title: Pisa syndrome in Parkinson's disease: an electrophysiological and imaging study.
abstract: The pathophysiology of postural abnormalities in patients with Parkinson's disease is poorly understood. In the present study, 13 patients with Pisa syndrome (PS) underwent EMG study of paraspinal lumbar (L2-L4) and thoracic (T8-T10) muscles, and of non-paraspinal muscles. Patients also underwent a whole spine X-ray and an MRI assessment of paraspinal muscles (L1-S1). The EMG evaluation disclosed two main patterns: patients with pattern I (n = 6, hyperactivity of lumbar paraspinals ipsilateral to the trunk leaning side) or pattern II (n = 7: hyperactivity of lumbar paraspinals contralateral to the trunk leaning side. In pattern I, half the patients also had ipsilateral hyperactivity of the thoracic paraspinals, the other half had contralateral thoracic hyperactivity; in pattern II, thoracic paraspinal hyperactivity was contralateral in all patients (like the lumbar paraspinal hyperactivity). Non-paraspinal muscles were hyperactive ipsilaterally in four of six patients with pattern I and in all patients with pattern II. The MRI showed mild muscular atrophy with fatty degeneration in patients with pattern I, whereas in pattern II patients this was greater and prevalent on paraspinal lumbar muscles ipsilateral to the leaning side. The present data support the hypothesis that two main patterns of muscular activation are associated with PS. In both patterns, hyperactivity of contralateral paraspinal muscles is probably compensatory for the trunk leaning.
authors.affiliation: Dipartimento di Scienze Neurologiche, Psicologiche, Morfologiche e Motorie, Università di Verona, Verona, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Tinazzi
authors.forename: Ina
authors.initials: I
authors.lastname: Juergenson
authors.forename: Giovanna
authors.initials: G
authors.lastname: Squintani
authors.forename: Gaetano
authors.initials: G
authors.lastname: Vattemi
authors.forename: Stefania
authors.initials: S
authors.lastname: Montemezzi
authors.forename: Daniela
authors.initials: D
authors.lastname: Censi
authors.forename: Paolo
authors.initials: P
authors.lastname: Barone
authors.forename: Tommaso
authors.initials: T
authors.lastname: Bovi
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fasano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001284:Atrophy; D004421:Dystonia / Q000209:etiology* / Q000503:physiopathology*; D004576:Electromyography; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064170:Paraspinal Muscles / Q000473:pathology / Q000503:physiopathology*; D010300:Parkinson Disease / Q000150:complications* / Q000503:physiopathology*; D011187:Posture / Q000502:physiology; D011859:Radiography; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology; D013909:Thorax
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa