Pisa syndrome after unilateral pallidotomy in Parkinson's disease: an unrecognised, delayed adverse event?

Warrenburg, B.P.C. van de; Bhatia, Kailash P.; Quinn, Niall

doi:10.1136/jnnp.2006.103358

Cited by 31 publications

(10 citation statements)

References 6 publications

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“…Because PD without Pisa syndrome also had deficiencies in postural verticality compared to healthy controls [ 132 , 136 - 138 ], mismatch between proprioception and vestibular gravitation in PD may alter subjective postural verticality, resulting in Pisa syndrome. Alternatively, asymmetry of the basal ganglia output, which is due to cholinergic-dopaminergic imbalance in the striatum [ 134 , 139 , 140 ] or disturbance of the pallidal output [ 141 , 142 ], may also elicit left-right disproportion of the thalamocortical processing of vestibular information.…”

Section: Higher-order Regulation Of Posture-gait Controlmentioning

confidence: 99%

Functional Neuroanatomy for Posture and Gait Control

Takakusaki¹

2017

JMD

613

545

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Here we argue functional neuroanatomy for posture-gait control. Multi-sensory information such as somatosensory, visual and vestibular sensation act on various areas of the brain so that adaptable posture-gait control can be achieved. Automatic process of gait, which is steady-state stepping movements associating with postural reflexes including headeye coordination accompanied by appropriate alignment of body segments and optimal level of postural muscle tone, is mediated by the descending pathways from the brainstem to the spinal cord. Particularly, reticulospinal pathways arising from the lateral part of the mesopontine tegmentum and spinal locomotor network contribute to this process. On the other hand, walking in unfamiliar circumstance requires cognitive process of postural control, which depends on knowledges of self-body, such as body schema and body motion in space. The cognitive information is produced at the temporoparietal association cortex, and is fundamental to sustention of vertical posture and construction of motor programs. The programs in the motor cortical areas run to execute anticipatory postural adjustment that is optimal for achievement of goal-directed movements. The basal ganglia and cerebellum may affect both the automatic and cognitive processes of posturegait control through reciprocal connections with the brainstem and cerebral cortex, respectively. Consequently, impairments in cognitive function by damages in the cerebral cortex, basal ganglia and cerebellum may disturb posture-gait control, resulting in falling.

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Section: Higher-order Regulation Of Posture-gait Controlmentioning

confidence: 99%

Functional Neuroanatomy for Posture and Gait Control

Takakusaki¹

2017

JMD

613

545

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“…PD patients with PS show greater motor asymmetry than PD patients without PS . Basal ganglia involvement is further supported by the occurrence of PS after basal ganglia surgery …”

Section: Pathophysiology Of Psmentioning

confidence: 99%

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

et al. 2016

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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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“…There are two reports of PS developing in patients after pallidotomy, at a time interval of 4-9 years after surgery. 40,41 Postural control depends on vestibular, visual, and somatosensory information. For proper postural control, all these components should act in highly harmonized, synchronous, and orchestral manner.…”

Section: Pathophysiologymentioning

confidence: 99%

Pisa syndrome in Parkinson's disease: diagnostic and management challenges

Miletić¹

2016

JPRLS

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Pisa syndrome is a rare clinical entity characterized by marked lateral flexion of the trunk, which is typically mobile and resolves at supine position. When observed in clinical practice, it denotes an incapacitating symptom of underlying neurodegenerative disease such as Parkinson's disease, multiple system atrophy, and Alzheimer's disease. The underlying pathophysiological mechanisms responsible for the development of Pisa syndrome are poorly understood, and its management remains a challenge. In this review, we will focus our attention on Pisa syndrome in patients with Parkinson's disease, and provide an update on prevalence, pathophysiology, clinical manifestation, and treatment options.

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Pisa syndrome after unilateral pallidotomy in Parkinson's disease: an unrecognised, delayed adverse event?

Cited by 31 publications

References 6 publications

Functional Neuroanatomy for Posture and Gait Control

Functional Neuroanatomy for Posture and Gait Control

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

Pisa syndrome in Parkinson's disease: diagnostic and management challenges

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Pisa syndrome after unilateral pallidotomy in Parkinson's disease: an unrecognised, delayed adverse event?

Cited by 31 publications

References 6 publications

Functional Neuroanatomy for Posture and Gait Control

Functional Neuroanatomy for Posture and Gait Control

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

Pisa syndrome in Parkinson&#39;s disease: diagnostic and management challenges

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Pisa syndrome in Parkinson's disease: diagnostic and management challenges