcm11133775. [PMID: 35807060 PMCID: PMC9267576 DOI: 10.3390/jcm11133775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/15/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
Parkinson’s disease (PD) is a progressive neurodegenerative disease determining spinal deformities and muscle rigidity, weakness and dystonia that can be related to a change in muscular output during sit-to-stand tasks (STS). Purpose: The aim of this study was to determine the impacts of spinal alignment on lower limbs performance during STS tasks in Parkinson’s disease (PD) patients and healthy controls. Methods: In total, 43 consecutive PD patients (“PD” Group, 25 males and 18 females; age 73.7 ± 7.1) and 42 people not affected by any type of neurological disease (“CON” Group, 22 males, 20 females; age 69.8 ± 6.0) participated in the observational study. The clinical assessment included: IPAQ (International Physical Activity Questionnaire), Hoehn Yahr score, plumb-line distance from the spinous process of C7, kyphosis apex and the spinous process of L3 and S1. We used the Muscle Quality Index test (MQI) to assess muscle power output during STS in both groups. Results: The MQI test measurements of absolute and relative lower limb power was significantly lower in the PD group, in addition to a negative correlation with age and a positive correlation with PL-L3 in that group of patients. Conclusions: A final consideration regarding our results leads to the possibility that the preservation of lumbar lordosis may be one of the factors for maintaining efficient biomechanics of the lower limb muscles, with the preservation of the physiological contractile characteristics of these muscles being the objective for a multidisciplinary rehabilitation based on postural exercises of the spine and a program of training exercises for the lower limb muscles.
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Affiliation(s)
- Luciano Bissolotti
- Rehabilitation Service, Fondazione Teresa Camplani Casa di Cura Domus Salutis, 25123 Brescia, Italy;
- LARIN: Neuromuscular and Adapted Physical Activity Laboratory, 25123 Brescia, Italy
| | - Matteo Rota
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (M.R.); (S.C.)
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (M.R.); (S.C.)
| | - Eleuterio A. Sanchez Romero
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Correspondence: (E.A.S.R.); (J.H.V.); Tel.: +39-393-9064-922 (E.A.S.R.); Fax: +34-633-115-328 (E.A.S.R.)
| | | | - Jorge H. Villafañe
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy;
- Correspondence: (E.A.S.R.); (J.H.V.); Tel.: +39-393-9064-922 (E.A.S.R.); Fax: +34-633-115-328 (E.A.S.R.)
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Effect of subjective vertical perception on lateral flexion posture of patients with Parkinson's disease. Sci Rep 2022; 12:1532. [PMID: 35087194 PMCID: PMC8795259 DOI: 10.1038/s41598-022-05587-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/14/2022] [Indexed: 11/09/2022] Open
Abstract
In a retrospective study we tested our hypothesis that the subjective postural vertical ratio (SPV ratio), i.e., the subjective postural vertical measured in relation to the lateral flexion axis, is predictive of lateral trunk flexion in patients with Parkinson's disease (PD). Twenty-five patients were included. The SPV angle, i.e., the subjective perception of a vertical position with reference to the vertical axis, and the SPV ratio, i.e., the SPV angle with reference to the axis of lateral flexion, were calculated. The SPV ratio (r = 0.698, P = 0.001) and LTF angle (r = − 0.601, P = 0.001) correlated with change in the LTF angle at 1 year. The SPV ratio was significantly smaller in patients for whom lateral trunk flexion improved (n = 12) than in those for whom it did not improve (n = 13) (0.99 ± 0.78 vs 1.66 ± 0.71, P = 0.011). The AUC under the ROC curve of the SPV ratio for discrimination of improvement was 0.795 (95% confidence interval: 0.61–0.98). We found that the SPV ratio is associated with change in the LTF and that it can conceivably be used to predict the likelihood of improvement in PD-associated lateral trunk flexion.
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Shin JH, Woo KA, Lee CY, Jeon SH, Kim HJ, Jeon B. Automatic Measurement of Postural Abnormalities With a Pose Estimation Algorithm in Parkinson's Disease. J Mov Disord 2022; 15:140-145. [PMID: 35038858 PMCID: PMC9171303 DOI: 10.14802/jmd.21129] [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: 08/25/2021] [Accepted: 10/13/2021] [Indexed: 12/02/2022] Open
Abstract
Objective This study aims to develop an automated and objective tool to evaluate postural abnormalities in Parkinson’s disease (PD) patients. Methods We applied a deep learning-based pose-estimation algorithm to lateral photos of prospectively enrolled PD patients (n = 28). We automatically measured the anterior flexion angle (AFA) and dropped head angle (DHA), which were validated with conventional manual labeling methods. Results The automatically measured DHA and AFA were in excellent agreement with manual labeling methods (intraclass correlation coefficient > 0.95) with mean bias equal to or less than 3 degrees. Conclusion The deep learning-based pose-estimation algorithm objectively measured postural abnormalities in PD patients.
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Affiliation(s)
- Jung Hwan Shin
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Ah Woo
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chan Young Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Ho Jeon
- Department of Neurology, Jeonbuk National University Hospital, Jeonbuk National University College of Medicine, Jeonju, Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Pandey S, Chouksey A, Pitakpatapee Y, Srivanitchapoom P. Movement Disorders and Musculoskeletal System: A Reciprocal Relationship. Mov Disord Clin Pract 2021; 9:156-169. [DOI: 10.1002/mdc3.13390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sanjay Pandey
- Department of Neurology Govind Ballabh Pant Postgraduate Institute of Medical Education and Research New Delhi India
| | - Anjali Chouksey
- Department of Neurology Christian Medical College Vellore India
| | - Yuvadee Pitakpatapee
- Department of Medicine, Division of Neurology, Faculty of Medicine, Siriraj Hospital Mahidol University Bangkok Thailand
| | - Prachaya Srivanitchapoom
- Department of Medicine, Division of Neurology, Faculty of Medicine, Siriraj Hospital Mahidol University Bangkok Thailand
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Zak M, Sikorski T, Wasik M, Krupnik S, Andrychowski J, Brola W. Pisa syndrome: Pathophysiology, physical rehabilitation and falls risk. NeuroRehabilitation 2021; 49:363-373. [PMID: 34542040 DOI: 10.3233/nre-210167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pisa syndrome (PS) is a postural disorder characterised by lateral flexion of the spine (> 10°), predisposing the affected individuals to falls, and contributing to increased mortality in neurodegenerative diseases. OBJECTIVE An overview of currently applied therapeutic management options, primarily focused on specifically structured rehabilitation exercises, in conjunction with falls-risk assessment in the individuals affected by PS. METHODS A narrative literature review, augmented with the authors' own experience in physical rehabilitation management. RESULTS As individuals affected by PS are evidenced to be intrinsically exposed to higher falls-risk through acquired postural deformities, they often fall victims of traumatic accidents, occasionally also facing relocation into 24-hour nursing facilities due to the injuries sustained/resultant disability, consequently having overall quality of their life appreciably reduced. CONCLUSIONS sA comprehensive approach is postulated in designing optimal therapeutic management, comprised of the exercises controlling postural stability, whilst reducing lower back pain, and the ones also promoting specific skills essential for coping unassisted after an accidental fall effectively. Rehabilitation of individuals affected by PS should be a fully integrated service, eliminating all identified risk factors for falls. As clinical PS symptoms tend to recur after completion of a full course of therapeutic management, all PS patients should continue the pursuit of therapeutic exercises on an individual basis, to effectively retard their recurrence. In view of overall scarcity of clinical studies completed on the large population samples of PS patients, further in-depth research is still required to ensure higher credence to overall efficacy of the presently proposed therapeutic solutions.
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Affiliation(s)
- Marek Zak
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Tomasz Sikorski
- Doctoral School, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Magdalena Wasik
- Doctoral School, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Szymon Krupnik
- Symmetry, Medical Rehabilitation Centre, Sosnowiec, Poland
| | - Jaroslaw Andrychowski
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Waldemar Brola
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
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Tang H, Chen Y, Cen Z, Ouyang Z, Lou D, Tan Y, Luo W. The link between lateral trunk flexion in Parkinson's disease and vestibular dysfunction: a clinical study. Int J Neurosci 2020; 131:521-526. [PMID: 32942935 DOI: 10.1080/00207454.2020.1825419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Lateral trunk flexion (LTF) is a common postural deformity in Parkinson's disease (PD). Postural control is known to depend on visual, vestibular, and somatosensory information. OBJECTIVES This study aimed to investigate the relationship between vestibular dysfunction and postural abnormalities in PD patients with LTF. METHODS We enrolled a total of 19 PD patients with LTF (PD-LTF+) and 19 age- and sex-matched PD patients without LTF (PD-LTF-). All patients underwent vestibular tests, including spontaneous nystagmus, gaze-evoked nystagmus, ocular movements, optokinetic eye test, fast positioning maneuvers, and the bithermal caloric test. RESULTS Most of the PD-LTF + patients had abnormal vestibular function (11/19), while there were fewer vestibular function injuries in the control group (3/19). In PD-LTF + group, there were 5 patients (5/11, 45.5%) of peripheral vestibular dysfunction, 2 patients (2/11, 18.2%) of central vestibular damage, and 4 patients (4/11, 36.4%) of mixed injuries. The peripheral vestibular deficiencies could be either bilateral (4/9, 44.4%) or unilateral (5/9, 55.6%). The unilateral vestibular dysfunction was ipsilateral to the leaning side in 2 patients and contralateral to the leaning side in the other 3 patients. CONCLUSION Vestibular dysfunction may be an independent risk factor for LTF in PD patients.
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Affiliation(s)
- Haiyan Tang
- Department of Neurology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang, China.,Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - You Chen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhidong Cen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhiyuan Ouyang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Danning Lou
- Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Ying Tan
- Department of Neurology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang, China
| | - Wei Luo
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Lu H, Shagirova A, Goggi JL, Yeo HL, Roy S. Reissner fibre-induced urotensin signalling from cerebrospinal fluid-contacting neurons prevents scoliosis of the vertebrate spine. Biol Open 2020; 9:9/5/bio052027. [PMID: 32409296 PMCID: PMC7240301 DOI: 10.1242/bio.052027] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Reissner fibre (RF), discovered by the 19th-century German anatomist Ernst Reissner, is a filamentous structure present in cerebrospinal fluid (CSF). RF forms by aggregation of a glycoprotein called SCO-spondin (Sspo), but its function has remained enigmatic. Recent studies have shown that zebrafish sspo mutants develop a curved embryonic body axis. Zebrafish embryos with impaired cilia motility also develop curved bodies, which arises from failure of expression of urotensin related peptide (urp) genes in CSF-contacting neurons (CSF-cNs), impairing downstream signalling in trunk muscles. Here, we show that sspo mutants can survive into adulthood, but display severe curvatures of the vertebral column, resembling the common human spine disorder idiopathic scoliosis (IS). sspo mutants also exhibit significant reduction of urp gene expression from CSF-cNs. Consistent with epinephrine in CSF being bound by RF and required for urp expression, treating sspo mutants with this catecholamine rescued expression of the urp genes and axial defects. More strikingly, providing Urp2, specifically in the CSF-cNs, rescued body curvature of sspo homozygotes during larval stages as well as in the adult. These findings bridge existing gaps in our knowledge between cilia motility, RF, Urp signalling and spine deformities, and suggest that targeting the Urotensin pathway could provide novel therapeutic avenues for IS. Summary: Reissner fibre (RF) is a glycoprotein filament suspended in cerebrospinal fluid (CSF). We show that RF regulates zebrafish spine morphogenesis by regulating Urotensin signalling from CSF-contacting neurons of the spinal cord.
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Affiliation(s)
- Hao Lu
- Institute of Molecular and Cell Biology, Proteos, 61 Biopolis Drive, Singapore 138673
| | - Aidana Shagirova
- Institute of Molecular and Cell Biology, Proteos, 61 Biopolis Drive, Singapore 138673.,Department of Biological Sciences, National University of Singapore, 14 Science Drive 4, Singapore 117543
| | - Julian L Goggi
- Singapore Bioimaging Consortium, Helios, 11 Biopolis Way, Singapore 138667
| | - Hui Li Yeo
- Institute of Molecular and Cell Biology, Proteos, 61 Biopolis Drive, Singapore 138673
| | - Sudipto Roy
- Institute of Molecular and Cell Biology, Proteos, 61 Biopolis Drive, Singapore 138673 .,Department of Biological Sciences, National University of Singapore, 14 Science Drive 4, Singapore 117543.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119288
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Muscle echo intensity of abdominal wall in Parkinson's disease and healthy controls: a cross sectional study. Neurol Sci 2020; 41:3201-3207. [PMID: 32372195 DOI: 10.1007/s10072-020-04440-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/18/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of this study was to describe the differences between abdominal wall muscles echo intensity (EI) in PD patients and healthy controls. METHODS Forty-three consecutive PD patients (25 males and 18 females, age 73.7 ± 7.1, and 42 controls without neurological diseases (22 males, 20 females, age 69.8 ± 6.0) participated in this cross-sectional study. The clinical assessment included the following: IPAQ (International Physical Activity Questionnaire), Hoehn Yahr score, plumb line distance from the spinous process of C7, kyphosis apex, and spinous process of L3 and S1. A real-time ultrasound B-scanner (system MyLab40 by Esaote, Genoa, Italy) was used to obtain muscle images of the right and left biceps brachii (BB), external (EO), and internal oblique (IO) and rectus abdomen (RA). Heckmatt scale and measure of EI through ImageJ software were used to assess muscle quality. RESULTS When considering the Heckmatt score, the RA and BB did not significantly differ between PD and control patients, while there was a significant difference for right (p < 0.01) and left (p = 0.02) IO muscles. There was no difference among EI values of the RA, IO, and BB between PD and control patients. CONCLUSIONS Echo intensity of abdominal wall muscles (rectus abdominis, internal oblique) and biceps brachii did not differ between Parkinsonian patients and healthy subjects. We did not found ultrasound useful in disease evolution assessment or in early diagnosis of postural disorders.
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14
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Shetty AS, Bhatia KP, Lang AE. Dystonia and Parkinson's disease: What is the relationship? Neurobiol Dis 2019; 132:104462. [PMID: 31078682 DOI: 10.1016/j.nbd.2019.05.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/15/2019] [Accepted: 05/07/2019] [Indexed: 01/30/2023] Open
Abstract
Dystonia and Parkinson's disease are closely linked disorders sharing many pathophysiological overlaps. Dystonia can be seen in 30% or more of the patients suffering with PD and sometimes can precede the overt parkinsonism. The response of early dystonia to the introduction of dopamine replacement therapy (levodopa, dopamine agonists) is variable; dystonia commonly occurs in PD patients following levodopa initiation. Similarly, parkinsonism is commonly seen in patients with mutations in various DYT genes including those involved in the dopamine synthesis pathway. Pharmacological blockade of dopamine receptors can cause both tardive dystonia and parkinsonism and these movement disorders syndromes can occur in many other neurodegenerative, genetic, toxic and metabolic diseases. Pallidotomy in the past and currently deep brain stimulation largely involving the GPi are effective treatment options for both dystonia and parkinsonism. However, the physiological mechanisms underlying the response of these two different movement disorder syndromes are poorly understood. Interestingly, DBS for PD can cause dystonia such as blepharospasm and bilateral pallidal DBS for dystonia can result in features of parkinsonism. Advances in our understanding of these responses may provide better explanations for the relationship between dystonia and Parkinson's disease.
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Affiliation(s)
- Aakash S Shetty
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Kailash P Bhatia
- Department of Clinical Movement Disorders and Motor Neuroscience, University College London (UCL), Institute of Neurology, Queen Square, London, United Kingdom
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, Canada.
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15
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Lee TTY, Cheung JCW, Law SY, To MKT, Cheung JPY, Zheng YP. Analysis of sagittal profile of spine using 3D ultrasound imaging: a phantom study and preliminary subject test. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2019. [DOI: 10.1080/21681163.2019.1566025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Timothy Tin-Yan Lee
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
| | - Siu-Yu Law
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
| | - Michael Kai Tsun To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, China
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16
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Zhang X, Jia S, Chen Z, Chong YL, Xie H, Feng D, Wu X, Song DZ, Roy S, Zhao C. Cilia-driven cerebrospinal fluid flow directs expression of urotensin neuropeptides to straighten the vertebrate body axis. Nat Genet 2018; 50:1666-1673. [DOI: 10.1038/s41588-018-0260-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 09/21/2018] [Indexed: 01/27/2023]
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17
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Ruttiman R, Eltorai AEM, Daniels AH. Etiology and Management of Spinal Deformity in Patients With Parkinson's Disease. Int J Spine Surg 2018; 12:15-21. [PMID: 30280078 DOI: 10.14444/5003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Patients with Parkinson's disease (PD) commonly develop severe spinal deformity, including scoliosis, antecollis, camptocormia, and Pisa syndrome. The etiology of PD-associated spinal deformity is not completely understood and in most cases is likely due to multiple interrelated factors, including central dystonia and focal myopathy. Once spinal deformity has occurred, surgery is often the only modality that can correct the condition, although control of the movement disorder through medication and deep brain stimulation may slow progression. Advances in spinal instrumentation and deformity correction techniques have improved the outcomes of PD spinal deformity patients, though complications and revision surgery rates remain high. Surgical intervention is reserved for individuals who are physiologically healthy and whose condition is refractory to nonoperative management and follows similar treatment principles as other causes of neuromuscular scoliosis/kyphosis. Spinal deformity patients with PD are optimally treated by spinal deformity surgeons who are familiar with the unique needs of PD patients, with vigilant preoperative and postoperative treatment of their movement disorder and bone density.
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Affiliation(s)
- Roy Ruttiman
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adam E M Eltorai
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alan H Daniels
- Division of Spine Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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18
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Galbusera F, Bassani T, Stucovitz E, Martini C, Ismael Aguirre MF, Berjano PL, Lamartina C. Surgical treatment of spinal disorders in Parkinson's disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:101-108. [PMID: 29397444 DOI: 10.1007/s00586-018-5499-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/24/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Most patients suffering from Parkinson's disease (PD) exhibit alterations in the posture, which can in several cases give rise to spine deformities, both in the sagittal and the coronal plane. In addition, degenerative disorders of the spine frequently associated to PD, such as spinal stenosis and sagittal instability, can further impact the quality of life of the patient. In recent years, spine surgery has been increasingly performed, with mixed results. The aim of this narrative review is to analyze the spinal disorders associated to PD, and the current evidence about their surgical treatment. METHODS Narrative review. RESULTS Camptocormia, i.e., a pronounced flexible forward bending of the trunk with 7% prevalence, is the most reported sagittal disorder of the spine. Pisa syndrome and scoliosis are both common and frequently associated. Disorders to the spinopelvic alignment were not widely investigated, but a tendency toward a lower ability of PD patients to compensate the sagittal malalignment with respect to non-PD elderly subjects with imbalance seems to emerge. Spine surgery in PD patients showed high rates of complications and re-operations. CONCLUSIONS Disorders of the posture and spinal alignment, both in the sagittal and in the coronal planes, are common in PD patients, and have a major impact on the quality of life. Outcomes of spine surgery are generally not satisfactory, likely mostly due to muscle dystonia and poor bone quality. Knowledge in this field needs to be consolidated by further clinical and basic science studies. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Fabio Galbusera
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Tito Bassani
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Elena Stucovitz
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Carlotta Martini
- G Spine 4, IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy.
| | | | - Pedro L Berjano
- G Spine 4, IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy
| | - C Lamartina
- G Spine 4, IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy
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19
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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.
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20
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Ye X, Lou D, Ding X, Xie C, Gao J, Lou Y, Cen Z, Xiao Y, Miao Q, Xie F, Zheng X, Wu J, Li F, Luo W. A clinical study of the coronal plane deformity in Parkinson disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:1862-1870. [PMID: 28281005 DOI: 10.1007/s00586-017-5018-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 02/12/2017] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Postural deformities in the coronal plane were frequent and disabling complications of PD, which reduces the quality of life of patients. This study aimed to garner greater attention to the Parkinson disease (PD)-related postural trunk deviations in the coronal plane by exploring a method for diagnosis because of the lack of any uniform diagnostic criteria and epidemiological studies. It also aimed to provide correlation data in the Chinese PD patients. METHODS In this cross-sectional study, 503 consecutive outpatients with PD were enrolled who underwent standardized clinical evaluation. The study recruited 83 PD patients diagnosed with Pisa syndrome (PS). Scoliosis and coronal imbalance were diagnosed accurately by radiographic data. The PD patients were compared based on the Cobb angle and coronal balance for several demographic and clinical variables. RESULTS PD patients with PS had a prevalence of 16.5%. The prevalence of coronal imbalance and scoliosis was 10.34 and 7.75%, respectively. PD patients with PS were older and had a more severe disease, significantly longer disease duration and treatment duration, and reduced quality of life. The most important finding was that the different morphology of the spinal level had an effect on the severity of coronal balance or Cobb angle. CONCLUSIONS The present study indicated that the postural deformities in the coronal plane were related to the morphology of the spinal level, especially the position of the Cobb angle. To benefit the PD patients with PS, the full-length standing spine radiographs should be performed as early as possible.
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Affiliation(s)
- Xiaoyun Ye
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Danning Lou
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Xueping Ding
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Neurology, Haining People's Hospital, Jiaxing, China
| | - Chaoyan Xie
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Neurology, Beilun People's Hospital, Ningbo, China
| | - Jixiang Gao
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Yuting Lou
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Pediatrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhidong Cen
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Pediatrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuxiang Xiao
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Qianzhuang Miao
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Pharmacy, Fenghua Hospital, Fenghua, Ningbo, China
| | - Fei Xie
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaosheng Zheng
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Jianxin Wu
- Department of Neurology, No. 117 Hospital of People's Liberation Army, Hangzhou, China
| | - Fangcai Li
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
| | - Wei Luo
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
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21
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Baik JS. Understanding of skeletal deformities in Parkinson's disease. Indian J Med Res 2016; 144:650-652. [PMID: 28361815 PMCID: PMC5393073 DOI: 10.4103/ijmr.ijmr_1166_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jong Sam Baik
- Department of Neurology, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
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22
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Pandey S, Kumar H. Assessment of striatal & postural deformities in patients with Parkinson's disease. Indian J Med Res 2016; 144:682-688. [PMID: 28361820 PMCID: PMC5393078 DOI: 10.4103/ijmr.ijmr_502_15] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND & OBJECTIVES Though striatal and postural deformities are known to occur commonly in atypical Parkinsonism patients, these may also be seen in patients with Parkinson's disease (PD). These are frequently misdiagnosed as joint or orthopaedic pathology leading to unnecessary investigations. This study was conducted to observe the various striatal and postural deformities among patients with PD in India. METHODS This study was conducted at a tertiary care teaching institute in north# India. Seventy consecutive patients with PD diagnosed as per the modified UK Brain Bank criteria were included. Various striatal (hand & foot) and postural (antecollis, camptocormia, scoliosis & Pisa syndrome) deformities and their relation with the duration of disease, severity [measured by the Unified Parkinson's Disease Rating Scale (UPDRS)] and levodopa intake were analyzed. RESULTS Of the 70 patients with PD, 34 (48.57%) had either striatal or postural deformities. Striatal foot was the most common deformity observed (25.71%). Camptocormia was the second most common deformity (20%). Striatal and postural deformities were seen in more advanced PD as suggested by significantly higher UPDRS and Hoehn and Yahr scale (P<0.001). Striatal deformities were more ipsilateral to PD symptom onset side (agreement 94.44%). Pisa and scoliosis concavity were more on contralateral side to PD symptoms onset side (66.67%). INTERPRETATION & CONCLUSIONS Our results showed that striatal and postural deformities were common and present in about half of the patients with PD. These deformities we more common in patients with advanced stage of PD.
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Affiliation(s)
- Sanjay Pandey
- Department of Neurology, GB Pant Hospital, New Delhi, India
| | - Hitesh Kumar
- Department of Neurology, GB Pant Hospital, New Delhi, India
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23
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Tinazzi M, Geroin C, Gandolfi M, Smania N, Tamburin S, Morgante F, Fasano A. Pisa syndrome in Parkinson's disease: An integrated approach from pathophysiology to management. Mov Disord 2016; 31:1785-1795. [PMID: 27779784 DOI: 10.1002/mds.26829] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/09/2016] [Accepted: 09/11/2016] [Indexed: 12/26/2022] Open
Abstract
Pisa syndrome was first described in 1972 in patients treated with neuroleptics. Since 2003, when it was first reported in patients with Parkinson's disease (PD), Pisa syndrome has progressively drawn the attention of clinicians and researchers. Although emerging evidence has partially clarified its prevalence and pathophysiology, the current debate revolves around diagnostic criteria and assessment and the effectiveness of pharmacological, surgical, and rehabilitative approaches. Contrary to initial thought, Pisa syndrome is common among PD patients, with an estimated prevalence of 8.8% according to a large survey. Furthermore, it is associated with the following specific patient features: more severe motor phenotype, ongoing combined pharmacological treatment with levodopa and dopamine agonists, gait disorders, and such comorbidities as osteoporosis and arthrosis. The present literature on treatment outcomes is scant, and the uneven effectiveness of specific treatments has produced conflicting results. This might be because of the limited knowledge of Pisa syndrome pathophysiology and its variable clinical presentation, which further complicates designing randomized clinical trials on this condition. However, because some forms of Pisa syndrome are potentially reversible, there is growing consensus on the importance of its early recognition and the importance of pharmacological adjustment and rehabilitation. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Christian Geroin
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Morgante
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
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24
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Mano T, Nishi R, Kobayashi Y, Matsuo K, Kobayashi Y, Kakehi A. [The novel quantitative measures of gait and posture in Parkinson's disease: cross-sectional analysis]. Rinsho Shinkeigaku 2016; 55:259-62. [PMID: 25904256 DOI: 10.5692/clinicalneurol.55.259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Posture abnormality and gait impairments characterize of Parkinson's disease (PD), predict the risk of falling, and are important contributors to reduced quality of life. The quantitative measures of posture and gait may eventually provide usefulness as a biomarker in PD. This study included that 40 patients with PD (male 26, female 14, average age 70.4 ± 7.6 years old) and 17 normal healthy controls. We selected the quantified measures of the gait function, such as MDS-UPDRS, Timed up & go test, 5 feet walk test, 6 minutes-walk test. The posture angle of both forward flexion and lateral flexion were measured using the application of smartphone, which is capable even in a consulting room. The new posture quantitative measurement is stabile between examiners. The gait functions and the posture angles were significantly abnormal in the PD patients, compared to healthy controls (P < 0.001). The forward flexion angles were well correlated with the ages, on the other hand the lateral flexion angles were well correlated with the duration of the disease. The posture angles do not positively correlate with freezing gait but do correlate in limited univariate analyses with measures of gait function.
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Affiliation(s)
- Tomoo Mano
- Department of Neurology, Okazaki City Hospital; 2.Department of Neurology, Nagoya University Graduate School of Medicine
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25
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Abstract
A wide range of neuromuscular diseases, including Parkinson disease, cerebral palsy, multiple sclerosis, and myopathy, are associated with spinal deformities. The most common postural deformities include anterocollis, Pisa syndrome (pleurothotonus), scoliosis, and camptocormia. Nonsurgical management of spinal deformity in patients with neuromuscular disease centers on maximizing the medical management of the underlying neurodegenerative pathology before surgical intervention is contemplated. Surgical management can include decompression alone, or decompression and fusion with short or long fusion constructs. Patients with neuromuscular disease are susceptible to postoperative medical complications, such as delirium, epidural hematomas, pulmonary emboli, and cardiac events. Compared with outcomes in the typical patient with spinal deformity, postoperative outcomes in patients with neuromuscular disease have higher rates of surgical complications, such as instrumentation failure, proximal junctional kyphosis, loss of correction, and the need for revision surgery, regardless of the magnitude of surgical treatment.
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26
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Rabin ML, Earnhardt MC, Patel A, Ganihong I, Kurlan R. Postural, Bone, and Joint Disorders in Parkinson's Disease. Mov Disord Clin Pract 2016; 3:538-547. [PMID: 30363567 DOI: 10.1002/mdc3.12386] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 12/20/2022] Open
Abstract
Background Stooped posture was mentioned in the original description of the characteristic features of Parkinson's disease (PD). Since then, a variety of postural, bone, and joint problems have become recognized as common aspects of the illness and deserve attention. Methods A Medline literature search for the period from 1970 to 2016 was performed to identify articles relevant to this topic. Keywords for the search included posture, spine, bone disorders, fractures, joint disorders, kyphosis, scoliosis, stooping, camptocormia, Pisa syndrome, frozen shoulder, anterocollis, dropped head syndrome, and pain in combination with PD. The articles were then reviewed to summarize clinical features, frequency, impact, pathophysiology, and treatment options for these conditions. Results Postural disorders (kyphoscoliosis, camptocormia, Pisa syndrome, dropped head syndrome), bone mineralization disorders (osteoporosis, bone fractures), and joint disorders (frozen shoulder, dystonia involving joints, joint pain) are often seen in association with PD. Treatment options for these conditions are varied and may include medications, physical therapy, or surgical interventions. Conclusions Posture, bone, and joint disorders are common in patients with PD; they often produce added disability, and they may be treatable.
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Affiliation(s)
- Marcie L Rabin
- Atlantic Neuroscience Institute Overlook Medical Center Summit New Jersey USA
| | | | - Anvi Patel
- Atlantic Neuroscience Institute Overlook Medical Center Summit New Jersey USA
| | - Ivana Ganihong
- Atlantic Neuroscience Institute Overlook Medical Center Summit New Jersey USA
| | - Roger Kurlan
- Atlantic Neuroscience Institute Overlook Medical Center Summit New Jersey USA
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27
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Abstract
Parkinson's disease (PD) is the most common neurodegenerative disease and is characterized by tremor, rigidity and akinesia. Diagnosis is clinical in the majority of the patients. Patients with PD may have stooped posture but some of them develop different types of postural and striatal deformities. Usually these deformities are more common in atypical parkinsonian disorders such as progressive supranuclear palsy and multisystem atrophy. But in many studies it has been highlighted that these may also be present in approximately one third of PD patients leading to severe disability. These include antecollis or dropped head, camptocormia, Pisa syndrome, scoliosis, striatal hands and striatal toes. The pathogenesis of these deformities is a complex combination of central and peripheral influences such as rigidity, dystonia and degenerative skeletal changes. Duration of parkinsonism symptoms is an important risk factor and in majority of the patients these deformities are seen in advanced statge of the disease. The patients with such symptoms may initially respond to dopaminergic medications but if not intervened they may become fixed and difficult to treat. Pain and restriction of movement are most common clinical manifestations and these may mimick symptoms of musculoskeletal disorders like rheumatoid arthritis. Early diagnosis is important as the patients may respond to adjustment in dopaminergic medications. Recent advances such as deep brain stimulation (DBS) and ultrasound guided botulinum toxin injection are helpful in management of these deformities in patients with PD.
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Affiliation(s)
- Sanjay Pandey
- Department of Neurology, GB Pant Hospital, Delhi, India
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Rana AQ, Ahmed US, Chaudry ZM, Vasan S. Parkinson's disease: a review of non-motor symptoms. Expert Rev Neurother 2016; 15:549-62. [PMID: 25936847 DOI: 10.1586/14737175.2015.1038244] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder resulting from degeneration of the substantia nigra and the dopaminergic nigrostriatal pathway. Most treatments are geared toward the management and relief of motor symptoms in Parkinson's patients; however, as the disease progresses, various complications can be observed. Non-motor symptoms (NMS) may arise simply from the disease itself and are highly destructive to quality of life. These symptoms include mood disorders, cognitive dysfunction, pain, sensory dysfunction, and dysautonomia. Though it is undisputed that many NMS may appear years or even decades prior to the clinical diagnosis of PD, the focus of this review will be the overt motor phase of the condition. As such, the focus of this paper is to review the major NMS found in PD patients status post-diagnosis, their etiology, as well as treatment options available for the individual NMS.
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Affiliation(s)
- Abdul Qayyum Rana
- Parkinson's Clinic of Eastern Toronto & Movement Disorders Centre, Toronto, Ontario, Canada
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Association Between Sagittal Balance and Scoliosis in Patients with Parkinson Disease. Am J Phys Med Rehabil 2016; 95:39-46. [PMID: 26062043 DOI: 10.1097/phm.0000000000000328] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Ha Y, Oh JK, Smith JS, Ailon T, Fehlings MG, Shaffrey CI, Ames CP. Impact of Movement Disorders on Management of Spinal Deformity in the Elderly. Neurosurgery 2015; 77 Suppl 4:S173-85. [DOI: 10.1227/neu.0000000000000940] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Han SW, Cheon KY, Kim JY, Baik JS. Carpal Tunnel Syndrome in Patients with Tremor Dominant Parkinson's Disease. PLoS One 2015; 10:e0130779. [PMID: 26091110 PMCID: PMC4474427 DOI: 10.1371/journal.pone.0130779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/22/2015] [Indexed: 11/18/2022] Open
Abstract
Background Unilateral hand tremor is one of the cardinal symptoms of Parkinson’s disease. Additionally, mechanical traumatic hand movement is one of the risk factors for carpal tunnel syndrome. Our objective in this study was to examine whether repetitive mechanical movement may be related to the development of carpal tunnel syndrome in Parkinson’s disease with unilateral hand tremor using neurophysiological methods. Methods The study participants included 33 de novo Parkinson’s disease patients with unilateral hand tremor, and we compared the tremor hand and non-tremor hand within the same patients. Results Seven (21.2%) of the 33 patients had carpal tunnel syndrome. All of carpal tunnel syndrome patients showed neurophysiological abnormalities in both the hand without tremor and the hand with tremor. In addition, in patients without carpal tunnel syndrome, the sensory nerve action potential was lower in the hand without tremor than in the hand with tremor, although there were no significant differences. Conclusions We concluded that hand tremor in de novo Parkinson’s disease patients was not directly related to the development of carpal tunnel syndrome. In contrast, more frequent use of hand without tremor may induce mechanical loading and may be associated with CTS in the hand without tremor. Early diagnosis of Parkinson’s disease and proper education in hand use may be essential for preventing carpal tunnel syndrome in Parkinson’s disease tremor patients.
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Affiliation(s)
- Sang Won Han
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Kyeong Yeol Cheon
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jeong Yeon Kim
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jong Sam Baik
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
- * E-mail:
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Choi HJ, Smith JS, Shaffrey CI, Lafage VC, Schwab FJ, Ames CP, Matsumoto M, Baik JS, Ha Y. Coronal plane spinal malalignment and Parkinson's disease: prevalence and associations with disease severity. Spine J 2015; 15:115-21. [PMID: 25041726 DOI: 10.1016/j.spinee.2014.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/23/2014] [Accepted: 07/09/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Parkinson's disease (PD) is a progressive degenerative disorder of the central nervous system. Patients with PD often present with abnormal posturing. PURPOSE To investigate coronal plane deformities in patients with PD, and to evaluate the correlation between clinical features, coronal parameters related to spine alignment, and disease severity. STUDY DESIGN A cross-sectional study. PATIENT SAMPLE Eighty-nine patients with PD and 89 controls were included. OUTCOME MEASURES A medical history was collected from the medical records. METHODS This study was a prospective assessment of consecutive patients with PD. Clinical and demographic parameters were collected from medical records and outpatient interviews. Full-length standing anteroposterior and lateral spine radiographs were used to assess the spinal parameters. The threshold for scoliosis was set at a 10° Cobb angle, and the curve type was classified using Schwab classification. RESULTS A total of 178 patients (89 in PD and 89 in control groups) were included. Scoliosis was identified in 27 patients (30%) and 22 controls (p=.502). However, coronal imbalance was more common in patients with PD than in controls (11 vs. 0 patients, p=.001). Scoliosis was more common in women than in men (male:female=8:19, p=.04). Back pain was more common in patients with scoliosis than in those without scoliosis (14 of 27 vs. 17 of 62, p=.036). Schwab Type IV (thoracolumbar major) was the most common type of scoliosis in patients with PD and Type V (lumbar major) was the most common type in controls. With adjustment for patient age and gender, multiple linear regression analysis revealed that severity of PD (Unified Parkinson's Disease Rating Scale, p=.037) and magnitude of global coronal malalignment (p=.003) were associated with the scoliosis Cobb angle (p=.037, B=0.139). Direction of scoliosis and side of global coronal malalignment were not significantly correlated with the laterality of predominant PD symptoms (p>.05). CONCLUSIONS Global coronal malalignment is more prevalent in patients with PD than in controls. Greater severity of PD was significantly associated with greater magnitude of scoliosis Cobb angle, even after adjusting for the effects of patient age and gender. However, direction of scoliosis and side of global coronal malalignment were not significantly associated with the dominant laterality of PD symptoms.
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Affiliation(s)
- Hong June Choi
- Department of Neurosurgery, College of Medicine, Yonsei University, Seodaemun-gu, Seoul, Korea
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, 914 E Jefferson St., Charlottesville, VA 22902, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia, 914 E Jefferson St., Charlottesville, VA 22902, USA
| | - Virginie C Lafage
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 333 E 38th St. Fl 4, New York, NY 10016, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 333 E 38th St. Fl 4, New York, NY 10016, USA
| | - Christopher P Ames
- Department of Neurosurgery, University of California San Francisco, 220 Montgomery St., San Francisco, CA 94104, USA
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi Shinjuku, Tokyo, Japan
| | - Jong Sam Baik
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, College of Medicine, Yonsei University, Seodaemun-gu, Seoul, Korea.
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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
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Bissolotti L, Gobbo M, Zaina F, Lusini M, Donzelli S, Negrini S. Scoliosis and sagittal balance in Parkinson’s disease: analysis of correlations. SCOLIOSIS 2013. [PMCID: PMC3847865 DOI: 10.1186/1748-7161-8-s2-o7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Domenech J, Barrios C, Tormos JM, Pascual-Leone Á. Somatosensory cortectomy induces motor cortical hyperexcitability and scoliosis: an experimental study in developing rats. Spine J 2013; 13:938-46. [PMID: 23623636 DOI: 10.1016/j.spinee.2013.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 02/20/2013] [Accepted: 03/07/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Dysfunctions in sensorimotor integration, reminiscent to those described in idiopathic dystonia, have been found in idiopathic scoliosis (IS) and might be involved in its pathogenesis. Studying the effects of experimental disruption of sensory cortex may shed further insight into the etiopathology of IS. PURPOSE To evaluate whether disruption of central sensorimotor integration through partial ablation of the somatosensory cortex leads to scoliosis in developing rats and to describe the effects of such an intervention on motor cortico-cortical inhibition and facilitation. METHODS Fifty Wistar rats aged 3 weeks were used in the study. Twenty-four rats underwent craniotomy and electrocoagulation of the sensory cortex (PAR1) in the right hemisphere. A second group of 16 rats underwent a sham operation with craniotomy but no electrocoagulation. A third group of 10 rats was used as intact controls. Four weeks after surgery, motor cortical excitability was assessed with paired-pulse electrical cortical stimulation. Neurologic and behavioral examinations were completed serially, and 10 weeks after surgery, X-ray examinations were performed in anesthetized rats to assess spinal curvature. Electromyographic recordings of paravertebral muscle activity were performed in waking rats. At the end of the study, rats were sacrificed, and histologic examinations of brain tissue were performed to confirm the extent of the lesion. A grant from a Government Health Research Fund without salaries assignment financed the study. RESULTS Almost half of the animals with somatosensory cortectomy (46%) developed scoliosis, with an average Cobb angle of 23 ± 8°. None of the animals in the sham or control groups developed scoliosis. Despite cortical lesions, no motor or behavioral deficits were apparent in the experimental group, and cortectomized rats were neurologically indistinguishable from sham or control animals, except for the presence of scoliosis. Cortico-cortical inhibition was significantly reduced in the hemisphere of scoliotic concavity in the cortectomized group but was normal in the other groups. CONCLUSIONS These findings indicate that altered sensorimotor integration may cause scoliosis without noticeable motor impairment. Reduced cortico-cortical inhibition was observed in cortectomized rats. This finding is consistent with results in adolescents with IS and suggests that alteration of cortical hemispheric balance of sensorimotor integration may play an important role in the pathogenesis of IS.
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Affiliation(s)
- Julio Domenech
- Orthopedic Surgery Department, Hospital Arnau de Vilanova, Faculty of Health Science, Cardenal Herrera-CEU University, Calle San Clemente 12, 46015 Valencia, Spain.
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Doménech J, Tormos JM, Barrios C, Pascual-Leone A. Motor cortical hyperexcitability in idiopathic scoliosis: could focal dystonia be a subclinical etiological factor? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 19:223-30. [PMID: 20033462 DOI: 10.1007/s00586-009-1243-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 12/02/2009] [Indexed: 10/20/2022]
Abstract
The aetiology of idiopathic scoliosis (IS) remains unknown; however, there is a growing body of evidence suggesting that the spine deformity could be the expression of a subclinical nervous system disorder. A defective sensory input or an anomalous sensorimotor integration may lead to an abnormal postural tone and therefore the development of a spine deformity. Inhibition of the motor cortico-cortical excitability is abnormal in dystonia. Therefore, the study of cortico-cortical inhibition may shed some insight into the dystonia hypothesis regarding the pathophysiology of IS. Paired pulse transcranial magnetic stimulation was used to study cortico-cortical inhibition and facilitation in nine adolescents with IS, five teenagers with congenital scoliosis (CS) and eight healthy age-matched controls. The effect of a previous conditioning stimulus (80% intensity of resting motor threshold) on the amplitude of the motor-evoked potential induced by the test stimulus (120% of resting motor threshold) was examined at various interstimulus intervals (ISIs) in both abductor pollicis brevis muscles. The results of healthy adolescents and those with CS showed a marked inhibitory effect of the conditioning stimulus on the response to the test stimulus at interstimulus intervals shorter than 6 ms. These findings do not differ from those reported for normal adults. However, children with IS revealed an abnormally reduced cortico-cortical inhibition at the short ISIs. Cortico-cortical inhibition was practically normal on the side of the scoliotic convexity while it was significantly reduced on the side of the scoliotic concavity. In conclusion, these findings support the hypothesis that a dystonic dysfunction underlies in IS. Asymmetrical cortical hyperexcitability may play an important role in the pathogenesis of IS and represents an objective neurophysiological finding that could be used clinically.
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Affiliation(s)
- Julio Doménech
- Department of Orthopaedic Surgery, Hospital Arnau de Vilanova, Valencia, Spain.
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