title: Botulinum toxin type A potentiates the effect of neuromotor rehabilitation of Pisa syndrome in Parkinson disease: a placebo controlled study.
abstract: BACKGROUND
  Pisa syndrome (PS) is a tonic lateral flexion of trunk that represents a disabling complication of advanced Parkinson disease (PD). Conventional rehabilitation treatment (CT) ameliorates axial posture and trunk mobility in PD patients, but the improvement tends to wane in 4-6 months. Botulin toxin (BT) may reduce muscle hyperactivity, therefore improving CT effectiveness. We evaluated whether the injection of incabotulinum toxin type A (iBTA) into the hyperactive trunk muscles might improve the effectiveness of rehabilitation in a group of PD patients with PS.
  
  
  METHODS
  Twenty-six PD patients were enrolled in a randomized placebo-controlled trial. Group A was treated with iBTA before undergoing CT (a 4-week intensive programme), while Group B received saline before the 4-week CT treatment. Patients were evaluated at baseline, at the end of the rehabilitative period, 3 and 6 months with kinematic analysis of movement, UPDRS, Functional Independence Measure and Visual Analog Scale for pain.
  
  
  RESULTS
  At the end of the rehabilitation period, both groups improved significantly in terms of static postural alignment and of range of motion. Group A showed a significantly more marked reduction in pain score as compared with Group B and a more prolonged efficacy on several clinical and kinematic variables.
  
  
  CONCLUSIONS
  Our preliminary data suggest that BT may be considered an important addition to the rehabilitation programme for PD subjects with PS for improving axial posture and trunk mobility, as well as for a better control of pain.
authors.affiliation: Neurological Rehabilitation Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. Electronic address: Cristina.tassorelli@mondino.it.
authors.forename: C
authors.initials: C
authors.lastname: Tassorelli
authors.affiliation: Neurological Rehabilitation Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
authors.forename: R
authors.initials: R
authors.lastname: De Icco
authors.affiliation: Neurophysiology Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Alfonsi
authors.affiliation: Department of Neurorehabilitation, IRCCS Neurological Mediterranean Institute NEUROMED, Pozzilli, Isernia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bartolo
authors.affiliation: Department of Medical and Surgical Science and Biotechnology, La Sapienza University of Rome, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Serrao
authors.affiliation: Neurological Rehabilitation Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Avenali
authors.affiliation: Neurological Rehabilitation Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
authors.forename: I
authors.initials: I
authors.lastname: De Paoli
authors.affiliation: Rehabilitation Centre, Policlinico Italia, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Conte
authors.affiliation: Parkinson and Movement Disorder Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy.
authors.forename: N G
authors.initials: NG
authors.lastname: Pozzi
authors.affiliation: IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Bramanti
authors.affiliation: Neurological Rehabilitation Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy; Neurophysiology Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy; Parkinson and Movement Disorder Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Nappi
authors.affiliation: Neurological Rehabilitation Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Sandrini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004311:Double-Blind Method; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D026201:Musculoskeletal Manipulations / Q000379:methods*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000150:complications*; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000187:drug effects / Q000502:physiology; D016059:Range of Motion, Articular; D012678:Sensation Disorders / Q000188:drug therapy / Q000209:etiology / Q000534:rehabilitation; D016896:Treatment Outcome; D064232:Visual Analog Scale
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; Pain; Parkinson disease; Physical therapy; Pisa syndrome; Rehabilitation