Pisa syndrome as a motor complication of Parkinson's disease

Kim, Joong‐Seok; Park, Jeong Wook; Chung, Sung Woo; Kim, Yeong In; Kim, Hee-Tae; Lee, Kwang Soo

doi:10.1016/j.parkreldis.2006.03.010

Cited by 37 publications

(41 citation statements)

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“…In rare instances, idiopathic cases of ''lateral trunk flexion'' (LTF), mimicking Pisa syndrome, have been described in otherwise normal subjects not receiving any therapy [5], or in patients affected by neurodegenerative disorders such as multiple system atrophy [6] and Alzheimer's disease [7]. Recently, LTF has also been reported in patients affected by Parkinson's disease (PD) [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Lateral trunk flexion in Parkinson’s disease: EMG features disclose two different underlying pathophysiological mechanisms

et al. 2010

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Pisa Syndrome is clinically defined as the sustained lateral bending of the trunk worsened by a prolonged sitting position or by walking. Pisa syndrome, also termed lateral trunk flexion (LTF), has been rarely reported in patients affected by Parkinson's disease (PD) and, therefore, the pathophysiology has been poorly investigated. In some cases, the hyperactivity of paravertebral muscles contralateral to the leaning side has been interpreted as a sign of dystonia; however, it is well known that paravertebral muscles flex the trunk ipsilaterally. We systematically explored the pattern of muscular activation underlying the lateral flexion of trunk in 10 PD patients (mean disease duration: 9.2 ± 3.0 years) presenting LTF for 3.6 ± 2.1 years. EMG performed during stance and during left and right lateral trunk flexion showed a continuous ipsilateral muscular hyperactivity in three patients, while in the remaining ones there was no ipsilateral activity during standing and a tonic contraction of paravertebral muscles contralateral to the leaning side. In conclusion, this EMG study investigating the synergies of paravertebral muscles during dynamic conditions detected two different patterns with a typical dystonic activation in only a minority of cases. Possible pathophysiologic mechanisms and treatment approaches are discussed.

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Section: Introductionmentioning

confidence: 99%

Lateral trunk flexion in Parkinson’s disease: EMG features disclose two different underlying pathophysiological mechanisms

et al. 2010

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“…28,30,31 Another observation pointing to the involvement of central dopaminergic system is that PS can occur as a motor complication of PD. Kim et al 7 reported two PD patients who developed PS during the "off " period with favorable response to an increase of levodopa dosage. Nevertheless, most of the PD patients with PS will not benefit from increasing dopaminergic therapy.…”

Section: Pathophysiologymentioning

confidence: 99%

“…15,54,59 In some PD patients, PS can appear as a motor complication during the "off " period. 7 In such cases, increasing the dose of levodopa may provide amelioration of abnormal posture. Other oral medications used to treat PS include anticholinergics and novel antipsychotics without interference with dopaminergic receptors, such as clozapine and quetiapine.…”

Section: Treatmentmentioning

confidence: 99%

“…It was originally described by Ekbom et al 1 as acute truncal dystonia or pleurothonus related to butyrophenone administration. The term PS was subsequently applied to patients with dementia and other neurodegenerative diseases, such as Alzheimer's disease, 2 Lewy body disease, 3 Parkinson's disease (PD), [4][5][6][7] multiple system atrophy, 8 progressive supranuclear palsy, 9 and Huntington's disease, 10 who developed lateral trunk deviation. In addition, PS has been described in patients with normotensive hydrocephalus, 11 subdural hematoma, 12 subacute sclerosing panencephalitis, 13 or can present as an isolated and idiopathic condition.…”

Section: Introductionmentioning

confidence: 99%

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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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“…Lateral flexion in PD is poorly responsive to treatment with anti-parkinsonian drugs, although some success with levodopa was anecdotally reported [41]. If there is suspicion that dopamine agonists lead to the development of lateral flexion, this should be discontinued.…”

Section: Lateral Flexion and Pisa Syndromementioning

confidence: 99%