The Cross-Sectional Area of Paraspinal Muscles Predicts the Efficacy of Deep Brain Stimulation for Camptocormia

Sakai, Waka; Nakane, Shunya; Urasaki, Eiichirou; Toyoda, Keisuke; Sadakata, Eisaku; Nagaishi, Akiko; Fukudome, Takayasu; Yamakawa, Yuzo; Matsuo, Hidenori

doi:10.3233/jpd-160948

Cited by 14 publications

(34 citation statements)

References 20 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 .…”

Section: Resultsmentioning

confidence: 99%

“…Interestingly, ≤2 years of camptocormia duration was reported as predictive of better outcomes with an odds ratio of 4.15. Besides camptocormia duration, other presurgical characteristics reported as predictors of the DBS effects on camptocormia have been the camptocormia response to levodopa and evidence for truncal paraspinal myopathy, including imaging‐determined muscle thickness . Given that DBS is usually used to treat motor fluctuations in these patients, reported DBS modes and settings are variable and no study has attempted to correlate specific DBS programs with changes in camptocormia.…”

Section: Discussionmentioning

confidence: 99%

“…These three studies report comparisons of pre-and postsurgical means, but individual patient data are not available. [6][7][8] Of the remaining 35 articles, there were three additional retrospective cohort studies, [9][10][11] 12 case series with sample sizes of up to 25 patients, [12][13][14][15][16][17][18][19][20][21][22][23] and 20 case reports. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Thirty-one studies evaluated the effects of DBS on postural deformities in PD patients.…”

Section: High Risk Of Bias: Retrospective Design Variable Populationmentioning

confidence: 99%

“…18,19,[21][22][23][27][28][29][30]32,[35][36][37][38][39][40][41][42][43] Some of them provided figure(s) and/or video(s) allowing for a semiquantitative estimation of the corresponding postural angles. 23,27,[36][37][38][40][41][42] The most common quantitative outcomes reported for camptocormia were the changes in thoracolumbar angles, 6,[9][10][11]13,15,22 item 28 of part III of the Unified Parkinson's Disease Rating Scale (UPDRS-III), 6,7,14 trunk item of the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), 12,16,17,31 a composite camptocormia score, 20 and shoulder-hip-knee angles. 34 Quantitative outcomes for Pisa syndrome were the change in lateral thoracolumbar angle [24][25][26] and the UPDRS-III item 28.…”

Section: High Risk Of Bias: Retrospective Design Variable Populationmentioning

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: Discussionmentioning

confidence: 99%

Section: High Risk Of Bias: Retrospective Design Variable Populationmentioning

confidence: 99%

Section: High Risk Of Bias: Retrospective Design Variable Populationmentioning

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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Predictors and Pathophysiology of Axial Postural Abnormalities in Parkinsonism: A Scoping Review

Artusi,

Geroin,

Nonnekes

et al. 2023

Movement Disord Clin Pract

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BackgroundPostural abnormalities involving the trunk are referred to as axial postural abnormalities and can be observed in over 20% of patients with Parkinson disease (PD) and in atypical parkinsonism. These symptoms are highly disabling and frequently associated with back pain and a worse quality of life in PD. Despite their frequency, little is known about the pathophysiology of these symptoms and scant data are reported about their clinical predictors, making it difficult to prompt prevention strategies.ObjectivesWe conducted a scoping literature review of clinical predictors and pathophysiology of axial postural abnormalities in patients with parkinsonism to identify key concepts, theories and evidence on this topic.MethodsWe applied a systematic approach to identify studies, appraise quality of evidence, summarize main findings, and highlight knowledge gaps.ResultsNinety‐two articles were reviewed: 25% reported on clinical predictors and 75% on pathophysiology. Most studies identified advanced disease stage and greater motor symptoms severity as independent clinical predictors in both PD and multiple system atrophy. Discrepant pathophysiology data suggested different potential central and peripheral pathogenic mechanisms.ConclusionsThe recognition of clinical predictors and pathophysiology of axial postural abnormalities in parkinsonism is far from being elucidated due to literature bias, encompassing different inclusion criteria and measurement tools and heterogeneity of patient samples. Most studies identified advanced disease stage and higher burden of motor symptoms as possible clinical predictors. Pathophysiology data point towards many different (possibly non‐mutually exclusive) mechanisms, including dystonia, rigidity, proprioceptive and vestibular impairment, and higher cognitive deficits.This article is protected by copyright. All rights reserved.

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Deep brain stimulation for Parkinson’s disease–related postural abnormalities: a systematic review and meta-analysis

et al. 2022

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Deep brain stimulation (DBS) has become a well-established treatment modality for Parkinson’s disease (PD), especially regarding motor fluctuations, dyskinesias, and tremor. Although postural abnormalities (i.e., Camptocormia [CC] and Pisa syndrome [Pisa]) are known to be a major symptom of PD as well, the influence of DBS on postural abnormalities is unclear. The objective of this study is to analyze the existing literature regarding DBS for PD-associated postural abnormalities in a systematic review and meta-analysis. In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review and meta-analysis of 18 studies that reported the effect of DBS regarding postural abnormalities. After screening of 53 studies, a total of 98 patients (44 female, 53 males, 1 not reported; mean age: 62.3, range 30–83 years) with postural abnormalities (CC n = 98; Pisa n = 11) were analyzed from 18 included studies. Of those patients, 94.9% underwent STN-DBS and 5.1% had GPi as DBS target area. A positive outcome was reported for 67.8% with CC and 72.2% with Pisa. In the meta-analysis, younger age and lower pre-operative UPDRS-III (ON/OFF) were found as positive predictive factors for a positive effect of DBS. DBS might be a potentially effective treatment option for PD-associated postural abnormalities. However, the level of evidence is rather low, and definition of postoperative outcome is heterogenous between studies. Therefore larger, prospective trials are necessary to give a clear recommendation.

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The Cross-Sectional Area of Paraspinal Muscles Predicts the Efficacy of Deep Brain Stimulation for Camptocormia

Abstract: The CSA of paraspinal muscles and erector spinae width can be good predictive markers for improving camptocormia in patients with PD after deep brain stimulation.

Cited by 14 publications

References 20 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

Predictors and Pathophysiology of Axial Postural Abnormalities in Parkinsonism: A Scoping Review

Deep brain stimulation for Parkinson’s disease–related postural abnormalities: a systematic review and meta-analysis

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