C Tassorelli1, R De Icco2, E Alfonsi3, M Bartolo4, M Serrao5, M Avenali2, I De Paoli2, C Conte6, N G Pozzi7, P Bramanti8, G Nappi9, G Sandrini2. 1. Neurological Rehabilitation Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. Electronic address: Cristina.tassorelli@mondino.it. 2. Neurological Rehabilitation Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. 3. Neurophysiology Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy. 4. Department of Neurorehabilitation, IRCCS Neurological Mediterranean Institute NEUROMED, Pozzilli, Isernia, Italy. 5. Department of Medical and Surgical Science and Biotechnology, La Sapienza University of Rome, Rome, Italy. 6. Rehabilitation Centre, Policlinico Italia, Rome, Italy. 7. Parkinson and Movement Disorder Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy. 8. IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy. 9. Neurological Rehabilitation Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy; Neurophysiology Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy; Parkinson and Movement Disorder Unit, IRCCS National Neurological Institute "C. Mondino", Pavia, Italy.
Abstract
INTRODUCTION: Pisa syndrome (PS) is a tonic lateral flexion of trunk that represents a disabling complication of advanced Parkinson disease (PD). Conventional rehabilitation treatment (CT) ameliorates axial posture and trunk mobility in PD patients, but the improvement tends to wane in 4-6 months. Botulin toxin (BT) may reduce muscle hyperactivity, therefore improving CT effectiveness. We evaluated whether the injection of incabotulinum toxin type A (iBTA) into the hyperactive trunk muscles might improve the effectiveness of rehabilitation in a group of PD patients with PS. METHODS:Twenty-six PD patients were enrolled in a randomized placebo-controlled trial. Group A was treated with iBTA before undergoing CT (a 4-week intensive programme), while Group B received saline before the 4-week CT treatment. Patients were evaluated at baseline, at the end of the rehabilitative period, 3 and 6 months with kinematic analysis of movement, UPDRS, Functional Independence Measure and Visual Analog Scale for pain. RESULTS: At the end of the rehabilitation period, both groups improved significantly in terms of static postural alignment and of range of motion. Group A showed a significantly more marked reduction in pain score as compared with Group B and a more prolonged efficacy on several clinical and kinematic variables. CONCLUSIONS: Our preliminary data suggest that BT may be considered an important addition to the rehabilitation programme for PD subjects with PS for improving axial posture and trunk mobility, as well as for a better control of pain.
RCT Entities:
INTRODUCTION:Pisa syndrome (PS) is a tonic lateral flexion of trunk that represents a disabling complication of advanced Parkinson disease (PD). Conventional rehabilitation treatment (CT) ameliorates axial posture and trunk mobility in PDpatients, but the improvement tends to wane in 4-6 months. Botulin toxin (BT) may reduce muscle hyperactivity, therefore improving CT effectiveness. We evaluated whether the injection of incabotulinum toxin type A (iBTA) into the hyperactive trunk muscles might improve the effectiveness of rehabilitation in a group of PDpatients with PS. METHODS: Twenty-six PDpatients were enrolled in a randomized placebo-controlled trial. Group A was treated with iBTA before undergoing CT (a 4-week intensive programme), while Group B received saline before the 4-week CT treatment. Patients were evaluated at baseline, at the end of the rehabilitative period, 3 and 6 months with kinematic analysis of movement, UPDRS, Functional Independence Measure and Visual Analog Scale for pain. RESULTS: At the end of the rehabilitation period, both groups improved significantly in terms of static postural alignment and of range of motion. Group A showed a significantly more marked reduction in pain score as compared with Group B and a more prolonged efficacy on several clinical and kinematic variables. CONCLUSIONS: Our preliminary data suggest that BT may be considered an important addition to the rehabilitation programme for PD subjects with PS for improving axial posture and trunk mobility, as well as for a better control of pain.
Authors: Ji Hyun Choi; Jong Min Kim; Hee Kyung Yang; Hyo Jung Lee; Cheol Min Shin; Seong Jin Jeong; Won Seok Kim; Ji Won Han; In Young Yoon; Yoo Sung Song; Yun Jung Bae Journal: J Korean Med Sci Date: 2020-07-20 Impact factor: 2.153