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Pisa syndrome in Parkinson's disease: Clinical, electromyographic, and radiological characterization
Author(s) -
Tassorelli Cristina,
Furnari Anna,
Buscone Simona,
Alfonsi Enrico,
Pacchetti Claudio,
Zangaglia Roberta,
Pichiecchio Anna,
Bastianello Stefano,
Lozza Alessandro,
Allena Marta,
Bolla Monica,
Sandrini Giorgio,
Nappi Giuseppe,
Martigi Emilia
Publication year - 2012
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.23930
Subject(s) - medicine , trunk , abnormality , lumbar , sagittal plane , electromyography , parkinson's disease , atrophy , radiological weapon , low back pain , anatomy , surgery , disease , physical medicine and rehabilitation , pathology , ecology , alternative medicine , psychiatry , biology
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 the deviation, with a craniocaudal gradient. PS may represent a complication of advanced PD in a subgroup of patients who show more marked asymmetry of disease and who have detectable hyperactivity of the dorsal paravertebral muscles on the less affected side. This postural abnormality deserves attention and proper early treatment to prevent comorbidities and pain. © 2011 Movement Disorder Society