High-Frequency Pallidal Stimulation for Camptocormia in Parkinson Disease: Case Report

Thani, Nova; Bala, Arul; Kimber, Thomas; Lind, Christopher R. P.

doi:10.1227/neu.0b013e318210c859

Cited by 20 publications

(31 citation statements)

References 31 publications

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“…These three studies report comparisons of pre‐ and postsurgical means, but individual patient data are not available . Of the remaining 35 articles, there were three additional retrospective cohort studies, 12 case series with sample sizes of up to 25 patients, and 20 case reports …”

Section: Resultsmentioning

confidence: 99%

“…Camptocormia (trunk anteflexion, bent spine syndrome) was defined using a thoracolumbar or bending angle threshold of either ≥30 or ≥ 45 degrees . One case report used the shoulder‐hip‐knee angle . Ventral thoracolumbar angle ≥30 degrees and ventral thoracic angle ≥45 degrees were used to define lower and upper subtypes of camptocormia, respectively .…”

Section: Resultsmentioning

confidence: 99%

“…Some of them provided figure(s) and/or video(s) allowing for a semiquantitative estimation of the corresponding postural angles . The most common quantitative outcomes reported for camptocormia were the changes in thoracolumbar angles, item 28 of part III of the Unified Parkinson's Disease Rating Scale (UPDRS‐III), trunk item of the Burke‐Fahn‐Marsden Dystonia Rating Scale (BFMDRS), a composite camptocormia score, and shoulder‐hip‐knee angles . Quantitative outcomes for Pisa syndrome were the change in lateral thoracolumbar angle and the UPDRS‐III item 28 .…”

Section: Resultsmentioning

confidence: 99%

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Effects of Deep Brain Stimulation on Postural Trunk Deformities: A Systematic Review

Lizárraga

Fasano

2019

Movement Disord Clin Pract

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Background Deep brain stimulation (DBS) effects on postural deformities are still poorly explored. Methods Systematic review in accord with the Preferred Reporting Items for Systematic review and Meta‐Analysis guidelines (PRISMA). Results All 38 studies that met predefined eligibility criteria had high risk of bias attributed to retrospective analysis of heterogeneous populations with variable and incompletely reported demographic and clinical characteristics, definitions, outcomes, DBS indications, targets, and settings. Five patient groups were identified in the 35 studies with individual data available: (1) parkinsonian camptocormia (n = 96): 89 patients underwent subthalamic (STN) and 7 globus pallidus pars interna (GPi) DBS. Camptocormia was the indication in 3 patients. After DBS, camptocormia improved in 57 of 96 patients (4.3–100% improvement) and remained stable or worsened in 39 of 96 patients (2–100% worsening). (2) dystonic camptocormia (n = 16): All underwent GPi‐DBS. They were younger and with shorter disease duration, but longer deformity duration, compared with parkinsonian camptocormia. After GPi‐DBS, camptocormia improved in all patients (50–100% improvement). (3) Parkinsonian Pisa syndrome (n = 14): 11 patients underwent STN‐DBS for motor fluctuations whereas Pisa syndrome was the indication for pedunculopontine and GPi‐DBS in 2 patients. After DBS, Pisa improved in 10 of 14 patients (33.3–66.7% improvement). (4) Dystonic opisthotonus: 2 young patients remarkably responded to GPi‐DBS. (5) Parkinsonian anterocollis: There were variable responses in 3 patients after STN‐DBS for motor fluctuations. Conclusions Low‐quality level of evidence suggests that dystonic camptocormia and opisthotonus improve after GPi‐DBS. Parkinsonian camptocormia, Pisa syndrome, and anterocollis have variable responses, and their dystonic features should be further explored.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Effects of Deep Brain Stimulation on Postural Trunk Deformities: A Systematic Review

Lizárraga

Fasano

2019

Movement Disord Clin Pract

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“…857 Third, there have been a few cases showing that camptocormic symptoms could be reversed following levodopa. 6369 Fourth, camptocormic symptoms were also improved by high-frequency subthalamic nucleus 1970–75 or globus pallidus interna deep brain stimulation 7677 (STN or GPi-DBS) together with improved motor symptoms in patients with PD. The argument against this idea is that most cases of camptocormia in PD did not respond to either levodopa 858 or DBS.…”

Section: Pathogenesis Of Camptocormia In Pdmentioning

confidence: 99%

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

Srivanitchapoom

Hallett

2015

J Neurol Neurosurg Psychiatry

132

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

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“…The site of injection appears to play an important role in achieving a beneficial effect in certain PD patients with camptocormia. DBS of the subthalamic nuclei [40] and globus pallidus internus [41] is also reported to improve camptocormia. Surgical thoracolumbar spinal fixation for camptocormia has been reported with excellent sagittal correction [42].…”

Section: Managementmentioning

confidence: 99%

Postural Disorders in Parkinson’s Disease: Clinical characteristics, frequency, Pathophysiology and Management

Kashihara

2012

Neurodegen. Dis. Manage.

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SUMMARY Postural disorders are frequently observed in Parkinson’s disease patients and significantly affect patients’ quality of life. They may develop because of increased muscle tonus, which results in shortened muscle fibers and induces contracted postures and subsequent changes in muscles, connective tissue, bones and peripheral nerves. Enhanced muscle tonus may induce forward and/or lateral flexion of the spine. Abnormal postures usually occur in the middle or later stages of the disease, and are often reversible in the supine position. Forward flexion, lateral flexion and, less frequently, antecollis are the common axial postural disorders in Parkinson’s disease patients. While antiparkinsonian drugs may improve these symptoms, they may also induce or worsen them. As postural disorders become irreversible after the development of secondary changes, such as muscle atrophy and bone fracture, physicians should recognize postural disorders at early stages.

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High-Frequency Pallidal Stimulation for Camptocormia in Parkinson Disease: Case Report

Abstract: Camptocormia in Parkinson disease may represent a form of dystonia and can be treated effectively with chronic pallidal neuromodulation.

Cited by 20 publications

References 31 publications

Effects of Deep Brain Stimulation on Postural Trunk Deformities: A Systematic Review

Effects of Deep Brain Stimulation on Postural Trunk Deformities: A Systematic Review

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

Postural Disorders in Parkinson’s Disease: Clinical characteristics, frequency, Pathophysiology and Management

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