title: The pathogenesis of Pisa syndrome in Parkinson's disease.
abstract: 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.
authors.affiliation: Grenoble University Hospital, Psychiatry and Neurology Dept., Grenoble, France; Grenoble Institute of Neuroscience, INSERM-UJF-CEA U836, Grenoble, France.
authors.forename: Anna
authors.initials: A
authors.lastname: Castrioto
authors.forename: Céline
authors.initials: C
authors.lastname: Piscicelli
authors.forename: Dominic
authors.initials: D
authors.lastname: Pérennou
authors.forename: Paul
authors.initials: P
authors.lastname: Krack
authors.forename: Bettina
authors.initials: B
authors.lastname: Debû
mesh_terms: D000818:Animals; D001479:Basal Ganglia / Q000473:pathology*; D006801:Humans; D009141:Musculoskeletal System / Q000503:physiopathology; D010300:Parkinson Disease / Q000150:complications* / Q000209:etiology; D004856:Postural Balance / Q000502:physiology*; D012678:Sensation Disorders / Q000209:etiology* / Q000473:pathology*
keywords: Parkinson's disease; basal ganglia; postural deviation; sensory integration; verticality