How Do I Examine Postural Disorders in Parkinson's Disease? (original) (raw)

Postural deformities in Parkinson's disease

The Lancet Neurology, 2011

Postural deformities are frequent and disabling complications of Parkinson's disease (PD) and atypical parkinsonism. These deformities include camptocormia, antecollis, Pisa syndrome, and scoliosis. Recognition of specifi c postural syndromes might have diff erential diagnostic value in patients presenting with parkinsonism. The evidence to date suggests that postural deformities have a multifactorial pathophysiology. Contributing factors include muscular rigidity; axial dystonia; weakness caused by myopathy; body scheme defects due to centrally impaired proprioception; and structural changes in the spine. The relative contribution of these diff erent factors varies between patients and across specifi c syndromes. Improved understanding of the mechanisms underlying postural deformities in PD might ultimately lead us to more eff ective management strategies for these disabling and drug-refractory complications.

Postural Abnormalities in Parkinson's Disease: An Epidemiological and Clinical Multicenter Study

Movement Disorders Clinical Practice, 2019

ABSTRACTIntroductionThe overall frequency of postural abnormalities (PA) in Parkinson's disease (PD) is unknown. We evaluated the overall prevalence of PA and assessed the association with demographic and clinical variables.MethodsFor this multicenter, cross‐sectional study, consecutive PD outpatients attending 7 tertiary Italian centers were enrolled. Patients were evaluated and compared for the presence of isolated PA such as camptocormia, Pisa syndrome, and anterocollis and for combined forms (ie, camptocormia + Pisa syndrome) together with demographic and clinical variables.ResultsOf the total 811 PD patients enrolled, 174 (21.5%; 95% confidence interval [CI], 18.6%–24.3%) presented PA, 144 of which had isolated PA and 30 had combined PA. The prevalence of camptocormia was 11.2% (95% CI, 9%–13.3%), Pisa syndrome 8% (95% CI, 6.2%–9.9%), and anterocollis 6.5% (95% CI, 4.9%–8.3%). Patients with PA were more often male and older with longer disease duration, more advanced diseas...

Pisa syndrome in Parkinson's disease: Clinical, electromyographic, and radiological characterization

Movement disorders : official journal of the Movement Disorder Society, 2012

Abnormal postures of the trunk are a typical feature of Parkinson's disease (PD). These include Pisa syndrome (PS), a tonic lateral flexion of the trunk associated with slight rotation along the sagittal plane. In this study we describe clinical, electromyographic (EMG), and radiological features of PS in a group of 20 PD patients. All patients with trunk deviation underwent EMG and radiological (RX and CT scan) investigation. Clinical characteristics of patients with PS were compared with a control group of PD patients without trunk deviation. PD patients with PS showed a significantly higher score of disease asymmetry compared with the control group. In the majority of patients with PS, trunk bending was contralateral to the side of symptom onset. EMG showed abnormal tonic hyperactivity on the side of the deviation in the paravertebral thoracic muscles and in the abdominal oblique muscles. CT of the lumbar paraspinal muscles showed muscular atrophy more marked on the side of ...

Artículo original Differential diagnosis among parkinsonian and dystonic camptocormia

Background: Camptocormia is characterized by a marked thoracolumbar spine flexion that disappears in resting position. A clinical analysis among a patient with parkinsonian camptocormia and a case with dystonic camptocormia is described. Methods: Among our cohort of 140 patients with Parkinson disease we found one patient with camptocormia. The diagnosis was performed when the patient exhibited a flexion (> 45°) of thoracolumbar spine increasing during walking and disappearing in recumbent position. This patient was compared to a patient showing a severe lateral flexion of the spine that was diagnosed as dystonic camptocormia. Both cases had complete neurological examination, UPDRS, and head, cervical and thoracic magnetic resonance imaging. Clinical manifestations and response to treatment are described. Results: A 46 years-old male patient started with right lateral flexion of his trunk, head drop and laterocolis 3 years before evaluation, no extrapyramidal signs were observed. He received thioridazine for 2 years at the age of 40. MRI showed a normal brain, cervical lordosis and thoracic kyphosis. A moderate improvement with botulinum toxin was observed. A 72 years-old Parkinsonian male developed forward flexion (> 45º) in the last year that increased during walking. Head and spine MRI were normal. He showed improvement on his extrapyramidal signs and posture after levodopa treatment. Discussion: Patient with dystonic camptocormia showed a lateral flexion of the trunk associated to dystonic posture of the neck, head drop, absence of extrapyramidal signs and moderate response to botulinum toxin injection. On the other hand, the patient with Parkinsonian camptocormia showed severe forward flexion of the trunk, extrapyramidal signs, absence of head drop and improvement in his posture with levodopa treatment. Since the pathogenesis of camptocormia is unknown and the etiologies are multiple, there is no accepted form of treatment. Conclusion: Differential diagnosis of camptocormia subtype may be useful for an accurate classification and for an appropriate treatment. Diagnóstico diferencial entre camptocormia parkinsónica y camptocormia distónica RESUMEN Introducción: La camptocormia se caracteriza por flexión marcada de la columna toracolumbar que desaparece en reposo. Se describe análisis clínico en un paciente con camptocormia parkinsónica y otro con camptocormia distónica. Métodos: En nuestra cohorte de 140 pacientes con enfermedad de Parkinson sólo uno mostró camptocormia. El diagnóstico se efectuó en presencia de flexión > 45º de la columna toracolumbar que aumenta al caminar y desaparece en posición supina. Se compararon los datos clínicos con la severa flexión lateral de la columna observada en un paciente con distonía. En ambos casos se efectuó examen neurológico, UPDRS, resonancia magnética de cerebro, columna cervical y torácica. Se describen hallazgos clínicos y tratamiento. Resultados: Masculino de 46 años inició con flexión lateral derecha del tronco y cabeza con laterocolis de tres años de evolución y sin signos extrapiramidales. Recibió tioridazina por dos años a la edad de 40 años. La IRM cerebro fue normal y la columna reveló lordosis cervical y cifosis torácica. Posterior a la aplicación de toxina botulínica se observó mejoría de su postura. Masculino de 72 años de edad con enfermedad de Parkinson, desarrolló flexión anterior del tronco (> 45º) en el último año que aumentaba al caminar. La resonancia resultó normal. Se observó mejoría de su postura y signos extrapiramidales con levodopa. Discusión: El paciente con camptocormia distónica muestra flexión lateral del tronco asociada a postura distónica de cabeza y cuello, ausencia de signos extrapiramidales y moderada respuesta a la toxina botulínica. Por otra parte, el paciente con camptocormia parkinsónica mostró severa flexión anterior del tronco, signos extrapiramidales, ausencia de posturas anormales de cabeza y cuello y mejoría de la postura con levodopa. La etiología de la camptocormia es variada, su patogénesis es desconocida y no existe tratamiento aceptado. Conclusión: El diagnóstico diferencial del subtipo de camptocormia puede ser útil para una clasificación adecuada y tratamiento apropiado.

Parkinson's disease with camptocormia

Journal of Neurology, Neurosurgery & Psychiatry, 2006

Background: Camptocormia is defined as an abnormal flexion of the trunk that appears when standing or walking and disappears in the supine position. The origin of the disorder is unknown, but it is usually attributed either to a primary or a secondary paravertebral muscle myopathy or a motor neurone disorder. Camptocormia is also observed in a minority of patients with parkinsonism. Objective: To characterise the clinical and electrophysiological features of camptocormia and parkinsonian symptoms in patients with Parkinson's disease and camptocormia compared with patients with Parkinson's disease without camptocormia. Methods: Patients with parkinsonism and camptocormia (excluding patients with multiple system atrophy) prospectively underwent a multidisciplinary clinical (neurological, neuropsychological, psychological, rheumatological) and neurophysiological (electromyogram, ocular movement recording) examination and were compared with age-matched patients with Parkinson's disease without camptocormia. Results: The camptocormia developed after 8.5 (SD 5.3) years of parkinsonism, responded poorly to levodopa treatment (20%) and displayed features consistent with axial dystonia. Patients with camptocormia were characterised by prominent levodopa-unresponsive axial symptoms (ie, axial rigidity, gait disorder and postural instability), along with a tendency for greater error in the antisaccade paradigm. Conclusion: We suggest that (1) the salient features of parkinsonism observed in patients with camptocormia are likely to represent a specific form of Parkinson's disease and camptocormia is an axial dystonia and (2) both camptocormia and parkinsonism in these patients might result from additional, nondopaminergic neuronal dysfunction in the basal ganglia.

Pisa syndrome in Parkinson disease: An observational multicenter Italian study

Neurology, 2015

To estimate the prevalence of Pisa syndrome (PS) in patients with Parkinson disease (PD) and to assess the association between PS and demographic and clinical variables. In this multicenter cross-sectional study, consecutive outpatients with PD attending 21 movement disorders Italian tertiary centers were enrolled and underwent standardized clinical evaluation. PS was defined as trunk lateral deviation ≥10°. Patients with PD were compared according to the presence of PS for several demographic and clinical variables. Among 1,631 enrolled patients with PD, PS was detected in 143 patients (8.8%, 95% confidence interval 7.4%-10.3%). Patients with PS were older, had lower body mass index, longer disease duration, higher disease stages, and poorer quality of life. Falls were more frequent in the PS group as well as occurrence of "veering gait" (i.e., the progressive deviation toward one side when patient walked forward and backward with eyes closed). Patients with PS received h...

Diagnóstico diferencial entre camptocormia parkinsónica y camptocormia distónica

Background: Camptocormia is characterized by a marked thoracolumbar spine flexion that disappears in resting position. A clinical analysis among a patient with parkinsonian camptocormia and a case with dystonic camptocormia is described. Methods: Among our cohort of 140 patients with Parkinson disease we found one patient with camptocormia. The diagnosis was performed when the patient exhibited a flexion (> 45°) of thoracolumbar spine increasing during walking and disappearing in recumbent position. This patient was compared to a patient showing a severe lateral flexion of the spine that was diagnosed as dystonic camptocormia. Both cases had complete neurological examination, UPDRS, and head, cervical and thoracic magnetic resonance imaging. Clinical manifestations and response to treatment are described. Results: A 46 years-old male patient started with right lateral flexion of his trunk, head drop and laterocolis 3 years before evaluation, no extrapyramidal signs were observed. He received thioridazine for 2 years at the age of 40. MRI showed a normal brain, cervical lordosis and thoracic kyphosis. A moderate improvement with botulinum toxin was observed. A 72 years-old Parkinsonian male developed forward flexion (> 45º) in the last year that increased during walking. Head and spine MRI were normal. He showed improvement on his extrapyramidal signs and posture after levodopa treatment. Discussion: Patient with dystonic camptocormia showed a lateral flexion of the trunk associated to dystonic posture of the neck, head drop, absence of extrapyramidal signs and moderate response to botulinum toxin injection. On the other hand, the patient with Parkinsonian camptocormia showed severe forward flexion of the trunk, extrapyramidal signs, absence of head drop and improvement in his posture with levodopa treatment. Since the pathogenesis of camptocormia is unknown and the etiologies are multiple, there is no accepted form of treatment. Conclusion: Differential diagnosis of camptocormia subtype may be useful for an accurate classification and for an appropriate treatment.

Pisa syndrome in Parkinson's disease: An integrated approach from pathophysiology to management

Movement disorders : official journal of the Movement Disorder Society, 2016

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 pro...