title: Pisa syndrome in Parkinson's disease: clinical, electromyographic, and radiological characterization.
abstract: 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.
authors: IRCCS National Neurological Institute C. Mondino Foundation, Pavia, Italy. cristina.tassorelli@mondino.it
authors: Cristina
authors: C
authors: Tassorelli
authors: Anna
authors: A
authors: Furnari
authors: Simona
authors: S
authors: Buscone
authors: Enrico
authors: E
authors: Alfonsi
authors: Claudio
authors: C
authors: Pacchetti
authors: Roberta
authors: R
authors: Zangaglia
authors: Anna
authors: A
authors: Pichiecchio
authors: Stefano
authors: S
authors: Bastianello
authors: Alessandro
authors: A
authors: Lozza
authors: Marta
authors: M
authors: Allena
authors: Monica
authors: M
authors: Bolla
authors: Giorgio
authors: G
authors: Sandrini
authors: Giuseppe
authors: G
authors: Nappi
authors: Emilia
authors: E
authors: Martignoni
mesh_terms: D000368:Aged; D001284:Atrophy / Q000209:etiology; D004576:Electromyography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010300:Parkinson Disease / Q000150:complications*; D011187:Posture / Q000502:physiology*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014102:Torsion Abnormality / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology