title: Pisa Syndrome in Parkinson's Disease: Electromyographic Aspects and Implications for Rehabilitation.
abstract: Pisa Syndrome (PS) is a real clinical enigma, and its management remains a challenge. In order to improve the knowledge about resting state and during maximal voluntary muscle contraction (MVMC) of the axial muscles, we described the electromyography results of paraspinal muscles, rectus abdominis, external oblique, and quadratus lumborum of both sides of 60 patients. Electromyography was assessed at rest, during MVMC while bending in the opposite direction of the PS and during MVMC while bending in the direction of the PS. The MVMC gave information about the interferential pattern (INT) or subinterferential pattern (sub-INT). We defined asymmetrical activation (AA) when a sub-INT was detected on the muscle on the side opposite to the PS bending and an INT of same muscle in the direction of PS bending. We observed significant AA during MVMC only in the external oblique muscles in 78% of the subjects. Our results of asymmetric ability to generate maximal voluntary force of the external oblique muscles support a central dissynchronisation of axial muscles as a significant contributor for the bending of the spine in erect position. These results could have important implication to physiotherapy and the use of botulinum toxin in the treatment of PS.
authors.affiliation: Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, 22015 Como, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Frazzitta
authors.affiliation: Department of Neurorehabilitation, "Salvatore Maugeri" Foundation, IRCCS, Scientific Institute of Pavia, via Boezio, 27100 Pavia, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Balbi
authors.affiliation: Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, 22015 Como, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Gotti
authors.affiliation: Department of Biomedical Engineering, S. Maugeri Foundation, IRCCS, Scientific Institute of Montescano, 27040 Pavia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Maestri
authors.affiliation: Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, 22015 Como, Italy.
authors.forename: Annarita
authors.initials: A
authors.lastname: Sabetta
authors.affiliation: Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, 22015 Como, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Caremani
authors.affiliation: Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, 22015 Como, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Gobbi
authors.affiliation: Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, 22015 Como, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Capobianco
authors.affiliation: Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, 22015 Como, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Bera
authors.affiliation: Movement Disorders Unit, Neurological Institute, Tel Aviv Medical Centre, Sieratzki Chair of Neurology, Sackler School of Medicine, Sagol School for Neuroscience, Tel-Aviv University, 69978 Tel-Aviv, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Giladi
authors.affiliation: Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, 22015 Como, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Ferrazzoli