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Glize B, Jourda L, de Sèze M. Interrater reliability of a new tool to analyze sagittal parameters in camptocormic patients: The 3D morphological analysis system SAM3D®. Braz J Phys Ther 2025; 29:101194. [PMID: 40154095 PMCID: PMC11986966 DOI: 10.1016/j.bjpt.2025.101194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 02/20/2024] [Accepted: 02/18/2025] [Indexed: 04/01/2025] Open
Abstract
BACKGROUND Camptocormia is a trunk flexion occurring during walking that the patient can spontaneously correct in a static position. Therefore, capturing the flexed trunk posture on radiograph is difficult. OBJECTIVE To analyze the interrater reliability in different positions reflecting the dynamic phenomenon of camptocormia using a non-invasive visual three-dimensional capture tool. METHODS Sample size calculation was at least 31 participants. 34 patients who had camptocormia and were monitored in our clinical practice were included. Two different examiners performed measurements using SAM3D tool in the three following positions: Spontaneous Standing Position (SSP), Upright Standing Position (USP), and Walking-like Standing Position (WSP). Sagittal parameters were measured: arrow in C7, kyphosis, lordosis, and knee flexion. The interrater reliability was assessed using Lin's Concordance Correlation Coefficient (CCC). RESULTS Regarding the arrow in C7, the Lin's CCCs were excellent, respectively 0.96 (SSP), 0.98 (USP), and 0.97 (WSP). All the CCCs for other parameters were at least fairly good (>0.87). There were significant differences in arrows in C7 between USP and the two other positions (SSP and WSP). CONCLUSION SAM3D is a non-invasive visual three-dimensional capture tool allowing safe and automatic assessments, and repeated measurements with good interrater reliability.
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Affiliation(s)
- Bertrand Glize
- PMR Department, University Hospital of Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux France; ACTIVE Team, U1219 INSERM University of Bordeaux, 146 rue Léo Saignat, 33000 Bordeaux France
| | - Louca Jourda
- PMR Department, University Hospital of Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux France
| | - Mathieu de Sèze
- PMR Department, University Hospital of Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux France; ACTIVE Team, U1219 INSERM University of Bordeaux, 146 rue Léo Saignat, 33000 Bordeaux France.
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Naderi Beni K, Knutzen K, Kuhtz-Buschbeck JP, Margraf NG, Rieger R. Continuous mobile measurement of camptocormia angle using four accelerometers. Med Biol Eng Comput 2024; 62:3637-3652. [PMID: 38926332 PMCID: PMC11569011 DOI: 10.1007/s11517-024-03149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
Camptocormia, a severe flexion deformity of the spine, presents challenges in monitoring its progression outside laboratory settings. This study introduces a customized method utilizing four inertial measurement unit (IMU) sensors for continuous recording of the camptocormia angle (CA), incorporating both the consensual malleolus and perpendicular assessment methods. The setup is wearable and mobile and allows measurements outside the laboratory environment. The practicality for measuring CA across various activities is evaluated for both the malleolus and perpendicular method in a mimicked Parkinson disease posture. Multiple activities are performed by a healthy volunteer. Measurements are compared against a camera-based reference system. Results show an overall root mean squared error (RMSE) of 4.13° for the malleolus method and 2.71° for the perpendicular method. Furthermore, patient-specific calibration during the standing still with forward lean activity significantly reduced the RMSE to 2.45° and 1.68° respectively. This study presents a novel approach to continuous CA monitoring outside the laboratory setting. The proposed system is suitable as a tool for monitoring the progression of camptocormia and for the first time implements the malleolus method with IMU. It holds promise for effectively monitoring camptocormia at home.
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Affiliation(s)
- K Naderi Beni
- Chair of Networked Electronic Systems, Kiel University, Kiel, Germany.
| | - K Knutzen
- Neurological Clinic, UKSH, Kiel, Germany
| | | | | | - R Rieger
- Chair of Networked Electronic Systems, Kiel University, Kiel, Germany
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3
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Khan ASR, Mattei TA, Mercier PA, Cloney M, Dahdaleh NS, Koski TR, El Tecle NE. Camptocormia in Parkinson Disease: Systematic Review of Management Using Spine Surgery. World Neurosurg 2024; 191:156-164. [PMID: 39098502 DOI: 10.1016/j.wneu.2024.07.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 07/28/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE Postural abnormalities are a debilitating symptom of Parkinson disease (PD) that may require spinal intervention. Camptocormia is a unique abnormality most seen in PD, defined by a severe forward flexion of the trunk that completely resolves when supine. The condition presents a challenge due to an undefined pathophysiology and optimal therapeutic approach in a high-risk patient population. In this study, we systematically reviewed the literature regarding the use of spine surgery for the treatment of camptocormia in PD. METHODS PubMed, Embase, Web of Science, and Cochrane Library were systematically queried for studies involving spine surgery as treatment of PD-associated camptocormia. Studies involving nonsurgical management, involving deep brain stimulation, involving noncamptocormic PD patients undergoing surgery, or were out of scope were excluded. RESULTS The search resulted in 5 studies, with a total of 19 patients with PD with camptocormia who underwent spine surgery (73.7% women). The mean age was 69.5 years (range, 59-83), and the mean PD duration was 69.5 months (range, 36-84). Of 19 patients, 11 required surgical revision (57.9%), with an average of 0.68 revisions per patient (range, 0-2). Radiographic and patient-reported outcomes were inconsistently reported yet showed improvement. Ultimately, 18 patients were reported to have positive outcomes. CONCLUSIONS Despite an increased risk of complication and revision that is inherent to patients with PD, spine surgery has been proven as a reasonable alternative that should be prospectively studied further because 18 of 19 patients had favorable outcomes.
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Affiliation(s)
- Ali Saif R Khan
- Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri, USA.
| | - Tobias A Mattei
- Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Philippe A Mercier
- Department of Neurological Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Michael Cloney
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Tyler R Koski
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | - Najib E El Tecle
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
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Wang JR, Hu Y. Significant improvement after sensory tricks and trunk strength training for Parkinson's disease with antecollis and camptocormia: A case report. World J Clin Cases 2024; 12:443-450. [PMID: 38313646 PMCID: PMC10835692 DOI: 10.12998/wjcc.v12.i2.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Patients with Parkinson's disease (PD) exhibit symptoms such as antecollis (AC) and camptocormia (CC). The pathology of these two conditions is unclear. Additionally, standard treatment methods have not been established. The article reports the case of a 65-year-old female patient with AC and CC who was treated with central and peripheral interventions to alleviate symptoms. CASE SUMMARY We present the case of a 65-year-old female PD patient with AC and CC. The course of the disease was 5 years. She was treated with rehabilitation strategies such as sensory tricks and trunk strength training. During the inpatient period, we compared and analyzed the patient's gait, rehabilitation assessment scale score, and angles of her abnormal trunk posture in the first week, the third week, and the fifth week. The patient's stride length increased, indicating that the patient's walking ability was improved. The Unified Parkinson's Disease Scale Part Three score and CC severity score decreased. Furthermore, the score of the other scale increased. In addition, the patient showed significant improvements in AC, upper CC, and lower CC angles. CONCLUSION This case study suggested that sensory tricks and trunk strength training are beneficial and safe for patients with AC and CC.
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Affiliation(s)
- Jia-Ren Wang
- Department of Neurology and Neurological Rehabilitation, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai 201619, China
| | - Yue Hu
- Department of Neurology and Neurological Rehabilitation, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai 201619, China
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Artusi CA, Geroin C, Nonnekes J, Aquino C, Garg D, Dale ML, Schlosser D, Lai Y, Al‐Wardat M, Salari M, Wolke R, Labou VT, Imbalzano G, Camozzi S, Merello M, Bloem BR, Capato T, Djaldetti R, Doherty K, Fasano A, Tibar H, Lopiano L, Margraf NG, Moreau C, Ugawa Y, Bhidayasiri R, Tinazzi M, the International Parkinson and Movement Disorders Society Task Force on Postural Abnormalities. Predictors and Pathophysiology of Axial Postural Abnormalities in Parkinsonism: A Scoping Review. Mov Disord Clin Pract 2023; 10:1585-1596. [PMID: 38026508 PMCID: PMC10654876 DOI: 10.1002/mdc3.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/09/2023] [Accepted: 08/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Postural abnormalities involving the trunk are referred to as axial postural abnormalities and can be observed in over 20% of patients with Parkinson's disease (PD) and in atypical parkinsonism. These symptoms are highly disabling and frequently associated with back pain and a worse quality of life in PD. Despite their frequency, little is known about the pathophysiology of these symptoms and scant data are reported about their clinical predictors, making it difficult to prompt prevention strategies. Objectives We conducted a scoping literature review of clinical predictors and pathophysiology of axial postural abnormalities in patients with parkinsonism to identify key concepts, theories and evidence on this topic. Methods We applied a systematic approach to identify studies, appraise quality of evidence, summarize main findings, and highlight knowledge gaps. Results Ninety-two articles were reviewed: 25% reported on clinical predictors and 75% on pathophysiology. Most studies identified advanced disease stage and greater motor symptoms severity as independent clinical predictors in both PD and multiple system atrophy. Discrepant pathophysiology data suggested different potential central and peripheral pathogenic mechanisms. Conclusions The recognition of clinical predictors and pathophysiology of axial postural abnormalities in parkinsonism is far from being elucidated due to literature bias, encompassing different inclusion criteria and measurement tools and heterogeneity of patient samples. Most studies identified advanced disease stage and higher burden of motor symptoms as possible clinical predictors. Pathophysiology data point toward many different (possibly non-mutually exclusive) mechanisms, including dystonia, rigidity, proprioceptive and vestibular impairment, and higher cognitive deficits.
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Affiliation(s)
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Jorik Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourDepartment of RehabilitationNijmegenThe Netherlands
| | - Camila Aquino
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, and Department of Community Health SciencesUniversity of CalgaryCalgaryABCanada
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India. Department of NeurologyVardhman Mahavir Medical College and Safdarjung HospitalNew DelhiIndia
| | - Marian L. Dale
- Oregon Health & Science UniversityDepartment of NeurologyPortlandORUSA
| | - Darbe Schlosser
- Graduate Student in the Motor Learning Program at Teachers CollegeColumbia UniversityNew YorkNYUSA
| | - Yijie Lai
- Department of Neurosurgery, Center for Functional NeurosurgeryRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mohammad Al‐Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical SciencesJordan University of Science and TechnologyIrbidJordan
| | - Mehri Salari
- Department of NeurologyShahid Beheshti University of Medical SciencesTehranIran
| | - Robin Wolke
- Department of NeurologyUKSH, Christian‐Albrechts‐UniversityKielGermany
| | | | - Gabriele Imbalzano
- Department of Neuroscience Rita Levi MontalciniUniversity of TurinTorinoItaly
| | - Serena Camozzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Marcelo Merello
- Movement Disorders ServiceFLENI, CONICETBuenos AiresArgentina
| | - Bastiaan R. Bloem
- Department of NeurologyRadboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
| | - Tamine Capato
- Department of NeurologyRadboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
- University of São PauloDepartment of Neurology, Movement Disorders CenterSão PauloBrazil
| | - Ruth Djaldetti
- Department of Neurology, Rabin Medical Center, Petah Tikva; Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Karen Doherty
- Department of NeurologyRoyal Victoria HospitalBelfastUnited Kingdom
- Centre for Medical EducationQueens University BelfastBelfastUnited Kingdom
| | - Alfonso Fasano
- Division of NeurologyUniversity of TorontoTorontoONCanada
- Krembil Brain InstituteTorontoONCanada
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria ShulmanMovement Disorders Clinic, Toronto Western Hospital, UHNTorontoONCanada
| | - Houyam Tibar
- Service de Neurologie B et de Neurogénétique Hôpital des Spécialités OTO‐Neuro‐OphtalmologiqueIbn Sina University Hospital, Medical School of Rabat, Mohamed 5 University of RabatRabatMorocco
| | - Leonardo Lopiano
- Department of Neuroscience Rita Levi MontalciniUniversity of TurinTorinoItaly
| | - Nils G. Margraf
- Department of NeurologyUKSH, Christian‐Albrechts‐UniversityKielGermany
| | - Caroline Moreau
- Expert Center for Parkinson's Disease, Neurological Department, Inserm UMR 1172Lille University HospitalLilleFrance
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of MedicineFukushima Medical UniversityFukushimaJapan
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of MedicineChulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyBangkokThailand
- The Academy of ScienceThe Royal Society of ThailandBangkokThailand
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
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Murphy KT, Lynch GS. Impaired skeletal muscle health in Parkinsonian syndromes: clinical implications, mechanisms and potential treatments. J Cachexia Sarcopenia Muscle 2023; 14:1987-2002. [PMID: 37574254 PMCID: PMC10570091 DOI: 10.1002/jcsm.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/27/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
There is increasing evidence that neurodegenerative disorders including the Parkinsonian syndromes are associated with impaired skeletal muscle health, manifesting as wasting and weakness. Many of the movement problems, lack of muscle strength and reduction in quality of life that are characteristic of these syndromes can be attributed to impairments in skeletal muscle health, but this concept has been grossly understudied and represents an important area of unmet clinical need. This review describes the changes in skeletal muscle health in idiopathic Parkinson's disease and in two atypical Parkinsonian syndromes, the most aggressive synucleinopathy multiple system atrophy, and the tauopathy progressive supranuclear palsy. The pathogenesis of the skeletal muscle changes is described, including the contribution of impairments to the central and peripheral nervous system and intrinsic alterations. Pharmacological interventions targeting the underlying molecular mechanisms with therapeutic potential to improve skeletal muscle health in affected patients are also discussed. Although little is known about the mechanisms underlying these conditions, current evidence implicates multiple pathways and processes, highlighting the likely need for combination therapies to protect muscle health and emphasizing the merit of personalized interventions for patients with different physical capacities at different stages of their disease. As muscle fatigue is often experienced by patients prior to diagnosis, the identification and measurement of this symptom and related biomarkers to identify early signs of disease require careful interrogation, especially for multiple system atrophy and progressive supranuclear palsy where diagnosis is often made several years after onset of symptoms and only confirmed post-mortem. We propose a multidisciplinary approach for early diagnosis and implementation of personalized interventions to preserve muscle health and improve quality of life for patients with typical and atypical Parkinsonian syndromes.
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Affiliation(s)
- Kate T. Murphy
- Department of Anatomy and Physiology, Centre for Muscle ResearchThe University of MelbourneMelbourneAustralia
| | - Gordon S. Lynch
- Department of Anatomy and Physiology, Centre for Muscle ResearchThe University of MelbourneMelbourneAustralia
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Polythodorakis I, Brotis A, Charitidis C, Lycomitros V, Liveris I, Paterakis K. Minimally Invasive Spine Surgery for Kyphoscoliosis in a Patient With Parkinson's Disease: A Case Report. Cureus 2023; 15:e39397. [PMID: 37362499 PMCID: PMC10286849 DOI: 10.7759/cureus.39397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
The surgical treatment for severe deformity correction in patients with Parkinson's disease (PD) is usually challenging, requiring lengthy fusions, and with a high risk of postoperative complications. We present a patient with severe kyphoscoliosis and medical history of PD undergoing minimally invasive surgical deformity correction. A 75-year-old female with a 10-year history of medically controlled PD presented at our hospital's outpatient reporting progressive postural changes during the last two years and a half. On clinical examination, we recognized severe kyphoscoliosis associated with Pisa deformity, in the absence of any neurological manifestations. On the initial x-rays, the coronal angulation was 56° in the lumbar area with a significant lateral shift of the trunk, while the right ribs were close to the iliac crest. The patient underwent deformity correction with percutaneous pedicle screws from T5 to S1, a percutaneous transverse process hooks at T5, and transforaminal lumbar interbody fusion at L5-S1. The total duration of the operation was seven hours, and the estimated blood loss was approximately 300 mL. Clinically, the patient's posture improved significantly, alleviating any preoperative compensatory mechanisms such as knee flexion. The postoperative x-rays revealed a very satisfying correction in both the coronal and sagittal planes (20.1 degrees and 26.6 degrees, respectively). Our current case report showed that MIS constitutes a viable alternative for deformity correction in selected patients with PD as part of a multidisciplinary approach. Proper patient selection requires a detailed medical history and a complete neurological and musculoskeletal examination by a dedicated healthcare provider.
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Affiliation(s)
| | | | | | | | - Iason Liveris
- Neurological Surgery, Henry Dunant Hospital, Athens, GRC
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8
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Geroin C, Artusi CA, Nonnekes J, Aquino C, Garg D, Dale ML, Schlosser D, Lai Y, Al-Wardat M, Salari M, Wolke R, Labou VT, Imbalzano G, Camozzi S, Merello M, Bloem BR, Capato T, Djaldetti R, Doherty K, Fasano A, Tibar H, Lopiano L, Margraf NG, Moreau C, Ugawa Y, Bhidayasiri R, Tinazzi M. Axial Postural Abnormalities in Parkinsonism: Gaps in Predictors, Pathophysiology, and Management. Mov Disord 2023; 38:732-739. [PMID: 37081741 DOI: 10.1002/mds.29377] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
| | - Jorik Nonnekes
- Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Camila Aquino
- Department of Clinical Neurosciences, and Department of Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Marian L Dale
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Darbe Schlosser
- Motor Learning Program, Teachers College, Columbia University, New York, New York, USA
| | - Yijie Lai
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mohammad Al-Wardat
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Mehri Salari
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Robin Wolke
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | | | - Gabriele Imbalzano
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
| | - Serena Camozzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marcelo Merello
- Movement Disorders Service, FLENI, CONICET, Buenos Aires, Argentina
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Tamine Capato
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Neurology, Movement Disorders Center, University of São Paulo, São Paulo, Brazil
| | - Ruth Djaldetti
- Department of Neurology, Rabin Medical Center, Petah Tikva Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karen Doherty
- Department of Neurology, Royal Victoria Hospital, Belfast, UK
- Centre for Medical Education, Queens University Belfast, Belfast, UK
| | - Alfonso Fasano
- Krembil Brain Institute, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Houyam Tibar
- Service de Neurologie B et de Neurogénétique Hôpital des Spécialités OTO-Neuro-Ophtalmologique, Ibn Sina University Hospital, Medical School of Rabat, Mohamed 5 University of Rabat, Rabat, Morocco
| | - Leonardo Lopiano
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Torino, Italy
- Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Nils G Margraf
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Caroline Moreau
- Neurological Department, Expert Center for Parkinson's Disease, Inserm UMR 1172, Lille University Hospital, Lille, France
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Roongroj Bhidayasiri
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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9
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Masaki M, Kasahara M, Inagaki Y, Yokota M, Takeuchi M. Association of sagittal spinal alignment in the standing position with the masses and amounts of intramuscular non-contractile tissue of the trunk and lower extremity muscles in patients with Parkinson's disease. Clin Biomech (Bristol, Avon) 2023; 101:105868. [PMID: 36580828 DOI: 10.1016/j.clinbiomech.2022.105868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND We examined the association of sagittal spinal alignment in the standing position with the masses and amounts of intramuscular non-contractile tissue of multiple trunk and lower extremity muscles, such as the hip joint muscles, measured using an ultrasound imaging device in patients with Parkinson's disease (PD). METHODS The participants were 10 patients with PD. Sagittal spinal alignment (thoracic kyphosis, lumbar lordosis, and sacral anterior inclination angles) in the standing position was measured using a Spinal Mouse. Muscle thicknesses and echo intensities of the trunk and lower extremity muscles, including the hip joint muscles, were also measured in the prone or supine position using an ultrasound imaging device. FINDINGS Partial correlation analysis with body height and weight as control variables showed that a low lumbar lordosis angle in the standing position was significantly associated with low thicknesses of the trunk extensor muscles (lumbar erector spinae and multifidus). Partial correlation analysis also revealed that a high sacral anterior inclination angle in the standing position was significantly associated with low lumbar multifidus muscle thickness. However, the thicknesses and echo intensities of the trunk flexor and hip joint muscles were not significantly related to thoracic kyphosis, lumbar lordosis, or sacral anterior inclination angles. INTERPRETATION The results of this study suggested the association between a low lumbar lordosis angle in the standing position and low lumbar erector spinae and multifidus muscle thicknesses and between a high sacral anterior inclination angle in the standing position and low lumbar multifidus muscle thickness in patients with PD.
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Affiliation(s)
- Mitsuhiro Masaki
- Department of Physical Therapy, Takasaki University of Health and Welfare, Gunma 501 Nakaorui-machi, Takasaki 370-0033, Japan.
| | - Maki Kasahara
- Department of Rehabilitation, Tsunoda Hospital, Gunma 675-4 Kamishinden, Tamamura-machi, Sawagun 370-1133, Japan.
| | - Yukika Inagaki
- Department of Rehabilitation, Sawarabi Medical Welfare Center, Gunma 168-1 Oyagi-machi, Takasaki 370-0072, Japan.
| | - Minori Yokota
- Department of Rehabilitation, Takeda General Hospital, Fukushima 3-27 Yamaga-machi, Aizuwakamatsu 965-8585, Japan.
| | - Moeka Takeuchi
- Department of Rehabilitation, Iwamuro Rehabilitation Hospital, Niigata 772-1 Iwamuronsen, Nishikan-ku, Niigata 953-0104, Japan.
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10
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Cao S, Cui Y, Jin J, Li F, Liu X, Feng T. Prevalence of axial postural abnormalities and their subtypes in Parkinson's disease: a systematic review and meta-analysis. J Neurol 2023; 270:139-151. [PMID: 36098837 DOI: 10.1007/s00415-022-11354-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Axial postural abnormalities, mainly involving the spinal deformities, are disabling symptoms of Parkinson's disease (PD). However, the prevalence of axial postural abnormalities in PD and their clinical correlates remain unclear. The present study aimed to conduct a systematic review and meta-analysis of the prevalence of overall and subtypes of axial postural abnormalities in PD. METHODS PubMed, Embase, Web of Science and Cochrane databases were searched up to 31st March, 2022. We identified studies that reported the prevalence of axial postural abnormalities in PD. The pooled estimate of prevalence was calculated using a random effect model. Subgroup analysis and meta-regression were performed. RESULTS There were 19 studies met the inclusion criteria. The overall prevalence of axial postural abnormalities in PD was 22.1% (95% CI 19.7-24.5%). The prevalence of each subtype of axial postural abnormalities was 19.6% for scoliosis (95% CI 10.6-28.7%), 10.2% for camptocormia (95% CI 7.7-12.7%), 8% for Pisa syndrome (95% CI 4.7-11.4%), and 7.9% for antecollis (95% CI 3.9-11.9%). Subgroup analysis showed that the measuring method of axial postural abnormalities exerted significant effects on prevalence estimates. Axial postural abnormalities in PD were associated with older age, longer disease duration, higher H-Y stage, greater levodopa equivalent daily dose, more severe motor symptoms, motor fluctuations, and akinetic-rigid subtype. CONCLUSIONS Axial postural abnormalities, which include scoliosis, camptocormia, Pisa syndrome, and antecollis, are not uncommon in patients with PD. Future research on axial postural abnormalities should be based on uniform diagnostic criteria and measuring methods.
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Affiliation(s)
- Shuangshuang Cao
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurology, Yidu Central Hospital of Weifang, Shandong, China
| | - Yusha Cui
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianing Jin
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Fangfei Li
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xin Liu
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Tao Feng
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
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Muacevic A, Adler JR. Camptocormia, a Rare Complication of Hemorrhagic Stroke: A Case Report. Cureus 2022; 14:e32450. [PMID: 36644098 PMCID: PMC9833955 DOI: 10.7759/cureus.32450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Camptocormia (bent spine syndrome) is a rare complication after hemorrhagic stroke. It is a disabling, acquired postural abnormality that has a significant impact on a patient's physical function and quality of life and is more often seen in patients with Parkinson's disease. Treatment strategies pertaining to this condition can be broadly divided into invasive which involved deep brain stimulation and spinal fixation operation versus non-invasive approaches like physiotherapy, orthosis and drugs. However, most of the treatments described in the past are mainly for Parkinson's patients with camptocormia, and none are for camptocormia from hemorrhagic stroke. We report a rare case of camptocormia in a posthemorrhagic stroke patient whose rehabilitation progress was greatly impeded by this axial postural deformity and who responded well to Madopar treatment with an improvement in total camptocormia angle from 90 degrees to about 30 degrees, which translated to an improvement in physical function and reduction in care burden.
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12
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Eker A, Kaymakamzade B, Diker S, Cumaogulları O, Yigitoglu PH. Axial posture disorders in Parkinson's disease: Clinical correlates and future treatment directions1. J Back Musculoskelet Rehabil 2022; 35:1321-1328. [PMID: 35964166 DOI: 10.3233/bmr-210263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Postural disorders are frequently observed in Parkinson's disease (PD). The underlying mechanisms that cause postural disorders are not fully understood and the majority of these disorders have no response to antiparkinsonian treatments. These disabling conditions require further investigation to better understand the underlying mechanisms in order to develop effective treatments. OBJECTIVE The aim of this study was to investigate the frequency of axial postural disorders in PD and to determine the associated clinical risk factors. METHODS In this single-center clinical trial, the data of PD patients were reviewed retrospectively. The frequencies of postural disorders were determined, and the demographic clinical characteristics of the patients were compared. RESULTS The records of 127 patients with idiopathic PD were analyzed. Axial posture disorders were found in 42.6% of patients. Patients with axial posture disorders were older when the disease onset was detected, amongst these patients the condition was also longer lasting. The mean levodopa dose was higher in the patients with posture disorders. The initial symptom was bradykinesia and the Hoehn and Yahr's score was ⩾ 3 in the majority of the patients with posture disorder. Additionally, constipation, hallucinations, postural instability, and falls were significantly more common in patients with posture disorders. CONCLUSION Posture disorders were observed in nearly half of PD patients and were more frequently observed in patients with an advanced condition. In addition, our investigation has found that it is crucial to follow up with patients who present with bradykinesia for the development of postural disorder.
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Affiliation(s)
- Amber Eker
- Department of Neurology, Faculty of Medicine, Eastern Mediterranean University, Famagusta, North Cyprus, Mersin 10, Turkey
| | - Bahar Kaymakamzade
- Department of Neurology, Near East University Faculty of Medicine, Nicosia, Cyprus
| | - Sevda Diker
- Department of Neurology, Faculty of Medicine, Cyprus International University, Nicosia, Cyprus
| | - Ozge Cumaogulları
- Eastern Mediterranean University Faculty of Medicine, Famagusta, North Cyprus, Mersin 10, Turkey
| | - Pembe Hare Yigitoglu
- Department of Physical Medicine and Rehabilitation, Near East University Faculty of Medicine, Nicosia, Cyprus
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13
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Mei GL, Wei HT, Ma YR, Wan D. Surgical Correction of Kyphosis in Patients With Camptocormia Associated With Parkinson’s Disease: A Case Report and Review of the Literature. Front Surg 2022; 9:822015. [PMID: 35846949 PMCID: PMC9276974 DOI: 10.3389/fsurg.2022.822015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Camptocormia is a postural deformity that is characterized by a markedly flexed lumbar spine, with symptoms that worsen with walking and standing. Here, we report a case of camptocormia associated with Parkinson’s disease. Case description A 70-year-old man with a 7-year history of Parkinson’s disease presented with a fall injury that caused lower back pain for 3 months and was aggravated for 2 months. He had been diagnosed with a compression fracture after the fall and had undergone percutaneous kyphoplasty at a local hospital. MRI showed non-union of the L1 vertebra and compression fracture of L2. The patient underwent posterior osteotomy, canal decompression, and internal fixation of the T10-L3 intervertebral plate with bone graft fusion. Postoperative examination showed that the lumbar lordosis was corrected and sensation was restored in both lower extremities. However, after 1 month, the fixation was loosened and a correction surgery was performed at our hospital. At the most recent follow-up at 1.5 years, the patient was found to be in good general health and did not complain of lower back discomfort. He was also actively exercising according to the rehabilitation regimen and had resumed social life. Conclusion This is a rare case of camptocormia in a Parkinson’s patient that highlights the need for careful evaluation of whether internal spinal fixation surgery is beneficial in such patients.
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Affiliation(s)
- Guo-long Mei
- Spine Department, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Hui-ting Wei
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue-rong Ma
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Correspondence: Dun Wan Yue-rong Ma
| | - Dun Wan
- Spine Department, Sichuan Province Orthopedic Hospital, Chengdu, China
- Correspondence: Dun Wan Yue-rong Ma
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14
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Tinazzi M, Geroin C, Bhidayasiri R, Bloem BR, Capato T, Djaldetti R, Doherty K, Fasano A, Tibar H, Lopiano L, Margraf NG, Merello M, Moreau C, Ugawa Y, Artusi CA. Task force consensus on nosology and Cut‐Off values for axial postural abnormalities in parkinsonism. Mov Disord Clin Pract 2022; 9:594-603. [PMID: 35844289 PMCID: PMC9274349 DOI: 10.1002/mdc3.13460] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/16/2022] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is no consensus with regard to the nosology and cut‐off values for postural abnormalities in parkinsonism. Objective To reach a consensus regarding the nosology and cut‐off values. Methods Using a modified Delphi panel method, multiple rounds of questionnaires were conducted by movement disorder experts to define nosology and cut‐offs of postural abnormalities. Results After separating axial from appendicular postural deformities, a full agreement was found for the following terms and cut‐offs: camptocormia, with thoracic fulcrum (>45°) or lumbar fulcrum (>30°), Pisa syndrome (>10°), and antecollis (>45°). “Anterior trunk flexion,” with thoracic (≥25° to ≤45°) or lumbar fulcrum (>15° to ≤30°), “lateral trunk flexion” (≥5° to ≤10°), and “anterior neck flexion” (>35° to ≤45°) were chosen for milder postural abnormalities. Conclusions For axial postural abnormalities, we recommend the use of proposed cut‐offs and six unique terms, namely camptocormia, Pisa syndrome, antecollis, anterior trunk flexion, lateral trunk flexion, anterior neck flexion, to harmonize clinical practice and future research.
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Affiliation(s)
- Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences Biomedicine and Movement Sciences University of Verona Verona Italy
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society Bangkok 10330 Thailand
- The Academy of Science, The Royal Society of Thailand Bangkok 10330 Thailand
| | - Bastiaan R. Bloem
- Department of Neurology Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour Nijmegen The Netherlands
| | - Tamine Capato
- Department of Neurology Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour Nijmegen The Netherlands
- University of São Paulo, Department of Neurology, Movement Disorders Center São Paulo Brazil
| | - Ruth Djaldetti
- Department of Neurology, Rabin Medical Center, 39 Jabotinsky St, Petah Tikva, 49100; Sackler Faculty of Medicine Tel Aviv University, P.O. Box 39040 Tel Aviv 6997801 Israel
| | - Karen Doherty
- Department of Neurology Royal Victoria Hospital Belfast, N Ireland
- Centre for Medical Education Queens University Belfast, N Ireland
| | - Alfonso Fasano
- Division of Neurology University of Toronto Toronto ON Canada
- Krembil Brain Institute Toronto ON Canada
- Edmond J. Safra Program in Parkinson’s Disease and Morton and Gloria Shulman. Movement Disorders Clinic Toronto Western Hospital, UHN Toronto Ontario Canada
| | - Houyam Tibar
- Service de Neurologie B et de Neurogénétique Hôpital des spécialités OTO‐Neuro‐Ophtalmologique. Ibn Sina University hospital, Medical school of Rabat Mohamed 5 University of Rabat Morocco
| | - Leonardo Lopiano
- Department of Neuroscience “Rita Levi Montalcini” University of Turin, Via Cherasco 15 10126 Torino Italy
- Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126 Torino Italy
| | - Nils G. Margraf
- Department of Neurology UKSH, Christian‐Albrechts‐University Kiel Germany
| | - Marcelo Merello
- Movement Disorders Service. FLENI. CONICET. Buenos Aires. Argentina
| | - Caroline Moreau
- Expert center for Parkinson's disease, Neurological department, Inserm UMR 1171 Lille University Hospital Lille France
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine Fukushima Medical University Fukushima Japan
| | - Carlo Alberto Artusi
- Department of Neuroscience “Rita Levi Montalcini” University of Turin, Via Cherasco 15 10126 Torino Italy
- Neurology 2 Unit, A.O.U. Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126 Torino Italy
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15
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Shin JH, Woo KA, Lee CY, Jeon SH, Kim HJ, Jeon B. Automatic Measurement of Postural Abnormalities With a Pose Estimation Algorithm in Parkinson's Disease. J Mov Disord 2022; 15:140-145. [PMID: 35038858 PMCID: PMC9171303 DOI: 10.14802/jmd.21129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/13/2021] [Indexed: 12/02/2022] Open
Abstract
Objective This study aims to develop an automated and objective tool to evaluate postural abnormalities in Parkinson’s disease (PD) patients. Methods We applied a deep learning-based pose-estimation algorithm to lateral photos of prospectively enrolled PD patients (n = 28). We automatically measured the anterior flexion angle (AFA) and dropped head angle (DHA), which were validated with conventional manual labeling methods. Results The automatically measured DHA and AFA were in excellent agreement with manual labeling methods (intraclass correlation coefficient > 0.95) with mean bias equal to or less than 3 degrees. Conclusion The deep learning-based pose-estimation algorithm objectively measured postural abnormalities in PD patients.
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Affiliation(s)
- Jung Hwan Shin
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Ah Woo
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chan Young Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Ho Jeon
- Department of Neurology, Jeonbuk National University Hospital, Jeonbuk National University College of Medicine, Jeonju, Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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16
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Giustetto A, Vieira Dos Anjos F, Gallo F, Monferino R, Cerone GL, Di Pardo M, Gazzoni M, Micheletti Cremasco M. Investigating the effect of a passive trunk exoskeleton on local discomfort, perceived effort and spatial distribution of back muscles activity. ERGONOMICS 2021; 64:1379-1392. [PMID: 33970812 DOI: 10.1080/00140139.2021.1928297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 04/30/2021] [Indexed: 06/12/2023]
Abstract
This study aimed at determining the effect of a passive exoskeleton on local perceived discomfort, perceived effort and low back muscles' activity. Thirteen volunteers performed two simulated working tasks with and without the exoskeleton. In the static task, the exoskeleton decreased the lumbar perceived discomfort, the perceived effort and the level of low back muscles' activity (∼10%) while increasing discomfort in the chest and feet. The percent decrease in EMG amplitude was correlated with the percent increase in perceived effort with exoskeleton. For the dynamic task, the exoskeleton increased the discomfort in the chest and decreased the level of back muscle activity (∼5%). Current findings suggest exoskeleton is effective in reducing the back load while increasing the perceived discomfort at non-targeted body regions in both working tasks. The concurrent increase of discomfort in non-targeted areas probably led to a higher perceived effort despite the reduction of low back muscle activity. Practitioner summary: This study provided insights into exoskeleton effects on local discomfort, perceived effort and muscle activity. Overall, the potential benefits of passive exoskeleton should be considered alongside its adverse effects on the non-targeted body regions that can lead to an increase of perceived effort despite the reduction of back muscle activity.
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Affiliation(s)
- Ambra Giustetto
- Department of Life Sciences and Systems Biology, ICxT Innovation Center, University of Torino, Torino, Italy
| | - Fabio Vieira Dos Anjos
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications and PolitoBIOMed Lab, Politecnico di Torino, Torino, Italy
| | - Francesca Gallo
- Centro Ricerche Fiat - WCM Research and Innovation, Orbassano, Italy
| | | | - Giacinto Luigi Cerone
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications and PolitoBIOMed Lab, Politecnico di Torino, Torino, Italy
| | - Massimo Di Pardo
- Centro Ricerche Fiat - WCM Research and Innovation, Orbassano, Italy
| | - Marco Gazzoni
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications and PolitoBIOMed Lab, Politecnico di Torino, Torino, Italy
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17
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Romanato M, Volpe D, Guiotto A, Spolaor F, Sartori M, Sawacha Z. Electromyography-informed modeling for estimating muscle activation and force alterations in Parkinson's disease. Comput Methods Biomech Biomed Engin 2021; 25:14-26. [PMID: 33998843 DOI: 10.1080/10255842.2021.1925887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Electromyography (EMG)-driven neuromusculoskeletal modeling (NMSM) enables simulating the mechanical function of multiple muscle-tendon units as controlled by nervous system in the generation of complex movements. In the context of clinical assessment this may enable understanding biomechanical factor contributing to gait disorders such as one induced by Parkinson's disease (PD). In spite of the challenges in the development of patient-specific models, this preliminary study aimed at establishing a feasible and noninvasive experimental and modeling pipeline to be adopted in clinics to detect PD-induced gait alterations. Four different NMSM have been implemented for three healthy controls using CEINMS, an OpenSim-compatible toolbox. Models differed in the EMG-normalization methods used for calibration purposes (i.e. walking trial normalization and maximum voluntary contraction normalization) and in the set of experimental EMGs used for the musculotendon-unit mapping (i.e. 4 channels vs. 15 channels). Model accuracy assessment showed no statistically significant differences between the more complete model (non-clinically viable) and the proposed reduced one (clinically viable). The clinically viable reduced model was systematically applied on a dataset including ten PD's and thirteen healthy controls. Results showed significant differences in the neuromuscular control strategy of the PD group in term of muscle forces and joint torques. Indeed, PD patients displayed a significantly lower magnitude on force production and revealed a higher amount of force variability with the respect of the healthy controls. The estimated variables could become a measurable biomechanical outcome to assess and track both disease progression and its impact on gait in PD subjects.
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Affiliation(s)
- Marco Romanato
- Department of Information Engineering, University of Padua, Padova, Italy
| | - Daniele Volpe
- Fresco Parkinson Center, Villa Margherita, Vicenza, Italy
| | - Annamaria Guiotto
- Department of Information Engineering, University of Padua, Padova, Italy
| | - Fabiola Spolaor
- Department of Information Engineering, University of Padua, Padova, Italy
| | - Massimo Sartori
- Department of Biomechanical Engineering, University of Twente, AE Enschede, Netherlands
| | - Zimi Sawacha
- Department of Information Engineering, University of Padua, Padova, Italy.,Department of Medicine, University of Padua, Padova, Italy
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18
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Zhang LY, Cao B, Wei QQ, Ou RW, Zhao B, Yang J, Wu Y, Shang HF. Camptocormia in patients with multiple system atrophy at different disease durations: frequency and related factors. BMC Neurol 2021; 21:181. [PMID: 33910524 PMCID: PMC8080355 DOI: 10.1186/s12883-021-02210-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/14/2021] [Indexed: 02/08/2023] Open
Abstract
Background Camptocormia is common in patients with multiple system atrophy (MSA). The current study was aimed at assessing the frequency of camptocormia and its related factors in MSA patients with different disease durations. Also, the impact of camptocormia on disability was evaluated. Methods A total of 716 patients were enrolled in the study. They were classified into three groups based on disease duration (≤ 3, 3–5, ≥ 5 years). Specific scales were used to evaluate the motor and non-motor symptoms. Disease severity was assessed using the Unified Multiple System Atrophy Rating Scale (UMSARS). The binary logistic regression model was used to explore the factors related to camptocormia. To analyze the impact of camptocormia on disability in patients with disease duration less than 5 years, propensity score matching (PSM) and stratified Cox regression analysis were used. Results In the current study, we found that the frequency of camptocormia was 8.9, 19.7 and 19.2% when the disease duration was ≤3, 3–5, ≥ 5 years, respectively. In the disease duration ≤3 years group, we found that MSA-parkinsonian subtype (MSA-P) (OR = 2.043, P = 0.043), higher total UMSARS score (OR = 1.063, P < 0.001), older age of onset (OR = 1.047, P = 0.042), and lower score on the frontal assessment battery (FAB) (OR = 0.899, P = 0.046) were associated with camptocormia. Only greater disease severity was associated with camptocormia in the group of patients with disease duration 3–5 years (OR = 1.494, P = 0.025) and in the group of patients with disease duration ≥5 years (OR = 1.076, P = 0.005). There was no significant impact of camptocormia on disability in patients with a disease duration of < 5 years (HR = 0.687, P = 0.463). Conclusion The frequency of camptocormia increased with prolonged disease duration. Disease severity was related to camptocormia at different stages of the disease. The MSA-P subtype, older age of onset, and lower FAB score were associated with camptocormia in the early stage of the disease.
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Affiliation(s)
- Ling Yu Zhang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Bei Cao
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qian-Qian Wei
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ru Wei Ou
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Bi Zhao
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jing Yang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ying Wu
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hui Fang Shang
- Department of Neurology, Laboratory of Neurodegenerative Disorders, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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19
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Lai Y, Song Y, Huang P, Wang T, Wang L, Pan Y, Sun Q, Sun B, Zhang C, Li D. Subthalamic Stimulation for Camptocormia in Parkinson's Disease: Association of Volume of Tissue Activated and Structural Connectivity with Clinical Effectiveness. JOURNAL OF PARKINSONS DISEASE 2021; 11:199-210. [PMID: 33325395 PMCID: PMC7990421 DOI: 10.3233/jpd-202259] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Deep brain stimulation of the subthalamic nucleus (STN-DBS) has been reported to be effective for camptocormia in Parkinson's disease (PD). However, the association between clinical effectiveness and the stimulated volumes or structural connectivity remains unexplored. OBJECTIVE To investigate the effectiveness of STN-DBS for treating camptocormia in PD and its association with volumes of tissue activated (VTA) and structural connectivity. METHODS We reviewed video recordings of patients who had undergone STN-DBS. The total and upper camptocormia (TCC and UCC) angles were measured to quantify changes in camptocormia. The Movement Disorders Society Unified Parkinson's Disease Rating Scale III (MDS-UPDRS III) was used to assess motor symptoms. Pre- and postoperative brain images were collected for modeling volume of VTA and structural connectivity using Lead-DBS software. RESULTS Participants included 36 patients with PD (8 with TCC-camptocormia and 2 with UCC-camptocormia) treated with bilateral STN-DBS. After surgery, patients showed a significant improvement in postural alignment at follow-up (mean follow-up duration: 6.0±2.2 months). In the entire sample, higher structural connectivity to the right supplementary motor area (SMA) and right lateral premotor cortex along the dorsal plane (PMd) was associated with larger postsurgical improvements in axial signs and TCC angles after stimulation was turned on. In patients diagnosed with camptocormia, larger improvement in camptocormia angles after STN-DBS was associated with a larger VTA overlap with STN (R = 0.75, p = 0.032). CONCLUSION This study suggests that both VTA overlap with STN and structural connectivity to cortical motor regions are associated with the effectiveness of STN-DBS for managing camptocormia in PD.
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Affiliation(s)
- Yijie Lai
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunhai Song
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Neurosurgery, Shanghai Children's Medical Center Affiliated to the Medical School of Shanghai Jiaotong University, Shanghai, China
| | - Peng Huang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linbin Wang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixin Pan
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingfang Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lai Y, Song Y, Su D, Wang L, Zhang C, Sun B, Nonnekes J, Bloem BR, Li D. Pallidal stimulation as treatment for camptocormia in Parkinson's disease. NPJ Parkinsons Dis 2021; 7:8. [PMID: 33462205 PMCID: PMC7813849 DOI: 10.1038/s41531-020-00151-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023] Open
Abstract
Camptocormia is a common and often debilitating postural deformity in Parkinson's disease (PD). Few treatments are currently effective. Deep brain stimulation (DBS) of the globus pallidus internus (GPi) shows potential in treating camptocormia, but evidence remains limited to case reports. We herein investigate the effect of GPi-DBS for treating camptocormia in a retrospective PD cohort. Thirty-six consecutive PD patients who underwent GPi-DBS were reviewed. The total and upper camptocormia angles (TCC and UCC angles) derived from video recordings of patients who received GPi-DBS were used to compare camptocormia alterations. Correlation analysis was performed to identify factors associated with the postoperative improvements. DBS lead placement and the impact of stimulation were analyzed using Lead-DBS software. Eleven patients manifested pre-surgical camptocormia: seven had lower camptocormia (TCC angles ≥ 30°; TCC-camptocormia), three had upper camptocormia (UCC angles ≥ 45°; UCC-camptocormia), and one had both. Mean follow-up time was 7.3 ± 3.3 months. GPi-DBS improved TCC-camptocormia by 40.4% (angles from 39.1° ± 10.1° to 23.3° ± 8.1°, p = 0.017) and UCC-camptocormia by 22.8% (angles from 50.5° ± 2.6° to 39.0° ± 6.7°, p = 0.012). Improvement in TCC angle was positively associated with pre-surgical TCC angles, levodopa responsiveness of the TCC angle, and structural connectivity from volume of tissue activated to somatosensory cortex. Greater improvement in UCC angles was seen in patients with larger pre-surgical UCC angles. Our study demonstrates potential effectiveness of GPi-DBS for treating camptocormia in PD patients. Future controlled studies with larger numbers of patients with PD-related camptocormia should extend our findings.
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Affiliation(s)
- Yijie Lai
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunhai Song
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Neurosurgery Department, Shanghai Children's Medical Center Affiliated to the Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Daoqing Su
- Department of Neurosurgery, Liaocheng People's Hospital and Liaocheng Clinical School of Shandong First Medical University, Liaocheng, China
| | - Linbin Wang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jorik Nonnekes
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain Cognition and Behavior, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain Cognition and Behavior, Nijmegen, The Netherlands
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Waheed W, Allison JB, Dewitt J, Hallman S, Tandan R. Axial muscle weakness. Pract Neurol 2020; 21:practneurol-2020-002736. [PMID: 33262222 DOI: 10.1136/practneurol-2020-002736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 11/04/2022]
Abstract
Axial myopathy is a rare neuromuscular disorder characterised by selective involvement of the paraspinal muscles, and presenting either as a bent spine and/or dropped head syndrome. The axial muscles can be involved in various conditions, including neuromuscular disease, movement disorders, spinal disease and metabolic disorders. There have been recent descriptions of disorders with selective axial muscle involvement, but overall axial myopathy remains under-recognised. Here, we review disorders of axial muscle function, provide guidance on interpreting axial muscles imaging and suggest a diagnostic algorithm to evaluate patients with axial muscles weakness.
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Affiliation(s)
- Waqar Waheed
- Neurology, University of Vermont Medical Center, Burlington, Vermont, USA
| | | | - John Dewitt
- Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Sharon Hallman
- Physical Therapy, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Rup Tandan
- Neurology, University of Vermont Medical Center, Burlington, Vermont, USA
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Subacute axial parkinsonism associated with anti-Ri antibodies. Neurol Sci 2020; 42:1155-1156. [PMID: 32822059 DOI: 10.1007/s10072-020-04685-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/12/2020] [Indexed: 02/08/2023]
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Adult Spinal Deformity Surgery in Patients With Movement Disorders: A Propensity-matched Analysis of Outcomes and Cost. Spine (Phila Pa 1976) 2020; 45:E288-E295. [PMID: 32045403 DOI: 10.1097/brs.0000000000003251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This was a retrospective study using national administrative data from the MarketScan database. OBJECTIVE To investigate the complication rates, quality outcomes, and costs in a nationwide cohort of patients with movement disorders (MD) who undergo spinal deformity surgery. SUMMARY OF BACKGROUND DATA Patients with MD often present with spinal deformities, but their tolerance for surgical intervention is unknown. METHODS The MarketScan administrative claims database was queried to identify adult patients with MD who underwent spinal deformity surgery. A propensity-score match was conducted to create two uniform cohorts and mitigate interpopulation confounders. Perioperative complication rates, 90-day postoperative outcomes, and total costs were compared between patients with MD and controls. RESULTS A total of 316 patients with MD (1.7%) were identified from the 18,970 undergoing spinal deformity surgery. The complication rate for MD patients was 44.6% and for the controls 35.6% (P = 0.009). The two most common perioperative complications were more likely to occur in MD patients, acute-posthemorrhagic anemia (26.9% vs. 20.8%, P < 0.05) and deficiency anemia (15.5% vs. 8.5%, P < 0.05). At 90 days, MD patients were more likely to be readmitted (17.4% vs. 13.2%, P < 0.05) and have a higher total cost ($94,672 vs. $85,190, P < 0.05). After propensity-score match, the overall complication rate remained higher in the MD group (44.6% vs. 37.6%, P < 0.05). 90-day readmissions and costs also remained significantly higher in the MD cohort. Multivariate modeling revealed MD was an independent predictor of postoperative complication and inpatient readmission. Subgroup analysis revealed that Parkinson disease was an independent predictor of inpatient readmission, reoperation, and increased length of stay. CONCLUSION Patients with MD who undergo spinal deformity surgery may be at risk of higher rate of perioperative complications and 90-day readmissions compared with patients without these disorders. LEVEL OF EVIDENCE 3.
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Schlenstedt C, Boße K, Gavriliuc O, Wolke R, Granert O, Deuschl G, Margraf NG. Quantitative assessment of posture in healthy controls and patients with Parkinson's disease. Parkinsonism Relat Disord 2020; 76:85-90. [PMID: 32033879 DOI: 10.1016/j.parkreldis.2020.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION A stooped posture is a main clinical feature of Parkinson's disease (PD). The assessment of posture is important to measure treatment effects. The aim of this study was to investigate the reliability of a standardized postural rating tool, to calculate minimal detectable change scores and to assess the role of gender and age. METHODS Two independent raters assessed total camptocormia (TCC), upper camptocormia (UCC) and Pisa angles of 192 PD patients and 78 healthy controls (HC) with the free NeuroPostureApp©(http://www.neuroimaging.uni-kiel.de/NeuroPostureApp). Reliabilities and linear models were calculated for different effects. Three subgroups were defined based on two thresholds (mean+2SD of HC and PD): A) normal, B) presumed stooped/lateral bended posture and C) postural disorder. RESULTS Intraclass correlation coefficients ranged between 0.71 and 0.95 for the interrater and test-retest reliability of the three angles. The minimal detectable change values in the PD patients were 3.7°, 6.7° and 2.1° for the TCC, UCC and Pisa angles, respectively. Men had a more stooped posture than women (p < 0.05). Patients with PD had a worse posture than HC (p < 0.001) in all three angles. For the TCC angle, 39.1% of the patients had a normal posture (<17.4°), 47.9% a presumed stooped posture (>17.4°, <30.2°) and 6.3° had camptocormia (>30.2°). CONCLUSIONS The NeuroPostureApp© is reliable. Our results confirmed gender differences and the progression of postural deviation in PD patients with age and empirically support the ≥30° TCC angle as a defining criterium for camptocormia. Diagnostic criteria for UCC and Pisa syndrome should be further explored in future studies.
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Affiliation(s)
| | - Kathrin Boße
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Olga Gavriliuc
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany; Department of Neurology, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Republic of Moldova
| | - Robin Wolke
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Oliver Granert
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany.
| | - Nils G Margraf
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
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Soares C, Vilas-Boas MDC, Lopes EM, Choupina H, Soares-Dos-Reis R, Fitas D, Cunha JPS, Monteiro P, Linhares P, Rosas MJ. Automated and objective measures of gait dynamics in camptocormia Parkinson's Disease subthalamic deep brain stimulation. Clin Neurol Neurosurg 2019; 186:105537. [PMID: 31605896 DOI: 10.1016/j.clineuro.2019.105537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Axial motor features are common in Parkinson's disease (PD). These include gait impairment and postural abnormalities, such as camptocormia. The response of these symptoms to deep brain stimulation (DBS) is variable and difficult to assess objectively. For the first time, this study analyzes the treatment outcomes of two PD patients with camptocormia that underwent bilateral subthalamic nucleus (STN)-DBS evaluated with disruptive technologies. PATIENTS AND METHODS Two patients with PD and camptocormia who underwent STN-DBS were included. Gait parameters were quantitatively assessed before and after surgery by using the NeuroKinect system and the camptocormia angle was measured using the camptoapp. RESULTS After surgery, patient 1 improved 29 points in the UPDRS-III. His camptocormia angle was 68° before and 38° after surgery. Arm and knee angular amplitudes (117.32 ± 7.47 vs 134.77 ± 2.70°; 144.51 ± 7.47 vs 169.08 ± 3.27°) and arm swing (3.59 ± 2.66 vs 5.40 ± 1.76 cm) improved when compared with his preoperative measurements. Patient 2 improved 22 points in the UPDRS-III after surgery. Her camptocormia mostly resolved (47° before to 9° after surgery). Gait analysis revealed improvement of stride length (0.29 ± 0.03 vs 0.35 ± 0.03 m), stride width (18.25 ± 1.16 vs 17.9 ± 0.84 cm), step velocity (0.91 ± 0.57 vs 1.33 ± 0.48 m/s), arm swing (4.51 ± 1.01 vs 7.38 ± 2.71 cm) and arm and hip angular amplitudes (131.57 ± 2.45° vs 137.75 ± 3.18; 100.51 ± 1.56 vs 102.18 ± 1.77°) compared with her preoperative results. CONCLUSION The gait parameters and camptocormia of both patients objectively improved after surgery, as assessed by the two quantitative measurement systems. STN-DBS might have a beneficial effect on controlling axial posturing and gait, being a potential surgical treatment for camptocormia in patients with PD. However, further studies are needed to derive adequate selection criteria for this patient population.
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Affiliation(s)
- Carolina Soares
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Portugal.
| | | | | | - Hugo Choupina
- INESC TEC and Faculty of Engineering, University of Porto, Portugal
| | - Ricardo Soares-Dos-Reis
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Portugal; Department of Biomedicine, Faculty of Medicine, University of Porto, Portugal
| | - Diogo Fitas
- Department of Neurology, Hospital de Santa Luzia, Viana do Castelo, Portugal
| | | | - Pedro Monteiro
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Portugal; Department of Neurosurgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Movement Disorders Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paulo Linhares
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Portugal; Department of Neurosurgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Movement Disorders Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria José Rosas
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Neurosurgery, Centro Hospitalar Universitário de São João, Porto, Portugal
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Tinazzi M, Gandolfi M, Ceravolo R, Capecci M, Andrenelli E, Ceravolo MG, Bonanni L, Onofrj M, Vitale M, Catalan M, Polverino P, Bertolotti C, Mazzucchi S, Giannoni S, Smania N, Tamburin S, Vacca L, Stocchi F, Radicati FG, Artusi CA, Zibetti M, Lopiano L, Fasano A, Geroin C. Postural Abnormalities in Parkinson's Disease: An Epidemiological and Clinical Multicenter Study. Mov Disord Clin Pract 2019; 6:576-585. [PMID: 31538092 PMCID: PMC6749805 DOI: 10.1002/mdc3.12810] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/01/2019] [Accepted: 06/12/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The overall frequency of postural abnormalities (PA) in Parkinson's disease (PD) is unknown. We evaluated the overall prevalence of PA and assessed the association with demographic and clinical variables. METHODS For this multicenter, cross-sectional study, consecutive PD outpatients attending 7 tertiary Italian centers were enrolled. Patients were evaluated and compared for the presence of isolated PA such as camptocormia, Pisa syndrome, and anterocollis and for combined forms (ie, camptocormia + Pisa syndrome) together with demographic and clinical variables. RESULTS Of the total 811 PD patients enrolled, 174 (21.5%; 95% confidence interval [CI], 18.6%-24.3%) presented PA, 144 of which had isolated PA and 30 had combined PA. The prevalence of camptocormia was 11.2% (95% CI, 9%-13.3%), Pisa syndrome 8% (95% CI, 6.2%-9.9%), and anterocollis 6.5% (95% CI, 4.9%-8.3%). Patients with PA were more often male and older with longer disease duration, more advanced disease stage, more severe PD symptoms, a bradykinetic/rigid phenotype, and poorer quality of life. They were initially treated with levodopa, and more likely to be treated with a combination of levodopa and dopamine agonist, took a higher daily levodopa equivalent daily dose, and had more comorbidities. Falls and back pain were more frequent in PD patients with PA than in those without PA. Multiple logistic regression models confirmed an association between PA and male gender, older age, Hoehn and Yahr stage, and total Unified Parkinson's Disease Rating Scale score. CONCLUSIONS PA are frequent and disabling complications in PD, especially in the advanced disease stages.
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Affiliation(s)
- Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
- Neurorehabilitation UnitAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Roberto Ceravolo
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Marianna Capecci
- Department of Experimental and Clinical MedicineNeurorehabilitation Clinic, “Politecnica delle Marche” UniversityAnconaItaly
| | - Elisa Andrenelli
- Department of Experimental and Clinical MedicineNeurorehabilitation Clinic, “Politecnica delle Marche” UniversityAnconaItaly
| | - Maria Gabriella Ceravolo
- Department of Experimental and Clinical MedicineNeurorehabilitation Clinic, “Politecnica delle Marche” UniversityAnconaItaly
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical SciencesUniversity G. d'Annunzio of Chieti‐PescaraChieti‐PescaraItaly
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical SciencesUniversity G. d'Annunzio of Chieti‐PescaraChieti‐PescaraItaly
| | - Michela Vitale
- Department of Neuroscience, Imaging and Clinical SciencesUniversity G. d'Annunzio of Chieti‐PescaraChieti‐PescaraItaly
| | - Mauro Catalan
- Clinical Neurology Unit, Department of Medical, Surgical and Health ServicesUniversity of TriesteTriesteItaly
| | - Paola Polverino
- Clinical Neurology Unit, Department of Medical, Surgical and Health ServicesUniversity of TriesteTriesteItaly
| | - Claudio Bertolotti
- Clinical Neurology Unit, Department of Medical, Surgical and Health ServicesUniversity of TriesteTriesteItaly
| | - Sonia Mazzucchi
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Sara Giannoni
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
- Neurorehabilitation UnitAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Stefano Tamburin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
| | - Laura Vacca
- University and Institute for Research and Medical Care, Istituto di Ricovero e Cura a Carattere ScientificoSan RaffaeleRomaItaly
| | - Fabrizio Stocchi
- University and Institute for Research and Medical Care, Istituto di Ricovero e Cura a Carattere ScientificoSan RaffaeleRomaItaly
| | - Fabiana G. Radicati
- University and Institute for Research and Medical Care, Istituto di Ricovero e Cura a Carattere ScientificoSan RaffaeleRomaItaly
| | - Carlo Alberto Artusi
- Department of Neuroscience “Rita Levi Montalcini,”University of TorinoTorinoItaly
| | - Maurizio Zibetti
- Department of Neuroscience “Rita Levi Montalcini,”University of TorinoTorinoItaly
| | - Leonardo Lopiano
- Department of Neuroscience “Rita Levi Montalcini,”University of TorinoTorinoItaly
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western HospitalUniversity Health Network, Division of Neurology, University of TorontoTorontoOntarioCanada
- Krembil Brain InstituteTorontoOntarioCanada
| | - Christian Geroin
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement SciencesUniversity of VeronaVeronaItaly
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Chan AK, Chan AY, Lau D, Durcanova B, Miller CA, Larson PS, Starr PA, Mummaneni PV. Surgical management of camptocormia in Parkinson's disease: systematic review and meta-analysis. J Neurosurg 2019; 131:368-375. [PMID: 30215560 DOI: 10.3171/2018.4.jns173032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/02/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Camptocormia is a potentially debilitating condition in the progression of Parkinson's disease (PD). It is described as an abnormal forward flexion while standing that resolves when lying supine. Although the condition is relatively common, the underlying pathophysiology and optimal treatment strategy are unclear. In this study, the authors systematically reviewed the current surgical management strategies for camptocormia. METHODS PubMed was queried for primary studies involving surgical intervention for camptocormia in PD patients. Studies were excluded if they described nonsurgical interventions, provided only descriptive data, or were case reports. Secondarily, data from studies describing deep brain stimulation (DBS) to the subthalamic nuclei were extracted for potential meta-analysis. Variables showing correlation to improvement in sagittal plane bending angle (i.e., the vertical angle caused by excessive kyphosis) were subjected to formal meta-analysis. RESULTS The query resulted in 9 studies detailing treatment of camptocormia: 1 study described repetitive trans-spinal magnetic stimulation (rTSMS), 7 studies described DBS, and 1 study described deformity surgery. Five studies were included for meta-analysis. The total number of patients was 66. The percentage of patients with over 50% decrease in sagittal plane imbalance with DBS was 36.4%. A duration of camptocormia of 2 years or less was predictive of better outcomes (OR 4.15). CONCLUSIONS Surgical options include transient, external spinal stimulation; DBS targeting the subthalamic nuclei; and spinal deformity surgery. Benefit from DBS stimulation was inconsistent. Spine surgery corrected spinal imbalance but was associated with a high complication rate.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Alvin Y Chan
- 2Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Darryl Lau
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Beata Durcanova
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Catherine A Miller
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Paul S Larson
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Philip A Starr
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
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Marsili L, Bologna M, Kojovic M, Berardelli A, Espay AJ, Colosimo C. Dystonia in atypical parkinsonian disorders. Parkinsonism Relat Disord 2019; 66:25-33. [PMID: 31443953 DOI: 10.1016/j.parkreldis.2019.07.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023]
Abstract
Dystonia is common in the classic atypical parkinsonian disorders such as multiple system atrophy, progressive supranuclear palsy and corticobasal degeneration, and to a lesser extent in dementia with Lewy bodies. Its clinical phenomenology, including body distribution, timing of appearance, severity, and relationship to dopaminergic and other medications may vary considerably within and between atypical parkinsonian disorders. From a pathophysiological standpoint, the coexistence of dystonia with parkinsonism challenges the functional model of the basal ganglia. Clinical recognition of specific dystonic features may assist in the differential diagnosis of atypical parkinsonian disorders and in distinguishing them from Parkinson's disease. The presence of dystonia in atypical parkinsonian disorders informs management decisions. Reduction or withdrawal of levodopa should be considered if there is a close relationship between the onset of dystonia with periods of high dopaminergic tone. Botulinum neurotoxin may be considered in focal presentations. We here provide an updated overview of dystonia arising in the setting of atypical parkinsonian disorders, summarizing relevant clinical and clinicopathological studies, underlying pathophysiological mechanisms, diagnostic clues and potential pitfalls in the diagnosis. Finally, we suggest a tailored therapeutic approach for the management of these patients.
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Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Maja Kojovic
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy.
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Shetty AS, Bhatia KP, Lang AE. Dystonia and Parkinson's disease: What is the relationship? Neurobiol Dis 2019; 132:104462. [PMID: 31078682 DOI: 10.1016/j.nbd.2019.05.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/15/2019] [Accepted: 05/07/2019] [Indexed: 01/30/2023] Open
Abstract
Dystonia and Parkinson's disease are closely linked disorders sharing many pathophysiological overlaps. Dystonia can be seen in 30% or more of the patients suffering with PD and sometimes can precede the overt parkinsonism. The response of early dystonia to the introduction of dopamine replacement therapy (levodopa, dopamine agonists) is variable; dystonia commonly occurs in PD patients following levodopa initiation. Similarly, parkinsonism is commonly seen in patients with mutations in various DYT genes including those involved in the dopamine synthesis pathway. Pharmacological blockade of dopamine receptors can cause both tardive dystonia and parkinsonism and these movement disorders syndromes can occur in many other neurodegenerative, genetic, toxic and metabolic diseases. Pallidotomy in the past and currently deep brain stimulation largely involving the GPi are effective treatment options for both dystonia and parkinsonism. However, the physiological mechanisms underlying the response of these two different movement disorder syndromes are poorly understood. Interestingly, DBS for PD can cause dystonia such as blepharospasm and bilateral pallidal DBS for dystonia can result in features of parkinsonism. Advances in our understanding of these responses may provide better explanations for the relationship between dystonia and Parkinson's disease.
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Affiliation(s)
- Aakash S Shetty
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Kailash P Bhatia
- Department of Clinical Movement Disorders and Motor Neuroscience, University College London (UCL), Institute of Neurology, Queen Square, London, United Kingdom
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University of Toronto, Toronto, Canada.
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Subjective Vertical Position Allows Prediction of Postural Deterioration in Patients with Parkinson's Disease. PARKINSON'S DISEASE 2019; 2019:1875435. [PMID: 31061695 PMCID: PMC6466872 DOI: 10.1155/2019/1875435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/27/2019] [Accepted: 03/18/2019] [Indexed: 11/18/2022]
Abstract
Background We believe that, in patients with Parkinson's disease (PD), a forward-directed increase in the subjective vertical position (SV) leads to prolonged worsening of forward flexion of the trunk (FFT) mainly because the body adjusts to the SV. We conducted a study to clarify the relation between the SV angle, FFT angle, and various other clinical measures by comparing baseline values against values obtained 1 year later. Methods A total of 39 PD patients (mean age, 71.9 ± 10.1 years; disease duration, 7.2 ± 5.4 years; modified Hoehn & Yahr (mH&Y) score, 2.6 ± 0.7) were enrolled. The Unified Parkinson's Disease Rating Scale score, Mini-Mental State Examination (MMSE) score, mH&Y score, FFT angle, SV angle, and levodopa-equivalent dose (LED) were assessed at the time of enrollment (baseline evaluation) and 1 year later. Results Eighteen patients (46%) complied with the protocol and completed the study. Significant increases were observed in the 1-year SV angle (p=0.02), MMSE score (p=0.008), and LED (p=0.001) compared to baseline values. Correlation was observed between the baseline SV angle and baseline and 1-year FFT angles (r=0.64, p=0.008 and r=0.58, p=0.012, respectively) and between the 1-year SV angle and 1-year FFT angle (r=0.63, p=0.005). Conclusion Our data suggest that the SV contributes to increased FFT.
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Paucar M, Schechtmann G, Taylor AM, Svenningsson P. Variant ataxia-telangiectasia with prominent camptocormia. Parkinsonism Relat Disord 2019; 62:253-255. [PMID: 30579816 DOI: 10.1016/j.parkreldis.2018.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/05/2018] [Accepted: 12/15/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Martin Paucar
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Gaston Schechtmann
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Mr Taylor
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Per Svenningsson
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Ando Y, Fujimoto KI, Ikeda K, Utsumi H, Okuma Y, Oka H, Kamei S, Kurita A, Takahashi K, Nogawa S, Hattori N, Hirata K, Fukui T, Yamazaki K, Yamamoto T, Yoshii F. Postural Abnormality in Parkinson's Disease: A Large Comparative Study With General Population. Mov Disord Clin Pract 2019; 6:213-221. [PMID: 30949552 DOI: 10.1002/mdc3.12723] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/17/2018] [Accepted: 12/20/2018] [Indexed: 11/09/2022] Open
Abstract
Background Postural abnormalities in Parkinson's disease (PD) patients and unimpaired elderly are not well differentiated. Factors related to postural abnormality associated with PD are controversial. Objective We assessed differences in postural change between PD patients and unimpaired elderly and elucidated factors related to abnormal posture in PD patients. Methods We measured the dropped head angle (DHA), anterior flexion angle (AFA), and lateral flexion angle (LFA) of the thoracolumbar spine of an unprecedented 1,117 PD patients and 2,732 general population participants (GPPs) using digital photographs. Two statistical analyses were used for elucidating factors related to these angles. Results In GPPs, age was correlated with DHA, AFA, and LFA. DHAs, AFAs, and LFAs of PD patients and age-matched GPPs were 21.70° ± 14.40° and 13.13° ± 10.79°, 5.98° ± 12.67,°and - 3.82° ± 4.04°, and 0.86° ± 4.25° and 1.33° ± 2.16°, respectively. In PD patients, factors related to DHA were age, male sex, and H & Y stage during ON time. Factors related to AFA were age, duration of disease, H & Y stage during ON and OFF times, pain, vertebral disease, and bending to the right. A factor related to LFA was AFA. Conclusions DHA and AFA of GGPs correlated with age and were larger in PD patients than those with in GPPs. Some PD patients showed angles far beyond the normal distribution. Thus, factors associated with disease aggravation affected postural abnormality in PD patients.
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Affiliation(s)
- Yoshihito Ando
- Department of Internal Medicine Josai Hospital.,Division of Neurology, Department of Internal Medicine Jichi Medical University
| | | | - Ken Ikeda
- Department of Neurology Toho University Omori Medical Center
| | - Hiroya Utsumi
- Department of Neurology International University of Health and Welfare, Shioya Hospital
| | - Yasuyuki Okuma
- Department of Neurology Juntendo University Shizuoka Hospital
| | - Hisayoshi Oka
- Department of Neurology Daisan Hospital, The Jikei University School of Medicine
| | - Satoshi Kamei
- Department of Medicine, Division of Neurology Nihon University School of Medicine
| | - Akira Kurita
- Department of Neurology The Jikei University Kashiwa Hospital.,Department of Neurology Teikyo University Medical Center
| | | | - Shigeru Nogawa
- Department of Neurology Tokai University Hachioji Hospital
| | | | - Koichi Hirata
- Department of Neurology Dokkyo Medical University Hospital
| | | | - Kaoru Yamazaki
- Department of Neurology Tokyo Medical University Ibaraki Medical Center
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Fasano A, Geroin C, Berardelli A, Bloem BR, Espay AJ, Hallett M, Lang AE, Tinazzi M. Diagnostic criteria for camptocormia in Parkinson's disease: A consensus-based proposal. Parkinsonism Relat Disord 2018; 53:53-57. [PMID: 29759930 PMCID: PMC7293065 DOI: 10.1016/j.parkreldis.2018.04.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/17/2018] [Accepted: 04/29/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Camptocormia is defined as an involuntary, marked flexion of the thoracolumbar spine appearing during standing or walking and resolving in the supine position or when leaning against a wall. However, there is no established agreement on the minimum degree of forward flexion needed to diagnose camptocormia. Likewise, the current definition does not categorize camptocormia on the basis of the bending fulcrum. METHODS We performed a survey among movement disorders experts to identify camptocormia using images of patients with variable degrees and types of forward trunk flexion by fulcrum (upper and lower fulcra). We tested the subsequently generated diagnostic criteria in a sample of 131 consecutive patients referred for evaluation of postural abnormalities. RESULTS Experts reached full consensus on lower camptocormia (L1-Sacrum, hip flexion) with a bending angle ≥30° and upper camptocormia (C7 to T12-L1) with a bending angle ≥45°. This definition detected camptocormia in 9/131 consecutive PD patients (2 upper/7 lower) but excluded camptocormia in 71 patients considered to have camptocormia by the referring neurologist. CONCLUSIONS Camptocormia can be defined as "an involuntary flexion of the spine appearing during standing or walking and resolving in the supine position of at least 30° at the lumbar fulcrum (L1-Sacrum, hip flexion, i.e. lower camptocormia) and/or at least 45° at the thoracic fulcrum (C7 to T12-L1, i.e. upper camptocormia)". Strict criteria for camptocormia are met by 7% of patients with abnormal posture. The ascertainment of upper and lower camptocormia subtypes could improve the validity of epidemiological studies and assist future therapeutic trials.
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Affiliation(s)
- Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada.
| | - Christian Geroin
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza, University of Rome and IRCCS Neuromed Institute Pozzilli (IS), Italy.
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands.
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA.
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA.
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada.
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Ali F, Matsumoto JY, Hassan A. Camptocormia: Etiology, diagnosis, and treatment response. Neurol Clin Pract 2018; 8:240-248. [PMID: 30105164 DOI: 10.1212/cpj.0000000000000453] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/14/2018] [Indexed: 01/10/2023]
Abstract
Background We sought to determine the etiologies, diagnostic testing, and management of a retrospective cohort of patients with camptocormia evaluated at a single center. Methods We reviewed medical records of all adult patients evaluated at Mayo Clinic Rochester with a diagnosis of camptocormia from 2000 to 2014. Demographic and clinical data were abstracted and analyzed. Results There were 276 patients (58.0% male), with mean age at presentation of 68.6 (±12.7) years. An etiology was identified in 98.2%. The most common etiologies were idiopathic Parkinson disease (22.5%), idiopathic axial myopathy (14.1%), and degenerative joint disease without fixed deformity (13.0%). We also identified several rare causes of camptocormia. Investigations included spine imaging, needle and surface EMG, and muscle biopsy. Most patients received physical therapy and orthotic support with limited benefit. Limited improvement of camptocormia was seen where a treatable etiology was identified. Conclusions An etiology can be identified in almost all cases of camptocormia. Most cases are due to 3 common disorders: Parkinson disease, axial myopathy, and degenerative joint disease. A diagnostic and treatment algorithm is proposed.
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Affiliation(s)
- Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN
| | | | - Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN
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Debû B, De Oliveira Godeiro C, Lino JC, Moro E. Managing Gait, Balance, and Posture in Parkinson's Disease. Curr Neurol Neurosci Rep 2018; 18:23. [PMID: 29623455 DOI: 10.1007/s11910-018-0828-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Postural instability and gait difficulties inexorably worsen with Parkinson's disease (PD) progression and become treatment resistant, with a severe impact on autonomy and quality of life. We review the main characteristics of balance instability, gait disabilities, and static postural alterations in advanced PD, and the available treatment strategies. RECENT FINDINGS It remains very difficult to satisfactorily alleviate gait and postural disturbances in advanced PD. Medical and surgical interventions often fail to provide satisfactory or durable alleviation of these axial symptoms, that may actually call for differential treatments. Exercise and adapted physical activity programs can contribute to improving the patients' condition. Gait, balance, and postural disabilities are often lumped together under the Postural Instability and Gait Difficulties umbrella term. This may lead to sub-optimal patients' management as data suggest that postural, balance, and gait problems might depend on distinct underlying mechanisms. We advocate for a multidisciplinary approach from the day of diagnosis.
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Affiliation(s)
- Bettina Debû
- University Grenoble Alpes, Grenoble, France.
- INSERM U1216, Grenoble, France.
| | - Clecio De Oliveira Godeiro
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
- Division of Neurology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Jarbas Correa Lino
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
- Division of Neurology, CHU Amiens, Amiens, France
| | - Elena Moro
- University Grenoble Alpes, Grenoble, France
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
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Ou R, Liu H, Hou Y, Song W, Cao B, Wei Q, Yuan X, Chen Y, Zhao B, Shang H. Predictors of camptocormia in patients with Parkinson's disease: A prospective study from southwest China. Parkinsonism Relat Disord 2018; 52:69-75. [PMID: 29606604 DOI: 10.1016/j.parkreldis.2018.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Camptocormia is becoming increasingly recognized as a prominent phenomenon in Parkinson's disease (PD). OBJECTIVE This study aims to investigate the clinical predictors of future camptocormia in a cohort of PD patients. METHODS A total of 263 PD patients without camptocormia were prospectively monitored for approximately 3 years. The end-point was the occurrence of camptocormia. RESULTS Overall, camptocormia was observed in 23 patients (8.7%) during the study period. The following variables including the proportion of males; age; disease duration; total levodopa equivalent daily dosage; Unified PD Rating Scale (UPDRS) III score; Hoehn and Yahr stage; the percentages of festination, freezing of gait and falls; and the subscores (e.g., "problems having sex") and frequencies (e.g., "forget to do things") of the Non-Motor Symptoms Scale were significantly higher in patients with camptocormia compared to those variables in patients without camptocormia (P < 0.05). Patients with camptocormia showed lower "orientation" subscore of the Montreal Cognitive Assessment scale than patients without camptocormia (P < 0.05). The binary logistic regression model indicated that the presence of camptocormia was associated with male sex (OR = 6.758, P = 0.001), a higher UPDRS III score (OR = 1.099, P = 0.001), a higher sexual dysfunction score (OR = 1.033, P = 0.038) and a lower orientation score (OR = 0.392, P = 0.018). CONCLUSIONS Camptocormia may emerge as PD progresses. Male patients and those with sexual dysfunction or disorientation are likely to present with camptocormia in the future.
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Affiliation(s)
- Ruwei Ou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hui Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanbing Hou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Song
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bei Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qianqian Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoqin Yuan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yongping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bi Zhao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Galbusera F, Bassani T, Stucovitz E, Martini C, Ismael Aguirre MF, Berjano PL, Lamartina C. Surgical treatment of spinal disorders in Parkinson's disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:101-108. [PMID: 29397444 DOI: 10.1007/s00586-018-5499-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/24/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Most patients suffering from Parkinson's disease (PD) exhibit alterations in the posture, which can in several cases give rise to spine deformities, both in the sagittal and the coronal plane. In addition, degenerative disorders of the spine frequently associated to PD, such as spinal stenosis and sagittal instability, can further impact the quality of life of the patient. In recent years, spine surgery has been increasingly performed, with mixed results. The aim of this narrative review is to analyze the spinal disorders associated to PD, and the current evidence about their surgical treatment. METHODS Narrative review. RESULTS Camptocormia, i.e., a pronounced flexible forward bending of the trunk with 7% prevalence, is the most reported sagittal disorder of the spine. Pisa syndrome and scoliosis are both common and frequently associated. Disorders to the spinopelvic alignment were not widely investigated, but a tendency toward a lower ability of PD patients to compensate the sagittal malalignment with respect to non-PD elderly subjects with imbalance seems to emerge. Spine surgery in PD patients showed high rates of complications and re-operations. CONCLUSIONS Disorders of the posture and spinal alignment, both in the sagittal and in the coronal planes, are common in PD patients, and have a major impact on the quality of life. Outcomes of spine surgery are generally not satisfactory, likely mostly due to muscle dystonia and poor bone quality. Knowledge in this field needs to be consolidated by further clinical and basic science studies. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Fabio Galbusera
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Tito Bassani
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Elena Stucovitz
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Carlotta Martini
- G Spine 4, IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy.
| | | | - Pedro L Berjano
- G Spine 4, IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy
| | - C Lamartina
- G Spine 4, IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy
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Lee KH, Kim JM, Kim HS. Back Extensor Strengthening Exercise and Backpack Wearing Treatment for Camptocormia in Parkinson's Disease: A Retrospective Pilot Study. Ann Rehabil Med 2017; 41:677-685. [PMID: 28971053 PMCID: PMC5608676 DOI: 10.5535/arm.2017.41.4.677] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/04/2016] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the effect of a conservative treatment regime in Parkinson's disease patients with camptocormia. Methods Nine patients with Parkinson's disease were included in a retrospective pilot study of the value of back extensor strengthening exercise. Six inpatients received a 30-minute treatment, twice daily for 5 weeks, being treated on average for 34 days; while three outpatients visited the clinic and were educated for home exercise and backpack wearing treatment. Outpatients should be scheduled to visit the outpatient department to check physical status every 2–4 weeks for an average of 3 months. Results All patients except one showed statistically significant improvements in activities of daily living (ADL) and motor symptoms, as measured by flexion angle at standing posture, Unified Parkinson's Disease Rating Scale (UPDRS) II and III, and modified Hoehn-Yahr staging. Conclusion Conservative treatment is effective in postural correction of camptocormia in Parkinson's disease, as well as improvement in ADL and motor symptoms.
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Affiliation(s)
- Kun Hee Lee
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jong Moon Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Abstract
Parkinson disease (PD) is increasingly prevalent in the aging population. Spine disorders in patients with PD may be degenerative in nature or may arise secondary to motor effects related to the parkinsonian disease process. Physicians providing care for patients with PD and spine pathologies must be aware of several factors that affect treatment, including the patterns of spinal deformity, complex drug interactions, and PD-associated osteoporosis. Following spine surgery, complication rates are higher in patients with PD than in those without the disease. Literature on spine surgery in this patient population is limited by small cohort size, the heterogeneous patient population, and variable treatment protocols. However, most studies emphasize the need for preoperative optimization of motor control with appropriate medications and deep brain stimulation, as well as consultation with a movement disorder specialist. Future studies must control for confounding variables, such as the type of surgery and PD severity, to improve understanding of spinal pathology and treatment options in this patient population.
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Evolution and complications after surgery for spine deformation in patients with Parkinson's disease. Orthop Traumatol Surg Res 2017; 103:517-522. [PMID: 28285031 DOI: 10.1016/j.otsr.2016.12.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 11/10/2016] [Accepted: 12/15/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical treatment of spinal deformity is high risk in patients suffering from Parkinson's disease (PD). Several series have already reported a high rate of complications. However, none of these studies included more than 40 patients and none of the risk factors of complications were described. The aim of this study was to describe the rate and risk factors of revision surgery as well as the clinical outcome at the last visit in a large multicenter study of PD patients operated for spinal deformities. METHODS A multicenter retrospective study included arthrodesis for spinal deformity in patients with PD. Clinical and surgical data including revision surgeries were collected. Assessment of functional outcomes at last follow-up was classified in 3 grades and spinal balance was assessed on anteroposterior and lateral plain X-rays of the entire spine. RESULTS Forty-eight patients were included. Median age was 67 years old (range 41-80). Median follow-up was 27 months. The rate of surgical revision was 42%. Eighty per cent of revisions were performed for chronic mechanical complication. Global results were considered to be good in 17 patients (35%), doubtful in 17 patients (35%) and a failure in 14 patients (30%), for the whole series. CONCLUSIONS The results of surgery for spinal deformities in patients with Parkinson disease vary with a high rate of complications and revisions. Nevertheless, these results should be seen in relation to the natural progression of these spinal deformities once spinal imbalance has developed. The association between preoperative clinical balance and final outcome suggests that early surgery can probably play a role in treatment. LEVEL OF EVIDENCE Level IV (e.g. case series).
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Malla HP, Kim MK, Kim TS, Jo DJ. Multiple Spinal Revision Surgery in a Patient with Parkinson's Disease. J Korean Neurosurg Soc 2016; 59:655-658. [PMID: 27847583 PMCID: PMC5106369 DOI: 10.3340/jkns.2016.59.6.655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 09/07/2015] [Accepted: 10/05/2015] [Indexed: 11/27/2022] Open
Abstract
Parkinson's disease (PD) patients frequently have several spinal deformities leading to postural instabilities including camptocormia, myopathy-induced postural deformity, Pisa syndrome, and progressive degeneration, all of which adversely affect daily life activities. To improve these postural deformities and relieve the related neurologic symptoms, patients often undergo spinal instrumentation surgery. Due to progressive degenerative changes related to PD itself and other complicating factors, patients and surgeons are faced with instrument failure-related complications, which can ultimately result in multiple revision surgeries yielding various postoperative complications and morbidities. Here, we report a representative case of a 70-year-old PD patient with flat back syndrome who had undergone several revision surgeries, including anterior and posterior decompression and fusion for a lumbosacral spinal deformity. The patient ultimately benefitted from a relatively short segment fixation and corrective fusion surgery.
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Affiliation(s)
| | - Min Ki Kim
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Tae Sung Kim
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Dae Jean Jo
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Pandey S, Kumar H. Assessment of striatal & postural deformities in patients with Parkinson's disease. Indian J Med Res 2016; 144:682-688. [PMID: 28361820 PMCID: PMC5393078 DOI: 10.4103/ijmr.ijmr_502_15] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND & OBJECTIVES Though striatal and postural deformities are known to occur commonly in atypical Parkinsonism patients, these may also be seen in patients with Parkinson's disease (PD). These are frequently misdiagnosed as joint or orthopaedic pathology leading to unnecessary investigations. This study was conducted to observe the various striatal and postural deformities among patients with PD in India. METHODS This study was conducted at a tertiary care teaching institute in north# India. Seventy consecutive patients with PD diagnosed as per the modified UK Brain Bank criteria were included. Various striatal (hand & foot) and postural (antecollis, camptocormia, scoliosis & Pisa syndrome) deformities and their relation with the duration of disease, severity [measured by the Unified Parkinson's Disease Rating Scale (UPDRS)] and levodopa intake were analyzed. RESULTS Of the 70 patients with PD, 34 (48.57%) had either striatal or postural deformities. Striatal foot was the most common deformity observed (25.71%). Camptocormia was the second most common deformity (20%). Striatal and postural deformities were seen in more advanced PD as suggested by significantly higher UPDRS and Hoehn and Yahr scale (P<0.001). Striatal deformities were more ipsilateral to PD symptom onset side (agreement 94.44%). Pisa and scoliosis concavity were more on contralateral side to PD symptoms onset side (66.67%). INTERPRETATION & CONCLUSIONS Our results showed that striatal and postural deformities were common and present in about half of the patients with PD. These deformities we more common in patients with advanced stage of PD.
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Affiliation(s)
- Sanjay Pandey
- Department of Neurology, GB Pant Hospital, New Delhi, India
| | - Hitesh Kumar
- Department of Neurology, GB Pant Hospital, New Delhi, India
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Margraf NG, Granert O, Hampel J, Wrede A, Schulz-Schaeffer WJ, Deuschl G. Clinical Definition of Camptocormia in Parkinson's Disease. Mov Disord Clin Pract 2016; 4:349-357. [PMID: 30363363 DOI: 10.1002/mdc3.12437] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/19/2016] [Accepted: 08/01/2016] [Indexed: 12/29/2022] Open
Abstract
Background Clinical key aspects of camptocormia in patients with idiopathic Parkinson's disease (PD) await further definition. Methods Based on a self-assessment of PD patients, we performed an observational study, asking patients with subjectively felt involuntary forward bending to return a questionnaire and provide photographs showing their axial disorder. Forty-two matched PD patients without subjective signs of camptocormia were recruited as controls. Results The stooped posture of patients with advanced PD without camptocormia is characterized by a forward bending angle of always less than 30 degrees. Of the 145 camptocormia patients in our study, 70% had an angle ≥30 degrees. The patients with a more-severe forward bending angle were more severely affected in daily life than those with an angle of less than 30 degrees. Back pain was more frequent (81% vs. 43%) and more severe in PD patients with camptocormia than in controls. Back diseases in camptocormia PD patients were also significantly more frequent than in the PD control patients (55% vs. 26%). Camptocormia is a relevant burden in everyday life. Seventy-seven percent of patients needed walking aids and 85% reported specific disabilities attributed to camptocormia (e.g. increased risk of falling, dyspnea, problems in eating or swallowing). Conclusions Camptocormia cannot be clinically defined based on the forward bending angle alone, but an angle larger than 30 degrees is only found in camptocormia. Back pain is an essential aspect of camptocormia in PD. Back diseases can be seen as a risk factor in these patients.
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Affiliation(s)
- Nils G Margraf
- Department of Neurology University Hospital Schleswig-Holstein Kiel Germany
| | - Oliver Granert
- Department of Neurology University Hospital Schleswig-Holstein Kiel Germany
| | - Julia Hampel
- Department of Neurology University Hospital Schleswig-Holstein Kiel Germany
| | - Arne Wrede
- Institute of Neuropathology University Medical Center Göttingen Germany
| | | | - Günther Deuschl
- Department of Neurology University Hospital Schleswig-Holstein Kiel Germany
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Ghosh PS, Milone M. Reply. Muscle Nerve 2016; 54:343-4. [DOI: 10.1002/mus.25122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/22/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Partha S. Ghosh
- Department of Neurology; Boston Children's Hospital; Boston Massachusetts USA
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Rabin ML, Earnhardt MC, Patel A, Ganihong I, Kurlan R. Postural, Bone, and Joint Disorders in Parkinson's Disease. Mov Disord Clin Pract 2016; 3:538-547. [PMID: 30363567 DOI: 10.1002/mdc3.12386] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 12/20/2022] Open
Abstract
Background Stooped posture was mentioned in the original description of the characteristic features of Parkinson's disease (PD). Since then, a variety of postural, bone, and joint problems have become recognized as common aspects of the illness and deserve attention. Methods A Medline literature search for the period from 1970 to 2016 was performed to identify articles relevant to this topic. Keywords for the search included posture, spine, bone disorders, fractures, joint disorders, kyphosis, scoliosis, stooping, camptocormia, Pisa syndrome, frozen shoulder, anterocollis, dropped head syndrome, and pain in combination with PD. The articles were then reviewed to summarize clinical features, frequency, impact, pathophysiology, and treatment options for these conditions. Results Postural disorders (kyphoscoliosis, camptocormia, Pisa syndrome, dropped head syndrome), bone mineralization disorders (osteoporosis, bone fractures), and joint disorders (frozen shoulder, dystonia involving joints, joint pain) are often seen in association with PD. Treatment options for these conditions are varied and may include medications, physical therapy, or surgical interventions. Conclusions Posture, bone, and joint disorders are common in patients with PD; they often produce added disability, and they may be treatable.
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Affiliation(s)
- Marcie L Rabin
- Atlantic Neuroscience Institute Overlook Medical Center Summit New Jersey USA
| | | | - Anvi Patel
- Atlantic Neuroscience Institute Overlook Medical Center Summit New Jersey USA
| | - Ivana Ganihong
- Atlantic Neuroscience Institute Overlook Medical Center Summit New Jersey USA
| | - Roger Kurlan
- Atlantic Neuroscience Institute Overlook Medical Center Summit New Jersey USA
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Nair P, Bohannon RW, Devaney L, Maloney C, Romano A. Reliability and Validity of Nonradiologic Measures of Forward Flexed Posture in Parkinson Disease. Arch Phys Med Rehabil 2016; 98:508-516. [PMID: 27373746 DOI: 10.1016/j.apmr.2016.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 05/06/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the intertester reliability and validity of 5 nonradiologic measures of forward flexed posture in individuals with Parkinson disease (PD). DESIGN Cross-sectional observational study. SETTING University outpatient facility and community centers. PARTICIPANTS Individuals (N=28) with PD with Hoehn and Yahr scores of 1 through 4. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Occiput to wall status, tragus to wall distance, C7 to wall distance, photographically derived trunk flexion angle, and inclinometric kyphosis measure. RESULTS Participants were older adults (mean, 69.7±10.6y) with a 14-month to 15-year (mean, 5.9±3.5y) history of PD. Intertester reliability was excellent for all measures (κ=.89 [cued condition] and 1.0 [relaxed condition] for occiput to wall status; intraclass correlation coefficients, .779-.897 for tragus to wall distance, C7 to wall distance, flexion angle, and inclinometric kyphosis measure). Convergent validity was supported for all measures by significant correlations between the same measures obtained during relaxed and cued conditions (eg, occiput to wall relaxed and cued) and for most measures by significant correlations between measures obtained under the same condition (eg, occiput to wall cued and tragus to wall cued). Significant correlations between tragus to wall distance, C7 to wall distance, flexion angle, and inclinometric kyphosis measure and the Unified Parkinson Disease Rating Scale item 28 (posture) also supported convergent validity. Significant differences between tragus to wall distance, C7 to wall distance, and inclinometric kyphosis measure values under relaxed and cued conditions supported known condition validity. Known group validity was demonstrated by significant differences in tragus to wall distance, C7 to wall distance, and inclinometric kyphosis measure obtained from individuals able and individuals unable to touch their occiput to wall when cued to stand tall. CONCLUSIONS Tragus to wall distance, C7 to wall distance, and inclinometric kyphosis measure are reliable and valid nonradiologic measures of forward flexed posture in PD.
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Affiliation(s)
- Prajakta Nair
- Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT.
| | - Richard W Bohannon
- Department of Physical Therapy, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC
| | - Laurie Devaney
- Physical Therapy Program, Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT
| | - Catherine Maloney
- Physical Therapy Program, Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT
| | - Alexis Romano
- Physical Therapy Program, Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, CT
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Margraf N, Wrede A, Deuschl G, Schulz-Schaeffer W. Pathophysiological Concepts and Treatment of Camptocormia. JOURNAL OF PARKINSON'S DISEASE 2016; 6:485-501. [PMID: 27314757 PMCID: PMC5008234 DOI: 10.3233/jpd-160836] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 12/12/2022]
Abstract
Camptocormia is a disabling pathological, non-fixed, forward bending of the trunk. The clinical definition using only the bending angle is insufficient; it should include the subjectively perceived inability to stand upright, occurrence of back pain, typical individual complaints, and need for walking aids and compensatory signs (e.g. back-swept wing sign). Due to the heterogeneous etiologies of camptocormia a broad diagnostic approach is necessary. Camptocormia is most frequently encountered in movement disorders (PD and dystonia) and muscles diseases (myositis and myopathy, mainly facio-scapulo-humeral muscular dystrophy (FSHD)). The main diagnostic aim is to discover the etiology by looking for signs of the underlying disease in the neurological examination, EMG, muscle MRI and possibly biopsy. PD and probably myositic camptocormia can be divided into an acute and a chronic stage according to the duration of camptocormia and the findings in the short time inversion recovery (STIR) and T1 sequences of paravertebral muscle MRI. There is no established treatment of camptocormia resulting from any etiology. Case series suggest that deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) is effective in the acute but not the chronic stage of PD camptocormia. In chronic stages with degenerated muscles, treatment options are limited to orthoses, walking aids, physiotherapy and pain therapy. In acute myositic camptocormia an escalation strategy with different immunosuppressive drugs is recommended. In dystonic camptocormia, as in dystonia in general, case reports have shown botulinum toxin and DBS of the globus pallidus internus (GPi-DBS) to be effective. Camptocormia in connection with primary myopathies should be treated according to the underlying illness.
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Affiliation(s)
- N.G. Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - A. Wrede
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - G. Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Bertram KL, Colosimo C. Camptocormia may be myopathic or dystonic. Muscle Nerve 2016; 54:343. [DOI: 10.1002/mus.25123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/20/2016] [Accepted: 03/22/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Kelly L. Bertram
- Faculty of Medicine Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
| | - Carlo Colosimo
- Department of Neurology; Santa Maria University Hospital; Terni Italy
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Abstract
Parkinson's disease (PD) is the most common neurodegenerative disease and is characterized by tremor, rigidity and akinesia. Diagnosis is clinical in the majority of the patients. Patients with PD may have stooped posture but some of them develop different types of postural and striatal deformities. Usually these deformities are more common in atypical parkinsonian disorders such as progressive supranuclear palsy and multisystem atrophy. But in many studies it has been highlighted that these may also be present in approximately one third of PD patients leading to severe disability. These include antecollis or dropped head, camptocormia, Pisa syndrome, scoliosis, striatal hands and striatal toes. The pathogenesis of these deformities is a complex combination of central and peripheral influences such as rigidity, dystonia and degenerative skeletal changes. Duration of parkinsonism symptoms is an important risk factor and in majority of the patients these deformities are seen in advanced statge of the disease. The patients with such symptoms may initially respond to dopaminergic medications but if not intervened they may become fixed and difficult to treat. Pain and restriction of movement are most common clinical manifestations and these may mimick symptoms of musculoskeletal disorders like rheumatoid arthritis. Early diagnosis is important as the patients may respond to adjustment in dopaminergic medications. Recent advances such as deep brain stimulation (DBS) and ultrasound guided botulinum toxin injection are helpful in management of these deformities in patients with PD.
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Affiliation(s)
- Sanjay Pandey
- Department of Neurology, GB Pant Hospital, Delhi, India
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Cervantes-Arriaga A, Rodríguez-Violante M, Morales-Briceño H, Neri-Nani G, Millán-Cepeda R, Velázquez-Osuna S. Frequency and clinical correlates of postural and striatal deformities in Parkinson’s disease. Clin Neurol Neurosurg 2016; 142:140-144. [DOI: 10.1016/j.clineuro.2016.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 09/04/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
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