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The pathogenesis of Pisa syndrome in Parkinson's disease
Author(s) -
Castrioto Anna,
Piscicelli Céline,
Pérennou Dominic,
Krack Paul,
Debû Bettina
Publication year - 2014
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.25925
Subject(s) - parkinson's disease , pathophysiology , neuroscience , physical medicine and rehabilitation , disease , basal ganglia , medicine , movement disorders , psychology , affect (linguistics) , central nervous system , pathology , communication
Postural abnormalities such as postural deviations affect nearly all patients with advanced Parkinson's disease and represent an important source of disability. Although their existence has long been known, their management remains a challenge as they respond poorly to medication, brain surgery, or physiotherapy. Improving management strategies will require better understanding of the mechanisms underlying such postural deformities. In this review on the pathophysiology of Pisa syndrome, we examine the data supporting the central and peripheral hypotheses that attempt to explain these lateral trunk deviations. Although the pathophysiology is very probably multifactorial, the bulk of the data supports central, rather than peripheral, hypotheses. The central hypotheses that are best supported by both animal studies and clinical data include asymmetry of basal ganglia output and abnormalities in the central integration of sensory information. Further studies are needed to elucidate the pathophysiology underlying Pisa syndrome. © 2014 International Parkinson and Movement Disorder Society