title: Pisa syndrome in Parkinson's disease: An integrated approach from pathophysiology to management.
abstract: Pisa syndrome was first described in 1972 in patients treated with neuroleptics. Since 2003, when it was first reported in patients with Parkinson's disease (PD), Pisa syndrome has progressively drawn the attention of clinicians and researchers. Although emerging evidence has partially clarified its prevalence and pathophysiology, the current debate revolves around diagnostic criteria and assessment and the effectiveness of pharmacological, surgical, and rehabilitative approaches. Contrary to initial thought, Pisa syndrome is common among PD patients, with an estimated prevalence of 8.8% according to a large survey. Furthermore, it is associated with the following specific patient features: more severe motor phenotype, ongoing combined pharmacological treatment with levodopa and dopamine agonists, gait disorders, and such comorbidities as osteoporosis and arthrosis. The present literature on treatment outcomes is scant, and the uneven effectiveness of specific treatments has produced conflicting results. This might be because of the limited knowledge of Pisa syndrome pathophysiology and its variable clinical presentation, which further complicates designing randomized clinical trials on this condition. However, because some forms of Pisa syndrome are potentially reversible, there is growing consensus on the importance of its early recognition and the importance of pharmacological adjustment and rehabilitation. © 2016 International Parkinson and Movement Disorder Society.
authors: Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
authors: Michele
authors: M
authors: Tinazzi
authors: Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
authors: Christian
authors: C
authors: Geroin
authors: Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.|Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors: Marialuisa
authors: M
authors: Gandolfi
authors: Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.|Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors: Nicola
authors: N
authors: Smania
authors: Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
authors: Stefano
authors: S
authors: Tamburin
authors: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors: Francesca
authors: F
authors: Morgante
authors: Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.|Krembil Research Institute, Toronto, Ontario, Canada.
authors: Alfonso
authors: A
authors: Fasano
mesh_terms: D015897:Comorbidity; D020821:Dystonic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D010300:Parkinson Disease / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology
keywords: drug therapy; lateral trunk flexion; posture; rehabilitation; surgery